Once the device is assembled (Fig. 14.2), the constriction ring should be placed on the base of the pump, using lubrication to help apply the band. Some bands have a unique design to allow less tension over the urethra by creating a notch on the inferior portion of the ring. If this is the type of ring being used, one should make sure it is lined up appropriately when placed on the vacuum device. Plenty of water-soluble lubricant should be placed on the tip and base penis to assist in the insertion of the device and to help create a good seal against the body. Lubricant should also be placed inside the base of the device to further assist in creating a good seal. The lubricated penis should be placed in the device. This may be easier to perform while standing. The cylinder should be secured against the body to make sure an airtight seal is obtained, but be cautious that the scrotum is not caught within the device. Once the device is in place, the patient should pump up slowly to create the vacuum. Pumping too fast may cause discomfort within the penis , if this happens air should be released (via the pop-off valve) and then continue pumping again. It may take several cycles of pumping and releasing to reach a fully rigid erection.

Once a full erection is achieved, the erection is maintained by placing the constriction ring around the base of the penis . It is important to keep the cylinder snug against the body to maintain the airtight seal until ready to place the ring into position (Fig. 14.3). Some men find it easier to tilt the cylinder while placing the ring on that side of the penis . If there is difficulty removing the cylinder to place the ring, the vacuum can be released on the device to facilitate removal. The constriction ring around the base of the penis should be removed after sexual activity and remain n place no longer than 30 min at a time. Ensuring placement on the constriction band at the very base of the penis will circumvent the “fulcrum effect” that may occur. The penis will be rigid beyond the constriction band but entirely flaccid behind, and to maximize penile stability, the band should be placed as far proximal as possible .

To remove the constriction ring , reapply lubricant to the shaft of the penis , and then pull the loops around the ring outwards and away from the body and hold for approximately 10 s to allow detumescence to occur. Lying down might help the blood return to the body faster. Once the penis is less rigid, the ring can more easily be removed by continuing to pull the loops of the ring away from the body.