Erectile dysfunction has treatments that do not come in a tablet. Some of them are old, simple and unglamorous, and some of them work extremely well for the specific problem they address. This guide covers what exists, what the evidence says, and how to work out which category you are in.
The short version. If you get hard but cannot stay hard, a constriction ring is the cheapest and simplest thing to try. If you struggle to get hard at all, a vacuum erection device plus a ring is the established mechanical combination. If mechanical options and medication have both failed, a penile implant is the definitive answer and has the highest satisfaction rates of any ED treatment. And whichever applies, see a doctor about the underlying cause.
First: work out what is actually failing
An erection needs three things: a signal (arousal and nerve function), inflow (arteries dilating to fill the erectile tissue), and retention (veins closing off so the blood stays). ED is a failure in one or more of those, and different failures call for different devices.
Retention failure. You get hard, then lose it, sometimes within minutes, sometimes when you change position. This is venous leak, and it is the failure a constriction ring is purpose-built for. See venous leak .
Inflow failure. You cannot get properly hard in the first place. Usually vascular, the same arterial disease that causes heart problems, in smaller vessels that show it first. A vacuum device can force the issue mechanically. Medication helps if there is enough function left to amplify.
Signal failure. Nerve damage from diabetes, spinal injury or pelvic surgery, or a psychological block. Devices still work here, because they operate downstream of the signal, which is precisely why they matter after prostatectomy.
Hormonal. Low testosterone reduces desire and contributes to ED. Devices work but do not address it. Bloods.
Most real cases are a mix. That is a reason to see a doctor, not a reason to skip devices.
ED is a cardiovascular warning sign
The arteries supplying the penis are narrower than the coronary arteries, so vascular disease often shows up as erectile dysfunction years before it shows up as chest pain. New or worsening ED is a legitimate reason to get blood pressure, cholesterol, blood sugar and cardiovascular risk assessed. This is the single most important sentence on this page.Constriction rings
What it does. Restricts venous outflow so the erectile tissue stays engorged. Holds an erection you can already achieve.
Evidence. Well established. Constriction rings appear as conservative options in the ED literature from the AUA, EAU, SMSNA and ISSM, most often alongside vacuum erection devices.
Best for. Retention failure. Mild to moderate ED where you can get there but cannot stay.
Not for. Getting an erection from nothing. Also not for premature ejaculation, whatever the packaging in this category tends to imply. A 2007 study of 42 men found no meaningful change in ejaculatory latency.
Cost. $25 to $50.
Risks. Numbness, bruising and discomfort from over-tight sizing or exceeding the 30-minute limit. Avoid rigid one-piece rings, which cannot be cut off.
Practicalities. Sizing decides whether it works. Measure erect girth, divide by 3.14, and use the sizing chart . Thirty minutes maximum, never while sleeping.
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Vacuum erection devices (VEDs)
What it does. A cylinder over the penis with a manual or battery pump creates negative pressure, drawing blood in mechanically. Once erect, you slide a tension ring (a constriction ring) onto the base and remove the cylinder.
Evidence. Good. Effective across a wide range of ED causes precisely because it is mechanical rather than physiological. Also used in penile rehabilitation protocols after radical prostatectomy, where maintaining tissue oxygenation during nerve recovery is the goal.
Best for. Inflow failure. ED that has not responded to medication. Men who cannot take PDE5 inhibitors, including anyone on nitrates, which is an absolute contraindication.
Cost. $40 to $500. Prescription models exist and are sometimes insurance-covered.
Risks. Petechiae (small bruise-like spots), a cooler erection, a slight hinge at the base because the erection begins at the ring rather than inside the body, and trapped or reduced ejaculation. Do not exceed the pressure the device specifies, and never improvise one.
Practicalities. There is a learning curve, and it is not spontaneous. This is a device you use deliberately. Mammoth Force does not currently sell a vacuum erection device. The penis pump guide covers what to look for.
Rings and pumps together
This is the standard pairing and the reason tension rings ship with vacuum devices. The pump solves inflow; the ring solves retention. Either alone addresses half the problem, and for many men with moderate to severe ED, half is not enough.
Practically: pump to full erection in the cylinder, slide the tension ring down onto the base, release the vacuum, remove the cylinder. The ring is now doing the work. Thirty-minute limit from that point. See penis pump with ring .
Penile implants
What it does. A surgically placed prosthesis, either inflatable (a pump in the scrotum, a reservoir, cylinders in the corpora) or malleable (bendable rods).
Evidence. Strong, and satisfaction rates are the highest of any ED treatment, routinely reported above 90 percent for both patients and partners.
Best for. ED that has not responded to medication, injections or devices. Severe vascular disease. Post-surgical ED where nerve recovery has not happened.
Cost. Surgical. Frequently covered by insurance for documented refractory ED.
Risks. Surgery, infection risk, and mechanical failure over time. The one that matters most is that implantation destroys the erectile tissue, so it is not reversible. This is the last option in the sequence for a reason.
Other approaches worth knowing
Intracavernosal injection. Alprostadil injected directly into the corpus cavernosum. Highly effective, works independent of nerve signalling, and requires getting past the obvious objection. Prescription only.
Intraurethral suppository (MUSE). Alprostadil pellet inserted into the urethra. Less effective than injection, less invasive.
Low-intensity shockwave therapy. Acoustic waves aimed at improving vascular function. Genuinely promising for vasculogenic ED and still classed as investigational, because evidence quality varies and protocols are not standardised. Be sceptical of any clinic presenting it as established.
Pelvic floor training. Free, evidence-supported, and undersold. Pelvic floor muscle training has trial support for improving erectile function, particularly where venous leak is involved, since those are the same muscles that assist retention. See kegel exercises for men .
Lifestyle. Not a device, and it outperforms most of them over time. Cardiovascular exercise, weight loss, smoking cessation, alcohol reduction, sleep, and control of blood pressure and blood sugar all improve erectile function because erectile tissue is vascular tissue.
Choosing, in order
- See a doctor about the cause. Bloods, blood pressure, cardiovascular risk.
- Fix what is fixable. Medication side effects, untreated diabetes, sleep apnoea, low testosterone, alcohol.
- Try a constriction ring if you can get hard but not stay hard. Cheapest, simplest, lowest risk.
- Add or switch to a vacuum device if getting hard is the problem or the ring alone is not enough.
- Discuss medication with your doctor if you have not. PDE5 inhibitors and devices work fine together.
- Consider injections if oral medication is insufficient.
- Consider an implant if nothing else has worked.
Working in that order means you spend the least money and take the least risk before you find the thing that works.
After prostate surgery
A specific and common case. Radical prostatectomy disrupts the nerves controlling erection, and recovery, where it happens, takes months to years. Penile rehabilitation protocols aim to maintain tissue health during that window, and vacuum devices and constriction rings both appear in them.
The timing and the specifics depend on your surgery and your surgeon. This is the case where you clear a device with your urologist before using it, not after. See cock rings after prostatectomy .
What to read next
Start here
Understanding the problem
Other options
Frequently asked questions
What is the best device for erectile dysfunction?
Do ED devices work without pills?
Are ED devices covered by insurance?
Is a ring or a pump better?
Can I use a device instead of seeing a doctor?
Do ED devices have side effects?
Sources
- Sexual Medicine Society of North America — Vacuum erection devices and constriction rings in ED management. SMSNA. https://www.smsna.org/patients/conditions/erectile-dysfunction
- Erectile Dysfunction: AUA Guideline (amended). American Urological Association. https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
- EAU Guidelines on Sexual and Reproductive Health. European Association of Urology. https://uroweb.org/guidelines/sexual-and-reproductive-health
- Erectile Dysfunction — definition, causes and treatment. NIDDK, National Institutes of Health. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction
- International Society for Sexual Medicine — What is a constriction ring and how does it work?. ISSM. https://www.issm.info/sexual-health-qa
- Vacuum erection device use in penile rehabilitation after radical prostatectomy. PubMed. https://pubmed.ncbi.nlm.nih.gov/
- Massachusetts Male Aging Study — prevalence of erectile dysfunction by decade. PubMed. https://pubmed.ncbi.nlm.nih.gov/
- External penile rigidity devices — Class II special controls guidance. U.S. Food and Drug Administration. https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/external-penile-rigidity-devices-class-ii-special-controls-guidance-document-industry-and-fda-staff
- Medicare payment for vacuum erection systems was eliminated effective July 1, 2015 by Section 203 of the ABLE Act of 2014 (Division B of Public Law 113-295), which treats them as it treats erectile dysfunction drugs. HCPCS L7900 and L7902 are denied as non-covered. Private plan coverage varies.. Centers for Medicare & Medicaid Services. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52712
About this product category. The FDA classifies external penile rigidity devices as Class II devices subject to special controls. Mammoth Force constriction rings are sold as consumer products. They are intended to help maintain an erection you can already achieve, and they are not offered as a treatment, cure or prevention for erectile dysfunction or any other medical condition.