Oral tablets for ED such as Viagra have become the new conventional in the past 20 years. When these aren’t suitable, other treatments such as injections, creams and urethral suppositories might be a better option.

But there are rare cases in which no medications are suitable or effective. In such instances, other options including devices and surgery, might be considered. 

Vacuum Constriction Pumps (VCPs)

These devices have actually been around since 1985, long before oral treatments like Viagra, but have become increasingly popular in the twentieth century - arguably because online selling has enabled discreet access. 

Some online sources will claim that penis pumps are both good for erectile dysfunction and physical penile enlargement. However, there is scant evidence to support the theory that non-surgical treatment methods like constriction pumps can increase the size of the penis. 

While they may not increase penile size, constriction pumps can be beneficial in treating ED. One study showed that 70% of men were able to have successful intercourse after using one.

To operate a VCP, a plastic cylinder is placed over the penis. The air is then removed which creates a vacuum, which draws blood to the penis and encourages an erection. This can be done with a hand or battery operated device. Once firm, a ring or band is placed at the base of the penis which helps to maintain rigidity. This band should not be kept on for longer than 30 minutes, according to a paper by the British Association of Urological Surgeons (BAUS).

It sounds like an uncomfortable or awkward procedure, but can be effective and straightforward after a couple of tries. 

So why aren’t they more popular? 

Most likely because oral treatments are easier to administer, more discreet, and remain active for a longer time. Oral medicines for ED also cheaper for patients taking them on an occasional basis.

According to BAUS:

“Most patients must buy their own device. You will usually be required to pay between £120 and £350 for your VED. Specific treatment is only available on the NHS (Schedule 2) to patients who:

  • have diabetes mellitus, multiple sclerosis, Parkinson’s disease, poliomyelitis;
  • have renal failure treated by dialysis or transplantation;
  • have had radical pelvic surgery (e.g. radical prostatectomy) or have been treated for prostate cancer (using surgery and other treatments); 
  • have had severe pelvic injury, single-gene neurological disease, spinal cord injury or spina bifida; or
  • are not included in the above categories but were receiving NHS treatment (such as Caverject™, Viagra™ or Viridal™) for their erectile dysfunction on or before 14 September 1998.”

So how would you go about getting hold of a vacuum pump? Before considering paying for one, it might be advisable to have a consultation with your doctor. They’ll be able to help you weigh up the pros and cons, and give you tailored advice.

Who can use vacuum pumps?

Vacuum constriction pumps differ from conventional PDE5i treatments in that men suffering with certain pre-existing conditions can typically use them. For example, if you take certain medications that thin the blood - such as Apixaban (Eliquis), Dabigatran (Pradaxa), Edoxaban (Savaysa), Fondaparinux (Arixtra), Heparin (Fragmin, Innohep, and Lovenox), Rivaroxaban (Xarelto) or Warfarin - then VCPs may not be suitable for you. 

Additionally, if you suffer with a condition called sickle-cell anemia then you will likely not be recommended a VCP by a health professional. Sickle-cell anemia is defined as the production of oddly shaped red-blood cells which do not live as long as healthy ones, and their shape can block blood vessels - which can lead to clotting.

What are the side effects of vacuum pumps? 

Because vacuum constriction pumps are for external use, the side effects are limited. The chances of encountering side effects can also be reduced if VCPs are used correctly. To ensure correct use, it is recommended that people first visit their doctor or a urologist who can provide a demonstration. 

Side effects can include small red/purple dots on the surface of the skin. They’re formed when very small capillaries, or vessels, break open. 

You might also find, while the constriction band is in place, the penis feels numb or cold. You should remove the constriction band if your penis turns a blue-ish colour. 

You might also encounter mild pain or even bruising. (This typically happens because a VCP has been used incorrectly or used for too long). 

Lastly, if the constriction band is placed at the base of the penile shaft, above the scrotum, and is too tight, it can make ejaculation feel painful. It might feel as if your semen is trapped or has been prevented from leaving the penis. Certain VCP constriction bands are designed to resolve this. 

What to look for when buying a vacuum pump

If you want to look into purchasing a VCP over-the-counter, there are a number of places you can find them. 

Make sure there is a limit on the pressure inside the vacuum. Too much could damage the penis. 

Make sure the constriction band applies gentle pressure, and is not so tight that it feels uncomfortable. 

Make sure the device you purchase is tailored and designed to treat erectile dysfunction. Ones which claim to enlarge the penis will not fulfil this function and might not have been built with safety in mind. 

Vacuum Constriction Pumps (VCP) Advantages

Vacuum Constriction Pumps (VCP) Disadvantages

Worthwhile - Because pumps can be effective, they can be a long-lasting solution to your erectile dysfunction. You won’t need to spend money on expensive treatments.

Time constraints - For safety reasons, the constriction ring or band must be removed after 30 minutes to avoid any circulatory damage. 

Lasting - The ring, or constriction band, helps to maintain fitness and prevents blood from travelling away from the penis. 

Success rate - While VCPs can be effective, they’re not guaranteed to work for everybody. 

Effective - Once you have the hang of using them, pumps can be highly effective.

Side effects - While there aren’t many if used correctly, VCPs can cause some side effects like swelling or bruising.

Non-Prescription - Most men can use a VCP given they can afford it. No prescription is required. 

Expensive - Costs tend to vary between £120 and £350. This might not be a viable option for everyone.

External - VCPs are for external use. This means any side effects are limited, are likely to be visible and easily diagnosed. 

Preparation - VCPs aren’t the most useful for spontaneous sexual activity. They require some preparation time prior to sex. 

Pre-existing conditions - Many men who would not be able to take PDE5is (like Viagra) can use VCPs. 

Enlargement - Despite what some online sources may claim, VCPs do not increase the size of your penis over time. 

Side effects - VCPs typically don’t cause many side effects when used correctly.

Unnatural - The nature of VCPs can make erections feel odd, awkward or unnatural. 


Vascular Reconstruction Surgery 

If other forms of erectile dysfunction treatment have not proved successful, vascular reconstruction surgery may be an option. 

“Vascular surgery became a surgical specialty in its own right in 2012, having previously been a subspecialty of general surgery. The first trainee vascular surgeons started training in 2013.”

Vascular surgery is a highly complex and intricate medical procedure surrounding the veins, arteries and/or blood vessels (the vascular system). With ED, vascular reconstruction surgery will aim to do one or both of the following:

  • Reconstruct or re-route certain arteries in or near the penis (thereby bypassing blocked or tightly-restricted vessels) 
  • Unblocking the vessels which are preventing blood flow in and out of the penis. 

However, because vascular reconstruction surgery is highly costly, technical and doesn’t always work, doctors will scarcely recommend it to help treat erectile dysfunction. 

Who is eligible for vascular reconstruction surgery? 

Even when it isn’t related to ED, vascular surgery will typically only be recommended if absolutely necessary. Several health conditions involving the vascular system can be treated with certain medications and lifestyle changes. 

Doctors are even more reluctant to recommend vascular reconstruction surgery for erectile dysfunction. It is currently not something the NHS will pay for. If it is recommended, it will typically have to be sought out privately in the UK, which can be significantly costly. 

Men who are more likely to be recommended this route of treatment are typically younger, roughly 45 or below, and have suffered physical trauma near or around the groin, which has developed into ED. 

What are the side effects and risks of vascular reconstruction surgery? 

Any surgery, especially one as intricate and complex as vascular reconstruction surgery, comes with risks and potential side effects. 

Common side effects may include, at the site of the surgery, bleeding, bruising or swelling. There is also a risk of infection. 

After the site of surgery has had time to heal, there may be permanent, visible scar tissue. In serious cases, it may lead to a distorted shape and even painful erections. It may also lead to the permanent feeling of numbness. 

Because vascular reconstruction surgery is a highly technical procedure, there is, as is the case with any surgery, room for error. The procedure is not always guaranteed to work.

Furthermore, some find that the positive effects of the surgery ‘wear off’ over time, and symptoms of erectile dysfunction can return. 

Advantages of Vascular Reconstruction Surgery (VRS)

Disadvantages of Vascular Reconstruction Surgery (VRS)

Natural - Unlike other methods, VRS can restore the ability to achieve a natural erection.

Expensive - VRS often has to be paid for privately and is highly costly. 

Route of the Problem - If ED is caused by a problem with the blood vessels, VRS can tackle the route of this problem. 

Risk - There are a number of risks associated, including that VRS doesn’t always work and can cause lasting physical changes in appearance. 

Psychology - ED can have a negative psychological impact. VRS can help men to have normal sex lives, which can improve their quality of life. 

Invasive - Highly technical procedure and can be quite invasive. 

Age - The younger you are, the more likely VRS is to work.

Time - Symptoms of ED can return after some time. 


Recommendation - Often, doctors will not recommend VRS for ED. 


Failure - VRS for ED has a low success rate. 

Surgical implants

If people have tried a lot of different treatment types (lifestyle changes, therapy, prescription treatment or even vacuum constriction pumps), and none have been successful, they might be recommended surgical implants. 

Surgical implants involve the insertion of a prosthetic implant, or a prosthesis. This allows men suffering with the symptoms of ED to have an erection. 

Types of surgical implants

There are three main types of penile surgical implants. Choosing the right one will typically involve a conversation with your doctor or surgeon. 

‘Malleable’ rods

This option will consist of your surgeon inserting two metal flexible rods into the penile shaft. This induces a state of lasting, part-rigidity. 

Typically, the rods can be ‘reshaped’ or straightened when an erection is required for sexual activity. While this method can be highly effective when it comes to sex, it can raise certain questions outside of the bedroom. 

For example, the permanent state of fitness can be difficult to mask or hide in certain circumstances (when swimming or playing sports, for instance). The constant state of rigidity can also be generally uncomfortable. 

‘Inflatable’ rods

These types of operation are typically more widely sought after, as they do not cause a lasting state of firmness like the malleable rods. 

Typically, inflatable rods consist of three components. 

  • Two inflatable tubes, or rods, placed inside the penis. 
  • An inflatable pump, placed inside the scrotum. 
  • A fluid-filled reservoir or container (sometimes placed in the scrotum, sometimes placed somewhere in the abdomen). 

These three components are all connected via intricate tubing. Applying pressure to the inflatable pump encourages the fluid to move from the container and into the rods inside the penis. This causes inflation, which gives the appearance of ‘growth’ and an erection. 

Once sexual intercourse has concluded, a small valve is pressed which causes the fluid to return to the reservoir. This causes the penis to become flaccid again. 

This method is not dissimilar from how a natural erection works. The ‘rods’ act like the ‘smooth muscle’ or corpus cavernosum, and the ‘fluid’ found in the reservoir acts like blood. 

Some people report that inflatable rods feel and look just like natural erections, and overall satisfaction is generally high. However, some men also report that the ‘erection’ induced by the inflatable implant does not last as long as a natural erection. This is something surgeons have been looking to address. 

 Advantages of Surgical implants

Disadvantages of Surgical implants

Natural - Some men report the surgical implants feel just as a normal erection would. 

Expensive - Often an expensive procedure which will have to be sought out privately.


Invasive - The procedure is typically quite invasive. General anesthesia is sometimes used. 


Page last reviewed:  23/07/2020