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Specially designed vacuum devices to produce erections have been used successfully for many years. Vacuum devices are safe, relatively inexpensive, and reliable. Vacuum devices do not require surgery.

The typical vacuum device consists of a plastic cylinder that is placed over the penis, tension rings of various sizes, and a small hand pump. Air is pumped out, causing a partial vacuum, which draws blood into the penis and creates the erection.

Once an erection is obtained, a tension ring, which acts like a tourniquet to keep the blood in the penis and to maintain an erection, is placed around the base of the penis.

Using the correct size of tension ring is critical in obtaining the best possible result from this type of treatment. If the ring is too tight, it can be uncomfortable. If too large a ring is used, the erection may not last. The tension ring should not be left in place longer than 30 minutes.

Although these devices are generally safe, bruising can occur and the erect penis may lack some support. Other possible side effects include:

• Pain
  
  
• Lower penile temperature
  
  
• Numbness
  
  
• No or painful ejaculation
  
  
• Pulling of scrotal tissue into the cylinder

Many of these side effects can be helped by proper selection of the tension rings and cylinder size, use of adequate lubrication, adequate practice with the device, and proper technique.

Vacuum devices are effective in about 60-90% of men. About half of the men who use a vacuum device obtain good or excellent erections with them, but only half of these men consistently use the device over long periods of time.

The most common cause of failure is improper use of or unfamiliarity with the device. Other drawbacks to the use of vacuum devices include the need to assemble the equipment and the difficulty in transporting it. Many men also lose interest in the device because of:

• Necessary preparations (may need to interrupt foreplay)
  
  
• Inability to hide the tension ring
  
  
• Relative lack of spontaneity

Although vacuum devices can be operated and used quickly with experience, they still are perceived by many to be less "romantic" than other nonsurgical treatment options.

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