Introduction
Men with erectile dysfunction have ongoing problems getting and keeping an erection firm enough for sexual intercourse. A penis pump helps men with erectile dysfunction to achieve and maintain an erection. It is also called a vacuum constriction device or vacuum erectile device. A penis pump is most commonly advised in penile sexual rehabilitation after pelvic surgeries in men to regain sexual functions.
What Is a Penis Pump?
A penis pump consists of 3 main parts;
1) Plastic Cylinder:
A plastic tube with one open end where the penis will be placed.
2)Pump:
Attached to the other end of the plastic cylinder, creates a vacuum by drawing air out. The reduced air pressure inside the cylinder and full blood flow to the penis ultimately leads to an erection. Vacuums have valves to limit the vacuum pressure created in the cylinder, decreasing the chances of penis injury. These pumps can be manual or battery-operated.
3) Elastic Ring:
It is to be placed on the base of the penis after achieving the erection to limit the blood flowing out of the penis and to help sustain the erection. This ring comes in different sizes for individual fit. It should be removed after 30 minutes to minimize the risk of injury.
What Does the Penis Pump Do?
The penis pump uses negative pressure to distend the corpora cavernosa sinusoids (widely communicative and swiss-cheese appearance present in the center of the corpora tissue, enabling the blood within the penis to move easily from the top to the bottom of the shaft of the penis) and to increase blood inflow to the penis.
Depending on its purpose, a penis pump could be used with the aid of an external constricting ring placed at the base of the penis to prevent blood outflow, maintaining the erection for sexual intercourse. Also, it could be used without applying a constriction ring just to increase blood oxygenation to the corpora cavernosa (smooth muscle in the penis responsible for erection).
Multiple studies have established its value in preserving the penile size and incomplete facilitation of erectile functions.
How to Use a Penis Pump?
Using directions may vary depending on the manufacturer. Make sure to read the instructions before using. Below are general instructions for using a penis pump;
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Apply a small amount of water-soluble lubricant ( K-Y Jelly) to the penis and near the opening at the base of the penis pump tube.
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Place the penis inside the tube.
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Use the pump to manually create a vacuum inside the tube or by switching it on, depending on the type of the pump.
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Slide the elastic band off the end of the tube and at the base of an erected penis.
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After sexual activity, remove the elastic ring.
What Is the Optimal Pressure for Penis Pumps in Penile Rehabilitation?
Current suggestions for penis pumps to improve erectile functions after pelvic surgery are negative pressure settings ranging from −150 mmHg to −200 mmHg. However, the impact of other negative pressure values on treating erectile dysfunction remains unclear. However, study data on rat models show higher negative pressure and more complications above -200mmHg.
What Are the Advantages of a Penis Pump?
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Non-invasive.
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More cost-effective.
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It does not interfere with the action of another drug, so it allows use with other treatment modalities of erectile dysfunction, such as oral medications and intracavernous injections.
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Lower risk for systemic side effects than other choices for penile rehabilitation.
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Studies showed improved intracavernosal blood oxygen saturation (SO2) by increased arterial inflow in the penis after penis pump therapy.
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In addition, arterial blood may also carry other nutrients, such as certain growth factors, to the tissues, contributing to penile recovery.
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Increased blood flow to the penis inhibits cell apoptosis (cell death due to molecular changes) and prevents cavernosal tissue fibrosis.
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Studies have shown that penis pump therapy improves erectile function in 84 to 95 % of men with pelvic surgery.
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Improves sexual function recovery and helps in the preservation of penile length.
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The penis pump helps to inhibit abnormal collagen or scar formation in hypoxic penile conditions after radical prostatectomy.
What Are the Complications of Using a Penis Pump?
Widespread use of penis pumps surrounds patients with unsafe and unqualified vacuum devices that may harm the user. With increased penis pump pressure, complications gradually emerge and increase in frequency. Possible complications of penis pump use, mostly due to higher vacuum pressure, are as follows;
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Occasional numbness and pain.
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Ecchymoses ( skin bruises with blue or purple discoloration) or petechiae (tiny, pinpoint, and round bleeding spots under the skin).
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Bleeding.
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Foreskin avulsion (at -500mmHg pressure).
What Is the Indication of Using a Penis Pump?
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Postoperative erectile dysfunction following radical prostatectomy.
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Erectile dysfunction is associated with systemic conditions such as diabetes, heart disease, and nervous system disorders.
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Post-operative erectile dysfunction after low anterior or abdominoperineal resections for rectal cancer.
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Erectile dysfunctions related to psychological conditions.
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Penis pump therapy can improve or stabilize the curvature of Peyronie’s disease. It is safe to use in all stages of the disease and may reduce the number of patients going for surgery.
What Are the Contraindications of Using a Penis Pump?
Penis pump use is generally well tolerated. Thus, contraindications are very few and mainly include the following;
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Unexplained intermittent priapism.
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Bleeding disorders.
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There is an increased risk of bleeding with blood thinners, such as Warfarin, Clopidogrel, Apixaban, and other pain relievers, such as Aspirin, Ibuprofen, or Naproxen.
What Are the Drawbacks of Using a Penis Pump?
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Penis pumps can cause an erection that may feel unnatural. A person may lack firmness at the base of a penis, which makes the penis rotate or pivot more than with a natural erection.
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It does not allow spontaneous sex, as using a penis pump for erection interrupts sexual activity.
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It may take some time to become comfortable using a penis pump.
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A man may feel awkward using a penis pump during sexual activity, which may also affect a person's self-esteem.
Conclusion:
Current clinical evidence and studies support the safety, tolerability, effectiveness, and benefits of early penis pump therapy after pelvic surgical procedures. Scientific evidence demonstrates that penis pump therapy for penile rehabilitation achieves increased arterial inflow, anti-apoptotic, anti-fibrotic, and anti-hypoxia mechanisms. However, no additional benefits could help preserve erectile function or improve the penile tissue structure after pelvic surgery from excessive negative pressure, except for increased detrimental side effects. In addition, based on the advantages of penis pump therapy, multiple therapies combined with it have emerged and achieved more remarkable successes in managing erectile dysfunction.
