Vacuum constriction devices and constriction rings for men with

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ED: A vacuum constriction device (VCD) (93) is simply a rigid tube that is placed over the penis. A vacuum is then created inside the tube either manually or by a battery-powered motor. The penis becomes erect when such a negative pressure surrounds it. This principle is not new, and was being used as a treatment for ED as far back as 1874. For some men, this vacuum is sufficient, but others need a "constriction ring" which when applied to the base of the erect penis, preventing venous leakage once the tube is removed for sexual activity to commence.

This device is useful as a treatment for men with ED who are unable to use oral therapies. It also avoids the use of ICI therapy, which some men find objectionable. It is fairly simple to use although it is somewhat obtrusive. One drawback of use with the constriction ring is that the erection pivots about the ring making it less natural. Its use has been studied in men with diabetes, SCI, explanted penile prosthesis, and requiring dialysis for various reasons. These studies have all reported high success rates of VCD use with approximately three-quarters of men. Partners too find the device an acceptable compromise.

As with all of the treatments, there are some contraindications to the use of VCDs. Sickle cell trait/disease, leukemia, and anticoagulation therapy are medical considerations that can be complicated by VCD use. In addition, men with poor manual dexterity may find the manual pump and the constriction ring difficult to use, although this need not be a problem for men with obliging partners!

For a few individuals who are able to achieve an erection but not maintain it, they can use the constriction ring without the vacuum tube. This will enhance the firmness and size of the penis. In all cases where a constriction ring is used, a time limit of 30 min must be strongly emphasized.

Some adverse affects are reported by some individuals using VCDs, but these tend to be painless and self-correcting. Ecchymoses is reported in 12%

of users, and 25% report petechiae. Other effects that can put some men off the idea include cold/numb penis, lack of ejaculation, pivoting of the penis and altered sensation at orgasm, which may be uncomfortable.

As with other treatments, VCD may be combined with other therapies to augment response such as with MUSE or psychosexual therapy (94).

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