Vacuum erection device and penile size: effects and mechanisms_West China Medical Journal

Authors：

WU Changjing ¹ , FU Fudong ² ,  YUAN Jiuhong ¹

1. Andrology Laboratory, Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Institutes for Systems Genetics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

YUAN Jiuhong, Email: jiuhongyuan2107@163.com

Keywords：

Small penis syndrome; vacuum erection device; prostate cancer; bilateral cavernous nerve crush; penile atrophy

DOI：

10.7507/1002-0179.202503203

Video：

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Abstract Full text Figures/Tables Video References Cited by

Small penis syndrome is a disease caused by congenital or acquired factors. In clinical practice, a considerable number of men are dissatisfied with their penis size, leading to a persistent need to increase penis size. However, existing therapies (including psychological interventions, medication, and surgical procedures) have limited efficacy and often come with significant side effects. The vacuum erection device, as a non-invasive treatment method, has a positive effect on preventing penile shortening after radical prostatectomy for prostate cancer and penile elongation in rats during puberty and adulthood. The purpose of this article is to systematically explain the impact of vacuum erection device on penis size, in order to provide references for clinical practice.

Citation： WU Changjing, FU Fudong, YUAN Jiuhong. Vacuum erection device and penile size: effects and mechanisms. West China Medical Journal, 2026, 41(3): 510-514. doi: 10.7507/1002-0179.202503203 Copy

1.	中國性學會私密整形與產業分會《陰莖增粗術專家共識》編寫組, 袁明振, 姜輝, 等. 陰莖增粗術專家共識. 中國男科學雜志, 2024, 38(4): 3-9.
2.	鄭仲杰, 程建星, 姜輝, 等. 陰莖增粗延長手術的研究進展. 中國性科學, 2023, 32(1): 1-5.
3.	Zhang CL, Quan Y, Li H, et al. Penile augmentation with injectable hyaluronic acid gel: an alternative choice for small penis syndrome. Asian J Androl, 2022, 24(6): 601-606.
4.	劉毅東, 王林. 陰莖“增長”治療方式及進展(“大家泌尿網”觀看手術視頻). 現代泌尿外科雜志, 2024, 29(11): 937-940, 950.
5.	Khadilkar V, Mondkar SA. Micropenis. Indian J Pediatr, 2023, 90(6): 598-604.
6.	Rohayem J, Alexander EC, Heger S, et al. Mini-puberty, physiological and disordered: consequences, and potential for therapeutic replacement. Endocr Rev, 2024, 45(4): 460-492.
7.	Lehrfeld T, Lee DI. The role of vacuum erection devices in penile rehabilitation after radical prostatectomy. Int J Impot Res, 2009, 21(3): 158-164.
8.	Yuan J, Hoang AN, Romero CA, et al. Vacuum therapy in erectile dysfunction--science and clinical evidence. Int J Impot Res, 2010, 22(4): 211-219.
9.	Bodansky HJ. Treatment of male erectile dysfunction using the active vacuum assist device. Diabet Med, 1994, 11(4): 410-412.
10.	Nadig PW, Ware JC, Blumoff R. Noninvasive device to produce and maintain an erection-like state. Urology, 1986, 27(2): 126-131.
11.	Witherington R. Vacuum constriction device for management of erectile impotence. J Urol, 1989, 141: 320-322.
12.	Domes T, Najafabadi BT, Roberts M, et al. Canadian Urological Association guideline: erectile dysfunction. Can Urol Assoc J, 2021, 15(10): 310-322.
13.	Bosshardt RJ, Farwerk R, Sikora R, et al. Objective measurement of the effectiveness, therapeutic success and dynamic mechanisms of the vacuum device. Br J Urol, 1995, 75(6): 786-791.
14.	Lin HC, Yang WL, Zhang JL, et al. Penile rehabilitation with a vacuum erectile device in an animal model is related to an antihypoxic mechanism: blood gas evidence. Asian J Androl, 2013, 15(3): 387-390.
15.	Yuan J, Lin H, Li P, et al. Molecular mechanisms of vacuum therapy in penile rehabilitation: a novel animal study. Eur Urol, 2010, 58(5): 773-780.
16.	Qian SQ, Gao L, Wei Q, et al. Vacuum therapy in penile rehabilitation after radical prostatectomy: review of hemodynamic and antihypoxic evidence. Asian J Androl, 2016, 18(3): 446-451.
17.	李浩, 黃展森, 張宇(綜述), 等. 真空負壓吸引治療勃起功能障礙的研究進展. 中國男科學雜志, 2016, 30(7): 68-72.
18.	Qian SQ, Qin F, Zhang S, et al. Vacuum therapy prevents corporeal veno-occlusive dysfunction and penile shrinkage in a cavernosal nerve injured rat model. Asian J Androl, 2020, 22(3): 274-279.
19.	Wu CJ, Fu FD, Qin F, et al. Vacuum therapy ameliorates erectile dysfunction in bilateral cavernous nerve crush rats by inhibiting apoptosis and activating autophagy. Asian J Androl, 2021, 23(3): 273-280.
20.	Wu C, Xiong Y, Fu F, et al. The role of autophagy in erectile dysfunction. World J Mens Health, 2025, 43(1): 28-40.
21.	Schifano N, Cakir OO, Castiglione F, et al. Multidisciplinary approach and management of patients who seek medical advice for penile size concerns: a narrative review. Int J Impot Res, 2022, 34(5): 434-451.
22.	Aghamir MK, Hosseini R, Alizadeh F. A vacuum device for penile elongation: fact or fiction?. BJU Int, 2006, 97(4): 777-778.
23.	Kayes O, Shabbir M, Ralph D, et al. Therapeutic strategies for patients with micropenis or penile dysmorphic disorder. Nat Rev Urol, 2012, 9(9): 499-507.
24.	Albaugh J, Adamic B, Chang C, et al. Adherence and barriers to penile rehabilitation over 2 years following radical prostatectomy. BMC Urol, 2019, 19(1): 89.
25.	Ma M, Wu CJ, Zhang P, et al. N-acetylcysteine maintains penile length and erectile function in bilateral cavernous nerve crush rat model by reducing penile fibrosis. Asian J Androl, 2021, 23(2): 215-221.
26.	Kwon YS, Farber N, Yu JW, et al. Longitudinal recovery patterns of penile length and the underexplored benefit of long-term phosphodiesterase-5 inhibitor use after radical prostatectomy. BMC Urol, 2018, 18(1): 37.
27.	王博毅, 姜睿. 難治性勃起功能障礙的研究進展. 中華男科學雜志, 2013, 19(1): 82-85.
28.	吳昌靜, 付福棟, 袁久洪. N-乙酰半胱氨酸在難治性勃起功能障礙中的應用. 實用藥物與臨床, 2024, 27(11): 865-869.
29.	Zhang M, Che JZ, Liu YD, et al. A prospective randomized controlled study on scheduled PDE5i and vacuum erectile devices in the treatment of erectile dysfunction after nerve sparing prostatectomy. Asian J Androl, 2022, 24(5): 473-477.
30.	Qin F, Wang S, Li J, et al. The early use of vacuum therapy for penile rehabilitation after radical prostatectomy: systematic review and meta-analysis. Am J Mens Health, 2018, 12(6): 2136-2143.
31.	Zhang DL, Chen Z, Wang FX, et al. Adding a vacuum erection device to regular use of Tadalafil improves penile rehabilitation after posterior urethroplasty. Asian J Androl, 2019, 21(6): 582-586.
32.	吳金華, 王璐霞, 郭樹林, 等. 負壓助勃裝置聯合 PDE5i 藥物治療勃起功能障礙的臨床效果分析. 當代醫學, 2020, 26(22): 13-15.
33.	Tsambarlis PN, Chaus F, Levine LA. Successful placement of penile prostheses in men with severe corporal fibrosis following vacuum therapy protocol. J Sex Med, 2017, 14(1): 44-46.
34.	Shah BB, Kent M, Valenzuela R. Advanced penile length restoration techniques to optimize penile prosthesis placement outcomes. Sex Med Rev, 2021, 9(4): 641-649.
35.	Sultana A, Grice P, Vukina J, et al. Indications and characteristics of penile traction and vacuum erection devices. Nat Rev Urol, 2022, 19(2): 84-100.
36.	Yuan J, Westney OL, Wang R. Design and application of a new rat-specific vacuum erectile device for penile rehabilitation research. J Sex Med, 2009, 6(12): 3247-3253.
37.	Yang XL, Yang Y, Fu FD, et al. Optimal pressure in penile rehabilitation with a vacuum erection device: evidence based on a rat model. Asian J Androl, 2019, 21(5): 516-521.
38.	Ma M, Qin F, Wu C, et al. Optimal vacuum erectile device therapy regimen for penile rehabilitation in a bilateral cavernous nerve crush rat model. Andrology, 2021, 9(3): 894-905.
39.	Li T, Fu F, Wu C, et al. Characteristics of penile growth in pubertal rats and a non-invasive method to lengthen the penis. Andrology, 2020, 8(6): 1884-1894.
40.	Li T, Tian Y, Zhong Q, et al. HCG supplement did not accelerate tunica albuginea remodeling to facilitate penile growth. Sci Rep, 2023, 13(1): 16519.
41.	Li T, Fu FD, Wu CJ, et al. Anti-lysyl oxidase combined with a vacuum device induces penile lengthening by remodeling the tunica albuginea. Asian J Androl, 2020, 22(5): 485-492.
42.	張卿, 葉璐娟, 王艷華. 負壓助勃結合正念減壓法治療勃起功能障礙患者的療效研究. 現代診斷與治療, 2023, 34(4): 559-561.

1. 中國性學會私密整形與產業分會《陰莖增粗術專家共識》編寫組, 袁明振, 姜輝, 等. 陰莖增粗術專家共識. 中國男科學雜志, 2024, 38(4): 3-9.
2. 鄭仲杰, 程建星, 姜輝, 等. 陰莖增粗延長手術的研究進展. 中國性科學, 2023, 32(1): 1-5.
3. Zhang CL, Quan Y, Li H, et al. Penile augmentation with injectable hyaluronic acid gel: an alternative choice for small penis syndrome. Asian J Androl, 2022, 24(6): 601-606.
4. 劉毅東, 王林. 陰莖“增長”治療方式及進展(“大家泌尿網”觀看手術視頻). 現代泌尿外科雜志, 2024, 29(11): 937-940, 950.
5. Khadilkar V, Mondkar SA. Micropenis. Indian J Pediatr, 2023, 90(6): 598-604.
6. Rohayem J, Alexander EC, Heger S, et al. Mini-puberty, physiological and disordered: consequences, and potential for therapeutic replacement. Endocr Rev, 2024, 45(4): 460-492.
7. Lehrfeld T, Lee DI. The role of vacuum erection devices in penile rehabilitation after radical prostatectomy. Int J Impot Res, 2009, 21(3): 158-164.
8. Yuan J, Hoang AN, Romero CA, et al. Vacuum therapy in erectile dysfunction--science and clinical evidence. Int J Impot Res, 2010, 22(4): 211-219.
9. Bodansky HJ. Treatment of male erectile dysfunction using the active vacuum assist device. Diabet Med, 1994, 11(4): 410-412.
10. Nadig PW, Ware JC, Blumoff R. Noninvasive device to produce and maintain an erection-like state. Urology, 1986, 27(2): 126-131.
11. Witherington R. Vacuum constriction device for management of erectile impotence. J Urol, 1989, 141: 320-322.
12. Domes T, Najafabadi BT, Roberts M, et al. Canadian Urological Association guideline: erectile dysfunction. Can Urol Assoc J, 2021, 15(10): 310-322.
13. Bosshardt RJ, Farwerk R, Sikora R, et al. Objective measurement of the effectiveness, therapeutic success and dynamic mechanisms of the vacuum device. Br J Urol, 1995, 75(6): 786-791.
14. Lin HC, Yang WL, Zhang JL, et al. Penile rehabilitation with a vacuum erectile device in an animal model is related to an antihypoxic mechanism: blood gas evidence. Asian J Androl, 2013, 15(3): 387-390.
15. Yuan J, Lin H, Li P, et al. Molecular mechanisms of vacuum therapy in penile rehabilitation: a novel animal study. Eur Urol, 2010, 58(5): 773-780.
16. Qian SQ, Gao L, Wei Q, et al. Vacuum therapy in penile rehabilitation after radical prostatectomy: review of hemodynamic and antihypoxic evidence. Asian J Androl, 2016, 18(3): 446-451.
17. 李浩, 黃展森, 張宇(綜述), 等. 真空負壓吸引治療勃起功能障礙的研究進展. 中國男科學雜志, 2016, 30(7): 68-72.
18. Qian SQ, Qin F, Zhang S, et al. Vacuum therapy prevents corporeal veno-occlusive dysfunction and penile shrinkage in a cavernosal nerve injured rat model. Asian J Androl, 2020, 22(3): 274-279.
19. Wu CJ, Fu FD, Qin F, et al. Vacuum therapy ameliorates erectile dysfunction in bilateral cavernous nerve crush rats by inhibiting apoptosis and activating autophagy. Asian J Androl, 2021, 23(3): 273-280.
20. Wu C, Xiong Y, Fu F, et al. The role of autophagy in erectile dysfunction. World J Mens Health, 2025, 43(1): 28-40.
21. Schifano N, Cakir OO, Castiglione F, et al. Multidisciplinary approach and management of patients who seek medical advice for penile size concerns: a narrative review. Int J Impot Res, 2022, 34(5): 434-451.
22. Aghamir MK, Hosseini R, Alizadeh F. A vacuum device for penile elongation: fact or fiction?. BJU Int, 2006, 97(4): 777-778.
23. Kayes O, Shabbir M, Ralph D, et al. Therapeutic strategies for patients with micropenis or penile dysmorphic disorder. Nat Rev Urol, 2012, 9(9): 499-507.
24. Albaugh J, Adamic B, Chang C, et al. Adherence and barriers to penile rehabilitation over 2 years following radical prostatectomy. BMC Urol, 2019, 19(1): 89.
25. Ma M, Wu CJ, Zhang P, et al. N-acetylcysteine maintains penile length and erectile function in bilateral cavernous nerve crush rat model by reducing penile fibrosis. Asian J Androl, 2021, 23(2): 215-221.
26. Kwon YS, Farber N, Yu JW, et al. Longitudinal recovery patterns of penile length and the underexplored benefit of long-term phosphodiesterase-5 inhibitor use after radical prostatectomy. BMC Urol, 2018, 18(1): 37.
27. 王博毅, 姜睿. 難治性勃起功能障礙的研究進展. 中華男科學雜志, 2013, 19(1): 82-85.
28. 吳昌靜, 付福棟, 袁久洪. N-乙酰半胱氨酸在難治性勃起功能障礙中的應用. 實用藥物與臨床, 2024, 27(11): 865-869.
29. Zhang M, Che JZ, Liu YD, et al. A prospective randomized controlled study on scheduled PDE5i and vacuum erectile devices in the treatment of erectile dysfunction after nerve sparing prostatectomy. Asian J Androl, 2022, 24(5): 473-477.
30. Qin F, Wang S, Li J, et al. The early use of vacuum therapy for penile rehabilitation after radical prostatectomy: systematic review and meta-analysis. Am J Mens Health, 2018, 12(6): 2136-2143.
31. Zhang DL, Chen Z, Wang FX, et al. Adding a vacuum erection device to regular use of Tadalafil improves penile rehabilitation after posterior urethroplasty. Asian J Androl, 2019, 21(6): 582-586.
32. 吳金華, 王璐霞, 郭樹林, 等. 負壓助勃裝置聯合 PDE5i 藥物治療勃起功能障礙的臨床效果分析. 當代醫學, 2020, 26(22): 13-15.
33. Tsambarlis PN, Chaus F, Levine LA. Successful placement of penile prostheses in men with severe corporal fibrosis following vacuum therapy protocol. J Sex Med, 2017, 14(1): 44-46.
34. Shah BB, Kent M, Valenzuela R. Advanced penile length restoration techniques to optimize penile prosthesis placement outcomes. Sex Med Rev, 2021, 9(4): 641-649.
35. Sultana A, Grice P, Vukina J, et al. Indications and characteristics of penile traction and vacuum erection devices. Nat Rev Urol, 2022, 19(2): 84-100.
36. Yuan J, Westney OL, Wang R. Design and application of a new rat-specific vacuum erectile device for penile rehabilitation research. J Sex Med, 2009, 6(12): 3247-3253.
37. Yang XL, Yang Y, Fu FD, et al. Optimal pressure in penile rehabilitation with a vacuum erection device: evidence based on a rat model. Asian J Androl, 2019, 21(5): 516-521.
38. Ma M, Qin F, Wu C, et al. Optimal vacuum erectile device therapy regimen for penile rehabilitation in a bilateral cavernous nerve crush rat model. Andrology, 2021, 9(3): 894-905.
39. Li T, Fu F, Wu C, et al. Characteristics of penile growth in pubertal rats and a non-invasive method to lengthen the penis. Andrology, 2020, 8(6): 1884-1894.
40. Li T, Tian Y, Zhong Q, et al. HCG supplement did not accelerate tunica albuginea remodeling to facilitate penile growth. Sci Rep, 2023, 13(1): 16519.
41. Li T, Fu FD, Wu CJ, et al. Anti-lysyl oxidase combined with a vacuum device induces penile lengthening by remodeling the tunica albuginea. Asian J Androl, 2020, 22(5): 485-492.
42. 張卿, 葉璐娟, 王艷華. 負壓助勃結合正念減壓法治療勃起功能障礙患者的療效研究. 現代診斷與治療, 2023, 34(4): 559-561.

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