Vacuum Therapy After Prostate Cancer Treatment: A Patient Guide

Erectile changes are common after prostate cancer treatment, whether you had surgery (including radical prostatectomy), radiation, or hormone therapy. That can be hard for you and for a partner, but it does not mean intimacy has to end.

A vacuum erection device (VED), also called a vacuum constriction device or penis pump, is one of the options urologists discuss in this situation. Used as your doctor directs, it can create an erection firm enough for sex. It is also often used, without the tension ring, as part of a penile rehabilitation routine intended to bring blood into the penis while nerves recover.

What a vacuum erection device is and how it works

A medical-grade VED has three basic parts (Mayo Clinic; MedlinePlus; NIDDK): a clear plastic cylinder that fits over the penis; a pump, either hand-operated or battery-powered, that removes air from the cylinder; and a tension ring (also called a constriction band or ring).

When you place the cylinder over the penis and pump out the air, the lower pressure draws blood into the penis and produces an erection. For sexual activity, you slide the ring onto the base of the penis so blood is less likely to leave, then remove the cylinder. Take the ring off when you are finished — and no later than 30 minutes after you put it on (Mayo Clinic; MedlinePlus).

A VED does not use medication and does not require shots or surgery. It also does not automatically restore a spontaneous erection. In a rehabilitation program, it is used to bring blood and oxygen into the tissue on a regular schedule.

The American Urological Association's 2018 guideline on erectile dysfunction states that men with ED should be informed about vacuum erection devices, including benefits and risks (Moderate Recommendation; Evidence Level: Grade C). The same guideline states that only devices with a vacuum limiter should be used. A limiter, sometimes called a pop-off or pressure-release valve, keeps the vacuum from getting strong enough to injure the penis (AUA Guideline PDF; Mayo Clinic).

Why urologists use vacuum therapy in penile rehabilitation

After a radical prostatectomy, erections are often at their weakest right after surgery. When recovery happens, it can continue over the first 18 to 24 months. How much function returns depends on your erections before treatment, your age, whether the nerves around the prostate could be spared, and other health conditions such as diabetes or heart disease (Prostate Cancer Foundation). After radiation, changes often appear more gradually and may continue for several years. Hormone therapy can also affect erectile function.

When erections stop for a long stretch, the tissue gets less regular blood flow and oxygen. Over time, that can contribute to scarring and to a loss of penile length. A typical penile rehabilitation program is meant to protect that tissue while the nerves recover, often with oral medication, penile injections, and/or a vacuum erection device (PCF, Erectile Dysfunction). PCF notes that early use of a VED may help preserve penile length after surgery, and that combining a VED with oral medication may have added benefit over medication alone (Improving Erectile Function, Part 2). Movember's True North guide, developed with the International Society for Sexual Medicine, says pumps can be used after surgery, radiation, or hormone therapy, and may help prevent shrinkage as part of rehabilitation after surgery (Using a penis pump after prostate cancer treatment). A 2018 systematic review found improvements in erectile function scores and less shrinkage after early vacuum therapy, but the authors cautioned that the included studies were limited in quality (Feng et al., American Journal of Men's Health, 2018).

When to start

Do not start vacuum therapy on your own timetable. Ask your surgeon or urologist when it is safe for you. A VED is generally not used while a urinary catheter is still in place after prostatectomy. Many programs begin sometime after the catheter is removed, often within the first weeks, rather than waiting many months (PCF; Movember sexual health guidelines). After radiation or hormone therapy, the starting point may be different.

If your doctor recommends a schedule, ask how often to use the device, whether to use it with or without a tension ring, and whether it should be combined with a PDE5 inhibitor (the class that includes sildenafil and tadalafil). The AUA guideline notes that early use of those pills after prostatectomy or radiotherapy may not, by itself, improve spontaneous, unassisted erections (AUA Guideline PDF).

How to use a vacuum erection device

Follow the instructions that come with your system. The steps below are a general overview from MedlinePlus, Mayo Clinic, and Movember True North.

For rehabilitation (often without a ring): Your doctor may ask you to use the pump to draw blood into the penis, then release the vacuum, sometimes repeating this a few times, and to skip the tension ring. The goal is tissue blood flow, not a lasting erection.

For sexual activity (with a ring):

  1. Trim or shave hair at the base of the penis if it is likely to get caught in the ring or break the seal.
  2. Load the tension ring onto the open end of the cylinder, using the loader or cone that came with your system if it has one.
  3. Apply a small amount of water-soluble lubricant to the penis and to the opening of the cylinder. Do not use petroleum jelly, which can damage the device (MedlinePlus).
  4. Place the cylinder over the entire penis and hold it firmly against your body so the seal is even. Be careful not to pull scrotal skin into the cylinder.
  5. Pump slowly. Use only as much vacuum as you need for an erection. More pressure is not better and can cause injury.
  6. When the erection is firm enough, slide the ring onto the base of the penis, then release the vacuum and remove the cylinder.
  7. After sex — and in any case within 30 minutes — remove the ring.
  8. MedlinePlus advises allowing 60 minutes between uses of the device.

If pumping is painful, or you see more than mild pinpoint red spots, stop and contact your urologist. Do not try to "push through" discomfort with more vacuum.

About tension rings

Do not leave the ring on for more than 30 minutes. Cutting off blood flow for longer than that can injure the penis (Mayo Clinic; MedlinePlus; SMSNA; True North). Do not wear the ring to sleep, and do not put it back on to extend the time.

Rings come in several sizes and tightnesses. MedlinePlus advises using the largest ring that still maintains an erection. A tighter ring than you need is more likely to cause pain, numbness, or bruising. If scrotal skin tends to pull into the cylinder, ask whether a different ring style is intended for that problem.

While the ring is on, the penis may look slightly blue or purple and feel cooler than usual. These changes should fade after the ring comes off (MedlinePlus). The ring can also make ejaculation difficult or make semen feel trapped. After a prostatectomy, most men have a dry orgasm anyway, because the prostate and seminal vesicles have been removed. After radiation, some semen may still be produced. Either way, a tension ring is not birth control (MedlinePlus). For types and fit, see all tension rings and Best Tension Rings for a Vacuum Therapy Penis Pump.

Safety

Vacuum devices are safe for most men when they are used as directed and the device has a vacuum limiter. They are not automatically safe for everyone.

Talk with your urologist before using a VED if you:

  • Take a blood thinner, such as warfarin or clopidogrel, or regularly take NSAID pain medicines such as ibuprofen or naproxen (Mayo Clinic; True North)
  • Have a bleeding or blood disorder, including sickle cell disease or hemophilia (Mayo Clinic; MedlinePlus)
  • Have a history of priapism (a prolonged, painful erection) or a condition that raises that risk (MedlinePlus; AUA Guideline PDF)
  • Have significant penile curvature or Peyronie's disease, or have a penile implant
  • Are still healing from surgery or still have a catheter in place

The AUA guideline says men on anticoagulant therapy, men with bleeding disorders, and men with a history of priapism should use VEDs with caution (AUA Guideline PDF). Common, usually minor effects include pinpoint red dots (petechiae), mild bruising, discomfort, a cold or numb feeling while the ring is on, and trouble with ejaculation. The ring can also pinch scrotal skin if the cylinder is not seated carefully (SMSNA).

Contact your urologist if you have pain during or after use, serious bruising or blood blisters, or decreased sensation in the penis (MedlinePlus). Do not use a novelty or "sex shop" pump in place of a medical-grade device. Those products may lack a vacuum limiter and are not a safe substitute (Mayo Clinic; True North).

What to expect

A vacuum-assisted erection can be firm enough for sex, but it often feels different from the erections you had before treatment. The shaft may be firm beyond the ring while the area under the ring is less firm, which can let the penis pivot or point more downward than you are used to. The penis may also feel cooler. These are well-described effects, not a sign that you are doing it wrong (Mayo Clinic; PCF; True North).

With practice and correct use, many men can get an erection firm enough for sex. The Sexual Medicine Society of North America has reported that, with proper instruction, roughly 80 percent of men who use these devices achieve a functional erection — a general figure, not a guarantee, and not a result measured only in men recovering from prostate cancer treatment (SMSNA). Results still vary, especially after cancer treatment. A VED will not enlarge the penis, despite some advertising claims, and it will not "cure" erectile dysfunction. Used after prostate surgery, it may help preserve length rather than add it (Mayo Clinic; MedlinePlus). Some men later recover more spontaneous function; some continue to use a device, medication, or injections; and some eventually discuss a penile implant.

Orgasm is still possible without an erection and, after prostatectomy, usually without semen. Some men leak a little urine at climax (climacturia); if that happens, tell your urologist. ZERO Prostate Cancer encourages couples to talk plainly rather than guess, and notes that affection does not have to lead to sex. Counseling or sex therapy can help. For a broader conversation about intimacy later in life, see Let's Talk About Sex and Aging.

Choosing a device

Buy a medical-grade, FDA-cleared vacuum erection device with a vacuum limiter. You can purchase some devices without a prescription, but it is still wise to ask your clinician to recommend a model (Mayo Clinic; MedlinePlus). A manual pump lets you control the pace and needs no batteries. A battery-powered pump can be easier if arthritis, a tremor, or limited grip makes a hand pump difficult (Mayo Clinic). Look for a kit with more than one ring size, a way to fine-tune the cylinder seal, and replacement rings and pump heads later.

Two medical-grade lines widely used in the United States are Pos-T-Vac and Osbon. Rejoyn Store carries FDA-cleared vacuum therapy systems from both, including the Pos-T-Vac MVP 700, Pos-T-Vac BOS-2000, Pos-T-Vac Automatic 3000, Osbon ErecAid Classic, Osbon Esteem Manual, and Osbon Esteem Automatic. If you are deciding between those lines, Pos-T-Vac vs. Osbon ErecAid: How to Choose a Vacuum Therapy System walks through fit, ring systems, and manual versus battery pumps, without prices.

Orders from Rejoyn Store ship in a plain, unmarked box. For packaging, shipping, returns, and payment questions, see the FAQ.

Insurance, Medicare, and HSA/FSA. Coverage is not automatic. For dates of service on or after July 1, 2015, Original Medicare has listed vacuum erection devices and related supplies (HCPCS codes L7900 and L7902) as statutorily non-covered (CMS policy article A52712; LCD L34824). A prescription does not, by itself, make Original Medicare pay for the device. A Medicare Advantage, Medicaid, or private plan may have different rules, so ask your insurer and your doctor's office before you assume help with the cost (SMSNA).

These systems may be eligible for HSA or FSA reimbursement when they are used to treat erectile dysfunction. Your plan administrator has the final say, and a doctor's prescription or a letter of medical necessity is often required. We cannot promise that your plan will reimburse the purchase. Check with your plan before you order; more detail is on the FAQ.

Care and replacement parts

Wash the cylinder and rings after each use with the mild soap or cleaner your instructions allow, rinse well, and let the parts dry before you store them. Do not use harsh chemicals or petroleum-based products on rings or seals. Replace rings that are cracked, sticky, or permanently stretched, and use spares made for your system; rings are not all interchangeable across brands. Browse replacement tension rings for Pos-T-Vac and Osbon systems. Replace batteries when the pump begins to lag. Pump heads can often be replaced without replacing the entire system. If a part no longer seals, pumps unevenly, or shows damage, stop using it and replace that part.

Questions to ask your urologist

Bring a partner if you want a second set of ears. Useful questions include:

  • When may I start, and should I use the device for rehabilitation, for sex, or both?
  • How often should I use it, and should I use a tension ring for practice sessions?
  • May I combine it with a PDE5 inhibitor, injections, or another treatment you have prescribed?
  • I take [list your medicines, including blood thinners]. Is a VED safe for me?
  • What should I do if I get bruising, numbness, or scrotal pulling, and when should I stop and call you?
  • If natural erections do not return as I hope, what would we try next? Does my insurance plan cover a device? Would a prescription or letter of medical necessity help with an HSA or FSA claim?

Frequently asked questions

Will a vacuum device restore my natural erections?
It can create an erection when you use it, and it may support tissue health during recovery. It is not a cure, and it does not guarantee that spontaneous erections will return (Mayo Clinic).

Can I use a pump after radiation or hormone therapy, or only after surgery?
Vacuum devices are used after surgery, radiation, and hormone therapy (True North; ZERO). Timing and technique should still come from your clinician.

Do I have to use the tension ring every time?
No. For sexual activity, the ring keeps the erection after the cylinder comes off. For rehabilitation, many clinicians have men pump without leaving a ring on.

Does Medicare pay for a vacuum erection device?
Original Medicare has not covered these devices (codes L7900 and L7902) for dates of service on or after July 1, 2015 (CMS A52712). Other insurance may differ. Confirm with your plan.

Can I use an HSA or FSA?
A vacuum therapy system may be eligible for HSA or FSA reimbursement when it is used to treat erectile dysfunction. Your plan administrator has the final say, and a prescription or letter of medical necessity is often required. See the FAQ for more detail.

What if a VED is not enough?
Tell your urologist. Other options can include a change in medication, injection therapy, counseling, or, for some men, a penile implant.

Sources

Back to blog