Andrew Siegel MD 4/8/17
The vacuum erection device (VED) is an effective means of inducing a penile erection suitable for sexual intercourse–even in difficult to treat men who have diabetes, spinal cord injury, or after radical prostatectomy for prostate cancer. The device is also useful in the post-operative period following radical prostatectomy to maintain penile length and girth. It has some utility in Peyronie’s disease patients in order to improve curvature, pain and maintain penile dimensions. It can be used prior to penile prosthesis surgery in order to enhance penile length and facilitate the placement of the largest possible implant.
Image Above: Vacuum Erection Device (obtainable via UrologyHealthStore.com–use promo code UROLOGY 10 for 10% discount and free shipping)
Introduction
Tissue expansion is local tissue enlargement in response to a force that can be internal or external. Internal tissue expansion occurs naturally with pregnancy, weight gain and the presence of slow growing tumors. Plastic surgeons commonly tap into this principle by using implantable tissue expanders prior to breast reconstructive surgery.
The VED uses the principle of external tissue expansion by using negative pressures applied to the penis to stretch the smooth muscle and sinuses of the penile erectile chambers. The resultant influx of blood increases tissue oxygenation, activates tissue nutrient factors, mobilizes stem cells, helps prevent tissue scarring and cellular death and, importantly, induces an erection.
There are many commercially available VEDs on the market, which share in common a cylinder chamber with one end closed off, a vacuum pump and a constriction ring. The penis is inserted into the cylinder chamber and an erection is induced by virtue of a vacuum that creates negative pressures and literally sucks blood into the erectile chambers of the penis. To maintain the erection after the vacuum is released, a constriction ring is applied to the base of the penis. The end result is a rigid penis capable of penetrative intercourse.
Interesting factoid: Similarly designed vacuum suction devices are available for purposes of nipple and clitoral stimulation.
Brief History of VED
In 1874, an American physician named John King came up with the concept of using a glass exhauster to induce a penile erection. The problem with the device was the loss of the erection as soon as the penis was withdrawn from the exhauster. In 1917 Otto Lederer introduced the first vacuum suction device. After many years of quiescence, the VED was popularized by Geddins Osbon and named “the Erecaid device.” Currently, the VED is a popular mechanical means of inducing an erection that does not utilize medications or surgery.
Nuts and Bolts of VED Use
The VED is prepared by placing a constriction ring over the open end of the cylinder. A water-soluble lubricant is applied to the base of the penis to achieve a tight seal when the penis is placed into the cylinder. Either a manual or automatic pump is used to generate negative pressures within the cylinder, which pulls blood into the penis, causing fullness and ultimately rigidity. Once full rigidity is achieved, the constriction ring is pushed off the cylinder onto the base of the penis. Importantly, the ring should never be left on for more than 30 minutes to minimize the likelihood of problems. After the sexual act is completed, the constriction ring must be removed.
Interesting Factoid: The VED can be used alone or in combination with other forms of treatment for ED, including pills (Viagra, Levitra and Cialis), penile injection therapy and penile prostheses.
Pluses and Minuses of the VED
A distinct advantage of the VED is that it is a simple mechanical treatment that does not require drugs or surgery. Disadvantages are the need for preparation time, which impairs spontaneity. Another disadvantage is the necessity for wearing the constriction device, which can be uncomfortable and can cause “hinging” at the site of application of the constriction ring resulting in a floppy penis (because of lack of rigidity of the deep roots of the penis) as well as impairing ejaculation. Other potential issues are temporary discomfort or pain, coolness, numbness, altered sensation, engorgement of the penile head, and black and blue areas.
VED After Radical Prostatectomy
Erectile function can be adversely affected by radical prostatectomy with recovery taking months to years. The VED can be used to enhance the speed and extent of sexual recovery after surgery, minimize the decrease in penile length and girth that can occur, and enable achievement of a rigid erection suitable for sexual intercourse. Clinical studies have clearly demonstrated that VED use after prostatectomy helps maintain existing penile length and prevents loss of length.
Bottom Line: The VED is one of the oldest treatments for ED that remains in contemporary use. It works by creating negative pressures that cause an influx of blood into the penile erectile chambers resulting in penile expansion and erection. Although effective even in difficult to treat populations, the attrition rate is high, perhaps because of the cumbersome nature of the device and the preparation regimen and time involved. However, the VED is an important part of the “erection recovery program” (penile rehabilitation) after prostatectomy, second only to oral ED pills in use for this purpose. It is particularly vital in the preservation and restoration of penile anatomy and size. It also is useful in ED related to other radical pelvic surgical procedures including colectomy for colon cancer. It remains a viable alternative in men not interested or responsive to ED pills or penile injections and those not interested in surgery.
There are many different VED systems on the market. The Urology Health Store (www.UrologyHealthStore.com) has a nice selection of VEDs (use promo code UROLOGY 10 for 10% discount and free shipping).
** The Urology Health Store is offering live video VED instructional classes via Skype, Go-To-Meeting or FaceTime. These classes are available by appointment from 1PM-3PM, U.S. Eastern Time, Monday-Friday. Call 301-378-8433 for appointment. No purchase is necessary to take the class.
Excellent resource: External Mechanical Devices and Vascular Surgery for Erectile Dysfunction. L Trost, R Munarriz, R Wang, A Morey and L Levine: J Sex Med 2016; 13:1579-1617
Wishing you the best of health,
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Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery. Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.
Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com
Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health http://www.TheKegelFix.com
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