Posts Tagged ‘vacuum suction device’

The Penis Pump (Vacuum Erection Device): What You Need To Know

April 8, 2017

Andrew Siegel MD  4/8/17

The vacuum erection device (VED) is an effective means of inducing a penile erection suitable for sexual intercourse–even in difficult to treat men who have diabetes, spinal cord injury, or after radical prostatectomy for prostate cancer.  The device is also useful in the post-operative period following radical prostatectomy to maintain penile length and girth. It has some utility in Peyronie’s disease patients in order to improve curvature, pain and maintain penile dimensions. It can be used prior to penile prosthesis surgery in order to enhance penile length and facilitate the placement of the largest possible implant.  

VED

Image Above: Vacuum Erection Device (obtainable via UrologyHealthStore.com–use promo code UROLOGY 10 for 10% discount and free shipping)

Introduction

Tissue expansion is local tissue enlargement in response to a force that can be internal or external.  Internal tissue expansion occurs naturally with pregnancy, weight gain and the presence of slow growing tumors. Plastic surgeons commonly tap into this principle by using implantable tissue expanders prior to breast reconstructive surgery.

The VED uses the principle of external tissue expansion by using negative pressures applied to the penis to stretch the smooth muscle and sinuses of the penile erectile chambers. The resultant influx of blood increases tissue oxygenation, activates tissue nutrient factors, mobilizes stem cells, helps prevent tissue scarring and cellular death and, importantly, induces an erection.

There are many commercially available VEDs on the market, which share in common a cylinder chamber with one end closed off, a vacuum pump and a constriction ring.  The penis is inserted into the cylinder chamber and an erection is induced by virtue of a vacuum that creates negative pressures and literally sucks blood into the erectile chambers of the penis. To maintain the erection after the vacuum is released, a constriction ring is applied to the base of the penis.  The end result is a rigid penis capable of penetrative intercourse.

Interesting factoid: Similarly designed vacuum suction devices are available for purposes of nipple and clitoral stimulation.

Brief History of VED

In 1874, an American physician named  John King came up with the concept of using a glass exhauster to induce a penile erection. The problem with the device was the loss of the erection as soon as the penis was withdrawn from the exhauster. In 1917 Otto Lederer introduced the first vacuum suction device.  After many years of quiescence, the VED was popularized by Geddins Osbon and named “the Erecaid device.” Currently, the VED is a popular mechanical means of inducing an erection that does not utilize medications or surgery.

Nuts and Bolts of VED Use

The VED is prepared by placing a constriction ring over the open end of the cylinder. A water-soluble lubricant is applied to the base of the penis to achieve a tight seal when the penis is placed into the cylinder.  Either a manual or automatic pump is used to generate negative pressures within the cylinder, which pulls blood into the penis, causing fullness and ultimately rigidity. Once full rigidity is achieved, the constriction ring is pushed off the cylinder onto the base of the penis. Importantly, the ring should never be left on for more than 30 minutes to minimize the likelihood of problems. After the sexual act is completed, the constriction ring must be removed.

Interesting Factoid: The VED can be used alone or in combination with other forms of treatment for ED, including pills (Viagra, Levitra and Cialis), penile injection therapy and penile prostheses.

Pluses and Minuses of the VED

A distinct advantage of the VED is that it is a simple mechanical treatment that does not require drugs or surgery.  Disadvantages are the need for preparation time, which impairs spontaneity.  Another disadvantage is the necessity for wearing the constriction device, which can be uncomfortable and can cause “hinging” at the site of application of the constriction ring resulting in a floppy penis (because of lack of rigidity of the deep roots of the penis) as well as impairing ejaculation. Other potential issues are temporary discomfort or pain, coolness, numbness, altered sensation, engorgement of the penile head, and black and blue areas.

VED After Radical Prostatectomy

Erectile function can be adversely affected by radical prostatectomy with recovery taking months to years. The VED can be used to enhance the speed and extent of sexual recovery after surgery, minimize the decrease in penile length and girth that can occur, and enable achievement of a rigid erection suitable for sexual intercourse.  Clinical studies have clearly demonstrated that VED use after prostatectomy helps maintain existing penile length and prevents loss of length.

Bottom Line:  The VED is one of the oldest treatments for ED that remains in contemporary use.  It works by creating negative pressures that cause an influx of blood into the penile erectile chambers resulting in penile expansion and erection.  Although effective even in difficult to treat populations, the attrition rate is high, perhaps because of the cumbersome nature of the device and the preparation regimen and time involved. However, the VED is an important part of the “erection recovery program” (penile rehabilitation) after prostatectomy, second only to oral ED pills in use for this purpose. It is particularly vital in the preservation and restoration of penile anatomy and size.  It also is useful in ED related to other radical pelvic surgical procedures including colectomy for colon cancer. It remains a viable alternative in men not interested or responsive to ED pills or penile injections and those not interested in surgery.

There are many different VED systems on the market. The Urology Health Store (www.UrologyHealthStore.com) has a nice selection of VEDs (use promo code UROLOGY 10 for 10% discount and free shipping).

** The Urology Health Store  is offering live video VED instructional classes via Skype, Go-To-Meeting or FaceTime.  These classes are available by appointment from 1PM-3PM, U.S. Eastern Time, Monday-Friday.  Call 301-378-8433 for appointment.  No purchase is necessary to take the class.

Excellent resource: External Mechanical Devices and Vascular Surgery for Erectile Dysfunction.  L Trost, R Munarriz, R Wang, A Morey and L Levine: J Sex Med 2016; 13:1579-1617

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

Is There A Better Way To Manage Erectile Dysfunction Than “Doping”?

October 3, 2015

Andrew Siegel, MD    10/3/15

IMG_1457(1)

(My patient Ben Blank, a talented artist and cartoonist, gave me the cartoon shown above in 1998 when Viagra first became available.  It is hanging in one of my exam rooms)

Erectile dysfunction is usually caused by a combination of many factors, including lifestyle, medical issues, medications, impaired blood flow, nerve damage, pelvic muscle weakness, stress and psychological conditions.

Managing any medical problem should employ a sensible strategy trying the simplest, safest, and least expensive alternatives first. If unsuccessful, more aggressive, complicated and invasive options can be entertained.

For example, when a patient presents with arthritis, he or she is not offered a total knee replacement from the get-go (at least I hope not!). In accordance with the aforementioned strategy, managing knee arthritis should start with rest and anti-inflammatory medications and proceed, if necessary, down the pathway of exercise/physical therapy, arthroscopy, endoscopic knee surgery, and ultimately if all else fails, under the proper circumstances, to prosthetic joint replacement.

A Sensible and Practical Approach To Erectile Dysfunction

A similar approach should be applied to managing erectile dysfunction. Unfortunately, however, many patients and physicians alike seek the “quick fix” and ignore many treatments that can help prevent or reverse the condition.

I like to adhere to the following principles to manage sexual dysfunction:

  1. Provide education (verbal and in writing) so informed decisions can be made.
  2. Try simple and conservative solutions before complex and aggressive ones.
  3. If it isn’t broken, don’t fix it: “First do no harm.”
  4. Healthy lifestyle is crucial: “Genes load the gun, but lifestyle pulls the trigger.” Lifestyle improvement measures are of paramount importance.

“Doping” is common among athletes, who use illicit drugs to enhance their athletic performance. In my urology practice, many of my patients “dope”—with legal drugs—in an effort to improve their sexual performance. Is there not a better and more natural way than starting with performance-enhancing drugs from the get-go?

Don’t get me wrong, the oral meds for ED (Viagra, Levitra, Cialis and Stendra) are “revolutionary” additions to the limited resources we once had to treat ED. Although far from perfect—expensive, contraindicated with certain cardiac conditions and for those on nitrate medications, associated with some annoying side effects, and not effective in everyone—nonetheless, for many men they are highly effective in creating a “penetrable” erection.

These drugs are commonly used as the first-line approach to ED. As useful as they are, I contend that “doping” should not be first-line treatment, but should be reserved for situations in which the simple and natural first-line interventions fail to work.

Since erections are nerve/blood vessel/erectile smooth muscle/pelvic skeletal muscle events, optimizing erection capability involves doing what you can to have healthy nerves, blood vessels and muscles. How does one keep their tissues and organs healthy? The first-line approach is commonsense—getting in the best physical (and emotional) shape possible. This might mean a lifestyle makeover to get down to “fighting” weight, adopting a heart-healthy (and penis-healthy diet), exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc.—measures that will improve all aspects of health in general and blood vessel health in particular.

Focused pelvic floor muscle exercises improve the strength and endurance of the male “rigidity” muscles that surround the deep roots of the penis.

Since intact and functioning nerves are fundamental to the erectile process, activation of the nerves via penile vibratory stimulation can be an effective means of resurrecting erectile function.

The vacuum suction device—a.k.a., the penis pump—is a means of drawing blood into the penis to obtain an erection and enable penetration.

Second-line treatments are the well-established oral medications for ED. Although Viagra, Levitra, Cialis and Stendra all have the same mechanism of action, there are nuanced differences in potency, time to onset, duration of action, side effects, etc., so it may take some trial and error to find out which works best for you. Cialis uniquely is approved for both ED and prostate issues, so can be an excellent choice if you have both sexual and urinary issues.

Third-line alternatives include urethral suppositories and penile injection therapy. Suppositories are absorbable pellets that are placed in the urethra that act to increase penile blood flow. Injections do the same, but are injected directly into the penile erectile chambers.

Fourth-line treatment is the prosthetic penile implant. One variety is a semi-rigid non-inflatable device and another is a hydraulic inflatable device. They are implanted surgically within the erectile chambers and can be deployed on demand to enable sexual intercourse. For the right man, under the right circumstances, the penile implant is a life changer—as magical as a total knee replacement can be—converting a penile “cripple” into a functional male. However, it is vital to understand that the implant is a fourth-line approach, and less invasive options should be exhausted before its consideration.

Bottom Line: Sadly, our medical culture and patient population often prefer the quick fix of medications or surgery rather than the slow fix of lifestyle measures. A sensible approach to most medical issues—including ED—should be the following:

  • Get educated about all treatment options.
  • Explore the simplest, safest, and least expensive alternatives first.
  • Before considering medications to improve performance, think about committing to a healthy lifestyle and getting into optimal physical shape, including exercising the rigidity muscles of the penis and using vibratory nerve stimulation.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Vibrators and Kegels: Not Just For The Ladies

August 1, 2015

Andrew Siegel MD   8/1/2015

IMG_1382

At least 30 million men in the USA suffer with erectile dysfunction (ED) and with longevity on the rise, more and more men will have sexual issues. Traditional ED treatments focus on increasing blood flow to the penis, which is essential to erectile function.  However, other vital contributing factors include the roles of the nervous system and the pelvic floor muscles, which can now be tapped into to our advantage, thanks to emerging technologies.

Traditional Management of Erectile Dysfunction

Most conventional forms of management of ED focus on enhancing penile blood flow. This can be achieved via a variety of pharmaceuticals– oral ED medications (Viagra, Levitra, Cialis, Stendra), penile urethral suppositories (M.U.S.E.–alprostadil) and penile injection therapy (Caverject, Edex, Bimix, Trimix, etc.). The vacuum suction device is a mechanical means of filling the penis with blood, using a manual or battery-powered vacuum. Negative pressure engorges the penis with blood and a constriction ring placed around the base of the penis maintains the erection by trapping the blood.

Despite the emphasis on manipulating blood flow to the penis to manage ED, it is important to understand that erections are much more than simply a vascular (blood flow) event. Obtaining and maintaining an erection is a nerve-blood vessel-muscle event, dependent upon functioning nerves that provide sensation and muscle contraction, proper spinal cord and brain function; intact artery and vein blood supply to the penis; and well-functioning erectile smooth muscle within the penis and erectile skeletal muscles surrounding the roots of the penis. In addition to nerves, blood vessels and muscles essential to the process, additional influencing factors are hormones and the psycho-emotional state of the individual. All elements are integrated and provide the functional basis for an erection.

 Deconstructing the Erection Process

Obtaining and maintaining a rigid erection results from a complex interplay of the following elements within the human body:

Nerves: When the penis is stimulated by touch, sensory nerves (dorsal nerve and perineal nerve, which join up to form the pudendal nerve) relay this information to spinal cord centers, which reflexively (via the cavernous nerves) relay to the penile arteries the message to increase blood flow, resulting in the penis engorging with blood. Tactile stimulation of the penis is also conveyed directly to the brain, enhancing this reflex response. Brain-induced erotic stimulation (visual cues, sounds, smells, touch, thoughts, memories, etc.) leads to further stimulation of the penis via cavernous nerve stimulation from excitatory pathways that descend from the brain. The bulbo-cavernosus reflex is important in terms of initiating and maintaining an erection (governed by sensory and motor branches of the pudendal nerve): with stimulation of the head of the penis, there is a reflex contraction of the pelvic floor muscles that causes more blood to be pushed into the penis.

Blood vessels: The cavernous nerve stimulation causes the arteries to the penis and those within the vascular sinuses (erectile tissue) of the penis to substantially increase blood flow.

Smooth muscle: The erectile smooth muscle within the sinuses relaxes to allow filling of the sinuses with blood. Veins that drain the sinuses are occluded, trapping blood within the sinuses. This smooth muscle relaxation results in penile blood pressure becoming equal with systolic blood pressure and an engorged penis, plump but not rigid.

Skeletal muscle: There is no bone in the human penis as there is in many mammals, so nature has evolved a brilliant trick to generate erectile rigidity—the use of readily available blood as a pressure medium under sky-high pressures. To achieve maximal penile rigidity, penile blood pressure must exceed systolic pressure by 100 mm of mercury. This means a penile blood pressure in excess of 220 mm must be achieved for the average man. The penis is the only place in the body where high blood pressure is desirable and necessary for proper function! A hypertensive penis is an erect penis and a happy penis! This explains why blood pressure pills are the most common medications associated with ED.

How exactly does one achieve a hypertensive penis? This is where the “rigidity” muscles come into play, the ischiocavernosus and bulbocavernosus pelvic floor muscles muscles that surround the deep roots of the penis. In response to penile stimulation via the bulbocavernosus reflex, these muscles contract rhythmically, clamping venous outflow and squeezing the deep roots of the penis, pushing more blood into the erect penis, resulting in penile high blood pressure and full-fledged rigidity. Without the rigidity muscles, the penis would be engorged, but not rigid.

Hormones: Testosterone is “male rocket fuel.” A normal level of testosterone is important in terms of both sex drive and the facilitation of erections, although it is possible to obtain erections even in the face of low testosterone levels.

Psycho-emotional factors: Psychological and emotional status has a significant effect on erectile function. Mood, stress levels, interpersonal and relationship issues, etc.—acting via the mind-body connection and the release of a “cocktail” of neurochemicals—can influence erectile function for better or worse. Stress, for example, induces the adrenal glands to release a surge of adrenaline. Adrenaline constricts blood vessels, which has a negative effect on erections, the basis for the common occurrence of adrenaline-fueled performance anxiety.

The Down Side of Traditional Erectile Dysfunction Treatments

Medications undoubtedly can be very helpful for ED. However, they are expensive and are getting increasingly so, have side effects and there are a number of clinical situations in which they cannot be used. Other issues are lack of spontaneity and the need for chronic use. Pills are easy to swallow, but many men find the thought of inserting a suppository in their urethras or putting a sharp needle in their penis less than satisfactory.

Vacuum suction devices do not permit rigidity of the roots of the penis and therefore cause a pivoting and unstable erection. The skin of the penis can become cool and dusky because of the constriction ring, which can be uncomfortable and impede ejaculation. As of July 1, 2015, the vacuum device and accompanying tension ring were statutorily excluded from Medicare coverage and thus not payable when billed to Medicare.  Since the vacuum suction device is no longer covered by Medicare it has become a costly alternative.

These treatments that deal only with the blood flow component of erections neglect the important contributions of nerve stimulation and the “rigidity” muscles.

 New Treatment Options Beyond Drugs & Pumps

An alternative strategy is to focus on nerve stimulation and the rigidity muscles.

Vibratory genital stimulation has been used successfully for many years to enhance sexual response and induce climax in females, so why should it be any different for the male gender? Vibrators applied to the penis have traditionally been used for spinal cord injured patients who wish to father children, but cannot ejaculate. The use of vibratory genital stimulation has recently been expanded to ED, impaired rigidity, sexual dysfunction after radical prostatectomy and orgasmic/ejaculation issues.

Viberect, made by Reflexonic, is an FDA-certified hand-held penile vibratory stimulation device useful for triggering erection and ejaculation. It provides simultaneous stimulation of the genital nerves at both the dorsal (top) and ventral (bottom) surfaces of the penis. Penile vibratory stimulation stimulates the reflex between the penis and the spinal cord (pudendal-cavernosal reflex), resulting in tumescence (gradual filling of the penis with arterial blood). Penile vibratory stimulation of the head of the penis also contributes to erectile rigidity via inducing rhythmic contractions of the ischiocavernosus and bulbocavernosus via the bulbocavernosus reflex. By enhancing the bulbocavernosus reflex and triggering neural activity in the brain, spinal cord and peripheral nerves, vibratory stimulation provokes erection and ultimately, ejaculation.

Pelvic floor muscle training—which has also been used successfully in females for years—is capable of optimizing function of the male “rigidity” pelvic floor muscles. The Private Gym program, made by Adult Fitness Concepts, is the go-to means of increasing pelvic floor muscle strength, tone, power, and endurance. It is a comprehensive, interactive, easy-to-use, medically sanctioned and FDA-registered follow-along exercise program that builds upon the foundational work of Dr. Arnold Kegel. It is the first program of its kind designed specifically to teach men exactly how to perform the exercises. A clinical trial has demonstrated its effectiveness in fostering more rigid and durable erections, improved ejaculatory control and heightened orgasms. The Basic Training program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises, while the Complete Training program provides maximum opportunity for gains via resistance equipment.

Both the Viberect and the Private Gym are unique sexual management tools—approaches that go beyond the conventional blood flow enhancement treatments of ED—that work on different aspects of the many facets of erectile physiology. Combining use of the Viberect and the Private Gym is a partnership with great harmony and synergy that works on both the initiation of erection via Viberect’s ability to stimulate neurovascular cavernous reactivity as well as the maintenance of erection via Private Gym’s ability to enhance venous occlusion, penile blood pressure and durability of erectile rigidity. Using the Viberect – Private Gym combination does not in any way preclude using additional therapies such as the aforementioned medications. Both Viberect and Private Gym are safe, non-invasive, sustainable and cost-effective treatments with the Viberect costing $299 and the Private Gym $99.

 Preparing For and Recovering From Radical Prostatectomy

Having your prostate removed is an effective means of curing prostate cancer. Unfortunately, because of the prostate’s precarious location – – at the crossroads of the urinary and genital tracts, connected to the bladder on one end, the urethra on the other, touching upon the rectum, and nestled behind the pubic bone in a well-protected nook of the body – – it’s removal has the potential for causing unwanted and undesirable side effects.

Oftentimes, urologists are more focused on removing the prostate cancer (and saving the patient’s life) than spending time educating patients on how to minimize the negative effects of the surgery. Prior to and after radical prostatectomy, by using the combination of nerve stimulation in conjunction with strengthening the pelvic floor muscles, negative side effects can be greatly reduced.

It can take several years to recover maximal sexual function after radical prostatectomy. Post-prostatectomy ED seems to be on the basis of many factors including trauma to nerves, blood vessels, and muscular tissue that can compromise sexual function (and urinary control). The poor tissue oxygenation that results from the penis being flaccid for long periods of time can cause loss of erectile smooth muscle function, scarring and venous leakage (a condition in which there is rapid loss of an erection as blood is not properly trapped within).

Penile rehabilitation (“rehab”) is commonly used to get the blood flowing and maintain penile tissue oxygenation and elasticity, expediting erectile recovery. Treatment modalities that have been used for rehab include oral medications, urethral suppositories, penile injections and the vacuum suction device.

The partnership of Viberect neural stimulation and Private Gym pelvic muscle training is a welcome addition to the penile “rehab” regimen. Viberect stimulates the nerves that help induce an erection, while Private Gym strengthens the muscle system that powers, supports, and controls erectile rigidity. This combined treatment provides a safe, non-invasive, natural solution without side effects and does not preclude the use of traditional ED management.

Furthermore, using the Viberect and Private Gym together before and after prostate surgery can have a significant positive psychological impact on the patient. Once diagnosed with prostate cancer, men often have anywhere from four to eight weeks before surgery. This period of waiting and worrying about the upcoming surgery is often a very emotional and psychologically disruptive time. The same is true during the recovery process. Using Private Gym and Viberect enables patients to take an active role in preparing for surgery as well as facilitating recovery in the post-operative period, empowering them throughout the process.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com.  In the works is The Kegel Fix: Recharging Female Sexual, Urinary and Pelvic Health.

Private Gym: http://www.PrivateGym.com -available on Amazon as well as Private Gym website

Viberect: http://www.Reflexonic.com-available on Amazon as well as Viberect website