A 34 year old man already married came to us with erectile dysfunction.After basic evaluation he was started on PDE-5 inhibitors but the result was sub-optimal.
He was then given option of Intra-cavernosal Injection therapy with Bimix but he was repulsive for any injection over the penis.
His basic cause for erection was psychological so we though the medications along with Vacuum Erection Device would be good as he is bound to recover with thecourse of the time.
He opted for battery opted device and is happy with the usage.His wife has also accepted the method whole heartedly.
Vacuum erection devices, also known as vacuum constriction devices have been utilized for improving erectile rigidity for ovrigidity of the penile erection.
The vacuum device consists of a clear plastic cylinder with an aperture at one end that is placed over the penile shaft ; extending till the base of the penis. At the other end of the cylinder is a pump mechanism that is used to generate negative pressure within the cylinder. The pump mechanism can be in the form of either a manually operated(Figure 1 ) or a battery-operated system(Figure 2).
The former requires two hands to operate the device, one on the pump handle and the other to steady the cylinder on the penis itself. So this device is better to be given for people relatively yound and having dexterity over the movements.
The battery-operated device can be used with one hand. This is a better device in relatively infirm patients with neurological weaknesses.
Once a decision has been made to pursue sexual relations, water-soluble jelly is applied to the base of the penis (As shown in Figure). This maneuver helps in creating a water-tight seal, thus maintaining the negative pressure within the cylinder.
The patient can shave of the pubic hair for better fitting of the instrument. Once the cylinder has been placed over the penile shaft and held firmly against the pubic bone, the pump mechanism can be activated (either by hand held or battery). The negative pressure (vacuum generation) will cause blood to be drawn in the corpora cavernosa. The negative pressure build up is gradual and slow to prevent bruises and hematoma and resultant pain.
Once the erection is achieved the pressure can be let off and again rebuilt to maximize the erection . Once the erection has been achieved, a constriction ring (band) is applied to the base of the penis to act as an artificial valve, thus maintaining the blood within the corporal bodies. The rings come in a variety of shapes, sizes, and most importantly tension (tightness). The choice of the ring depends upon the patients penile size,turgidity and the patients preference.
The vacuum device is indicated for men with ED. Especially in older patient and with cardiac comorbidities who are not suitable for medications.The patients who donot improve with the medications also can respond to the Vacuum Erection Device.
It is best suited for the patients with co-operative partner who accepts the usage of the Vacuum Erection Device.
(i) using antiplatelet agents/or presence bleeding disorders
(ii) history of priapism
(iii) congenital penile curvature/peyronies disease
(iv) psychiatric disorders/neurological disorders
There are instances in older people mistakenly the Vacuum Erection Device has been applied over the testis also along with the penis and resultant gangrene of the testis.It may so happen that in an inebriated patient may forget to remove the ring after the sexual act.The patient having neurological deficit and no sensations over the penis may neglect ongoing hematoma or even may forget to remove the ring causing grave implications.
It is generally advised to keep ring for not more than 30 minutes.It is essential in old couple to involve both the partners so that such problems can be avoided.
Important Facts to remember:
It has been estimated that the surface temperature of the penis during use of the VED is lower than the temperature prior to application of the device. The patient and his partner should be counseled regarding this fact prior to the initial use of the device as some couple might find cool penis repulsive for the sexual act. The device can take around 15 minutes to obtain erection.This may sometimes kill the already awakened sexual excitement /arousal .
1)cool penis sensations
3)The penile numbness might develop in some patients
4)The penis may loosely hand beyond the ring.
Despite the apparent drawbacks to the use of vacuum devices, there is a population of patients who find its use easy and it has allowed many couples to successfully resume penetrative sexual relations. The satisfaction rate varies from 35-80% but there are drop outs because of the side effects or some couple opting for better alternatives like penile implants which tries to imitate the natural erection.This device is not good for young people who may feel embarrassed to do whole action-applying the Vacuum Erection Device ;creating the pressure and carrying it everywhere as cumbersome.