Scientific and Clinical Evidence for Vacuum Erection Devices (VEDs) in Penile Rehabilitation
Introduction: A Historical Perspective
The concept of the Vacuum Erection Device (VED) dates back to 1874. An American physician, Dr. John King, published an article in an American family medicine journal suggesting that for men experiencing impotence and genital shrinkage, using a "glass exhauster" (similar to today's vacuum cupping device) connected to an air pump could induce an erection. He noted that while the erection subsided after removing the device, daily use of this regimen could aid in restoring male sexual function. This early idea laid the groundwork for what we now know as penile rehabilitation.
It wasn't until 1917 that Dr. Otto Lederer invented and patented a constriction ring, creating the first true prototype of the vacuum device. However, the technology wasn't commercialized until 1982, when entrepreneur Geddins D. Osbon developed a VED that received FDA approval as a Class II medical device—112 years after Dr. King's initial proposal.
The Clinical Need: Prostate Cancer and Erectile Dysfunction
National health statistics indicate a rising number of new prostate cancer cases in Taiwan, with approximately 5,000 new patients annually. Radical prostatectomy is a common treatment for early-stage prostate cancer, but a significant side effect is post-operative erectile dysfunction (ED).
A 2011 survey of urologists in Taiwan found that over half of their patients experienced persistent ED long-term. This aligns with international reports, where 26-100% of patients face this challenge post-surgery. Therefore, preserving erectile function after cancer removal is a major priority in patient care.
The Science: How VEDs Aid Penile Rehabilitation
Medical research indicates that ED following prostatectomy or due to cardiovascular disease shares a key underlying cause: penile hypoxia (inadequate oxygen supply). This lack of oxygen triggers collagen buildup, penile fibrosis, venous leakage, and ultimately, ED. Studies have also observed an average penile shortening of about 2 cm within six months after surgery.
In contrast, men with normal erectile function experience nocturnal erections that oxygenate penile tissues. This process generates endogenous prostaglandin E, which inhibits fibrosis and helps maintain erectile health.
This is the core mechanism of VEDs in penile rehabilitation. By regularly drawing oxygen-rich blood into the penile chambers, VEDs mimic natural erections. This helps prevent fibrosis, preserve penile length, and support the recovery of neural function.
Evidence-Based Rehabilitation Methods
International clinical guidelines now recommend starting penile rehabilitation soon after prostate cancer surgery. The three primary methods are:
1、Oral Medications (PDE5 inhibitors like Sildenafil or Tadalafil)
2、Vacuum Erection Devices (Used without a constriction ring for rehabilitation; typically twice daily for 5-10 minutes per session)
3、Intracavernosal Injections (Alprostadil)
Key Clinical Findings on VEDs:
- A 2006 study by Raina et al. showed that VEDs helped over 80% of patients (with or without nerve-sparing surgery) achieve successful intercourse. Furthermore, 37% of nerve-sparing patients who used a VED daily for nine months regained spontaneous erectile function.
- Crucially, the VED user group maintained their pre-surgery penile length, while the non-user group experienced an average shortening of about 2 cm.
- A 2016 study in the American Journal of Men's Health found that combining oral medication with VED use was more effective at preserving erectile function after one year than using oral medication alone.
- A study from Ireland reported that 82% of VED users could successfully have intercourse, and 78% were satisfied enough to recommend it to others.
Recommended Rehabilitation Protocol
The recommended approach is to start rehabilitation as early as a few weeks after surgery (once the catheter is removed and healing is satisfactory), continuing for at least 6 to 12 months. A combination of oral medication and VED use is often the most effective strategy.
User Experience: Pros and Cons
The table below summarizes the common advantages and disadvantages reported by VED users.
| Pros | Cons |
|---|---|
| Rapid erection (avg. 2-3 min) | Penile root can feel less rigid (with ring) |
| Can help restore spontaneous erections | Penile coolness and bluish tint (venous blood) |
| Non-invasive and easy to use | Difficulty ejaculating (12-30% with ring) |
| Can be incorporated into foreplay | Discomfort or pain during use or with the ring |
| One-time cost, long device lifespan | Potential for bruising |
| Few contraindications |
Source: Adapted from Reviews in Urology, 2013.
Conclusion: The Resurgence of VEDs
VEDs have regained popularity as a key treatment for ED for several reasons:
1、They are effective for patients who don't respond well to oral medication (e.g., those with severe diabetes, post-prostatectomy nerve damage, or spinal cord injuries).
2、They are an excellent option for patients who cannot tolerate the side effects of oral medications or who are averse to injections.
3、They are safe for patients with severe cardiovascular conditions who use nitrate medications and cannot take PDE5 inhibitors.
4、They are the cornerstone of post-prostatectomy penile rehabilitation, helping to prevent fibrosis and penile shortening.
5、They can be used for pre-surgical rehabilitation prior to a penile implant.
6、They show therapeutic benefits for conditions like Micropenis and Peyronie's Disease.
Looking for More Information?
If you have questions about how Vacuum Erection Devices can fit into your wellness plan, consult with a healthcare professional or a urologist specializing in men's sexual health.
Source: Adapted from the Taiwan Association of Andrology and Aesthetic Sex Medicine. Original article in Chinese: 負壓助勃器用於陰莖復健之科學及臨床實證.