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Fact check: What are the potential side effects of using vacuum erection devices?
Executive summary
Vacuum erection devices (VEDs) commonly cause penile bruising and discomfort, with pooled studies reporting around 24% incidence of bruising and roughly 28% reporting discomfort, usually related to the constriction ring [1] [2]. Serious but rare harms — including penile erosion, skin necrosis, urethral bleeding, and injuries from prolonged constriction-ring use — are documented in case reports and reviews, especially among patients with reduced genital sensation or improper device use [3] [4] [5]. Recent systematic reviews still conclude VEDs are an effective adjunct when used with proper education and monitoring [1].
1. How users and clinicians describe everyday harms — common complaints that matter to patients
Multiple recent reviews and studies converge on bruising and discomfort as the most frequently reported side effects of VED use. A 2025 systematic review and meta-analysis reported a pooled incidence of penile bruising of 24.3% and noted higher rates (around 31.4%) in spinal cord–injured patients, while other literature summarizes about 28.6% of users report discomfort, typically attributable to the restraining ring [1] [2]. These findings underline that transient but bothersome physical effects are common, and they drive discontinuation or dissatisfaction even when erectile function benefits are achieved.
2. When VEDs cause severe harm — documented rare but serious complications clinicians warn about
Case reports and reviews spanning decades describe severe outcomes: penile erosion after suction device use, penile skin necrosis, urethral bleeding, and entrapment of scrotal tissue in the penile shaft. A case report emphasizing severe penile erosion highlights the role of decreased sensation and improper follow-up in precipitating harm [3]. A 1998 review summarized unusual but important complications, and a 2006 case described necrosis from prolonged constriction-ring installation, illustrating that serious tissue injury, though uncommon, is real and preventable with correct use [4] [5].
3. What the pressure data tell us — balancing efficacy against physical stress on penile tissue
Experimental work on optimal negative pressure suggests a therapeutic window exists. A 2019 rat-model study identified −200 mmHg as an apparent optimal setting for penile rehabilitation with VEDs, finding no additional benefit from stronger negative pressures but increased detrimental side effects with higher suction [6]. This mechanistic insight supports clinical observations that excessive vacuum or misuse may amplify bruising and tissue injury, and it frames recommendations to avoid maximal suction settings absent clear benefit.
4. Who is at higher risk — patient factors that change the risk–benefit calculus
Patients with spinal cord injuries or diminished genital sensation are repeatedly flagged as having a higher incidence of VED complications, including bruising and erosion, because they may not perceive early warning pain or ischemia [3] [1]. Prolonged or improper constriction-ring use appears particularly hazardous, with documented necrosis when rings are left in place too long [5]. These data make clear that individual risk profiles — neurologic status, ability to follow instructions, and ongoing follow-up — are central to safe VED prescribing.
5. Balancing benefit and harm — VEDs remain an effective adjunct if used correctly
A 2025 systematic review concluded that VEDs are an effective adjunct in refractory erectile dysfunction, improving intercourse success and patient satisfaction with a pooled effect size of 0.80, while simultaneously reporting nontrivial rates of bruising [1]. Older and clinical-scope reviews emphasize that education, device fitting, pressure guidance, and routine follow-up markedly reduce complications [3] [4]. The evidence therefore supports VED use when benefits are expected and preventive measures are implemented, rather than ad hoc self-use without medical oversight.
6. Where uncertainties remain and what clinicians should emphasize to patients
Key gaps include heterogeneity in reporting of side-effect rates across studies and limited high-quality prospective data on long-term complications; most severe harms are described in case reports and small series, which may overrepresent rare events but still signal clear hazards [4] [5]. Clinicians should emphasize device training, conservative pressure targets (consistent with experimental −200 mmHg guidance), time limits for constriction rings, and prompt follow-up for any bleeding, numbness, or skin changes. These measures are the practical synthesis of the available evidence [6] [3] [5].