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How do vacuum erection devices compare to sildenafil in success rates and patient satisfaction?
Executive summary
Randomized and prospective studies show both vacuum erection devices (VEDs) and sildenafil can produce satisfactory erections by validated scores (IIEF) but patient preference and satisfaction often favor sildenafil when oral efficacy, comfort and ease are better; in one crossover/preference study 66.6% of men chose to continue sildenafil while 33.3% resumed VED use despite similar IIEF scores (mean ~61–62) with each treatment [1][2]. Trials and reviews also report high success when VEDs are combined with PDE‑5 inhibitors (for example, higher IIEF and penetration rates with combined therapy in diabetic men and up to 90% IIEF-5 “success” at 1 year when VED was paired with tadalafil in some post‑prostatectomy series) [3][4].
1. Head‑to‑head outcomes: similar erectile‑function scores, different choices
Clinical comparisons using the International Index of Erectile Function found broadly comparable objective efficacy between VEDs and sildenafil in at least one study — mean IIEF totals while using each modality were about 61–62 — yet that did not translate into identical patient choices: two‑thirds preferred to stay on sildenafil and one‑third resumed the VED (24 vs 12 of 36 patients) [1][2]. ScienceDirect and PubMed abstracts of the same study note the increase in IIEF while using a VED was actually higher in the subgroup that ultimately chose VED (mean 66.75 vs 60.4; p = 0.002), suggesting objective measures and subjective preference can diverge [2].
2. Why patients pick one over the other: side effects, ease, and sexual mechanics
The published preference study reports that fewer ejaculatory difficulties, greater perceived efficacy, comfort and ease of use were common reasons men preferred sildenafil, while adverse side effects of sildenafil were a main reason some returned to VEDs [1][2]. VEDs require manual dexterity or partner assistance and use of a constriction ring for penetration; they can also block ejaculation — practical features that affect satisfaction differently than pill side‑effect profiles [4][5].
3. Combination therapy often improves success and satisfaction
Multiple prospective studies and randomized trials show combining VEDs with PDE‑5 inhibitors yields better outcomes than either alone in selected populations: diabetic men dissatisfied with sildenafil alone had higher IIEF scores and better penetration/intercourse success at 1 and 3 months when sildenafil was combined with a VED (higher successful penetration 73.3% vs 46.6%) [3]. Post‑prostatectomy rehabilitation studies likewise report synergistic effects — for example, VED use plus tadalafil three times weekly was associated with a 90% IIEF‑5 “success” at one year versus 60% without VED in cited series [4].
4. Where the evidence is strongest — and where it’s thin
Reviews and guideline‑level pieces describe VEDs as safe and effective with few side effects and note they’re usable by most men including those who cannot take PDE‑5 inhibitors [6][5]. Systematic reviews and a 2025 meta‑analysis focus attention on VEDs’ role in refractory ED and rehabilitation after prostate surgery, but they also flag limited high‑quality data for some applications — evidence is stronger for combined or rehabilitation strategies than for universal superiority/inferiority versus oral therapy alone [7][8].
5. How to interpret “success” and “satisfaction”
Success metrics differ across studies: objective IIEF scores, rates of successful penetration/intercourse, return of spontaneous erections, or patient global satisfaction questions. The preference study shows that similar IIEF can coexist with divergent satisfaction choices, so clinicians should not equate a numeric IIEF with a patient’s real‑world preference or partner considerations [2][1]. Studies report improved clinical outcomes when combining modalities, underscoring that single‑metric comparisons can miss clinically meaningful benefits [3][9].
6. Practical takeaways for patients and clinicians
Available reporting supports offering both options and discussing tradeoffs: sildenafil is often preferred for ease and perceived comfort but carries systemic side effects that push some men toward VEDs; VEDs are effective for many, usable when PDE‑5 therapy is contraindicated, and frequently enhance outcomes when used alongside PDE‑5 inhibitors [1][5][3]. For post‑prostatectomy or refractory ED, combined approaches and early penile rehabilitation with VEDs have the best supportive evidence in current reviews [4][8].
Limitations: available sources do not provide a single large, contemporary randomized trial directly comparing long‑term real‑world satisfaction between modern VED designs and current PDE‑5 regimens, nor do they cover partner satisfaction in depth; statements above cite the cited trials and reviews only [2][7][8].