Patients should add 0.5–1 cm extenders to the device every 2–4 weeks, as tolerated. Overall compliance is poor, so patients should be advised about the importance of using the traction as much as possible. In our patient population, only 20 % of patients continue use exactly as prescribed after the first month of use. Some patients complain of skin changes, coolness, or bluish discoloration on the glans , and this is all related to the distal loop causing skin irritation or compression to the vasculature of the glans . These skin changes resolve once the device is no longer being used. For severe discomfort , the device should be removed and reapplied after a 5–15 min break.