Vaccum device - Frequency of use ?

The pump is unlikely improve the chances of the erection nerves recovering, but it does no harm either. The area where the nerves get damaged is not in the penis, it's where they wrap around the surface of the prostate.

However, the penis needs regular erections (perfusing with blood) to maintain its health, and the pump ensures this during a period of non-working erection nerves (or loss of libido). Without this, some tissues in the penis will start to suffer from fibrosis, and this will reduce the size of the erection when nerves eventually recover.

Guideline I was given was 10 mins per day or 15 mins every other day. This is known as penile rehabilitation. You can pump up and let down 2-3 times in that period, rather than a single erection the whole time, although I'm not aware of any evidence that this is better. (This is presuming you've done the initial training period with the pump - you are unlikely be able to hold an erection anything like this long when you first start without it being too painful.)

I was on hormone therapy, but was lucky enough to still be able to get erections naturally, and never really understood why I'd been given a pump at the time. (Clinicians are not great at explaining such things.) After a year on hormone therapy, my libido had made me "can't be bothered" and on the few occasions I could be bothered, I noticed my penis was thinning and curving. Spoke with a urologist who suggested using the pump more, so I went on a bit of a blitz, and did 15 mins twice a day, and within a month, penis recovered, and I've continued doing 15 mins every 1-2 days since then. It was this which made me realise what the pump is for.

You don't use the rings for penile rehabilitation, you just keep the pump on. If you want to have sex or masturbate or whatever, then do try the rings. Make sure you know how to get a ring off before putting one on. You never try to remove one from an erect penis - you'll probably injure yourself in the panic when you realise it won't come off. You stretch the ring open and let the erection drain away, and then remove the ring from the flaccid penis. Don't keep a ring on more than 30 mins, and never fall asleep with one on.

Good that you're on daily Cialis (Tadalafil) although 2.5mg is a strange dose. 5mg is the normal daily low dose, dropping down to 2.5mg if you get unacceptable side effects. (I don't think 2.5mg tablets are any cheaper.) Some people get 20mg twice a week instead. The Cialis improves blood flow in the area, which can help nerves to heal, and also improves blood flow in the penis even when flaccid, which might reduce the rate at which harm happens with too few erections.

This dose (or even the 5mg dose) is unlikely to be enough to help much with getting erections, and it's worth trying an event dose (20mg Tadalafil, or 50 or 100mg Sildenafil/Viagra) occasionally, as this is likely to give you the first signs of recovery which can be quite a psychological boost, although it won't speed up the recovery procedure. Note that none of these drugs give you an erection just because you took them - you also need sexual stimulation, physical and/or mental.

Edited by member 30 Sep 2021 at 08:27  | Reason: Not specified

The side effects from the different PDE5 inhibitors fall into 2 categories, those which are due to inhibiting PDE5 itself, which are fortunately quite rare, and those which are due to inhibiting other PDEs which all the PDE5 inhibitors do, but these vary between the different PDE5 inhibitors, so switching can avoid them.

Unfortunately, acid reflux is in the first group - it's caused by inhibiting PDE5 itself, so it's quite likely all the PDE5 inhibitors will do this for you. Therefore, be careful trying the larger event doses. The right action in this case is to try the half-doses of Cialis/Tadalafil (e.g. 2.5mg or 10mg, instead of 5mg or 20mg), so your consultant did the right thing.

The reason for this is the smooth muscle of the esophagus and lower esophageal sphincter which seals off the top of your stomach also uses PDE5 to contract, and in some people, the PDE5 inhibitor will interfere with this too, and allow acid reflux into the esophagus. It generally only happens to people who get acid reflux anyway, making it worse. It might be made worse by swallowing broken tablets, because they are film coated to protect your esophagus from direct contact, but even the drug in your blood stream may be enough to do this.

If you do regularly get acid reflux anyway, it's worth getting this checked out as it can cause esophageal cancer over time. It's quite common that esophageal cancer patients have been taking things like Gaviscon for some time. (Gaviscon doesn't cause the cancer, but indicates there's been an acid reflux problem for some time.)

The muscle pain is because Cialis/Tadalafil is also a PDE11 inhibitor. None of the other PDE5 inhibitors also inhibit PDE11, so they don't generate this side effect (but they all do inhibit other PDEs as well).

Edited by member 01 Oct 2021 at 08:52  | Reason: Not specified

Injections are not almost guaranteed to work, I think the figure is about 60% success rate. Peyronie's disease (curvature of the penis) may rule out injections as an option because they can make it worse. Incorrect use of the vacuum can also cause peyronie's or make it worse, particularly if using a tube that is too large.

John did manage to get prescriptions for cialis and viagra at the same time, but only from the ED specialist. You can ask the GP but prepare yourself for a resounding no! Best thing for an attempt at an event in your situation will be to take 4 or 6 cialis at once ... but do give it a miss the following day. Dont have too high expectations though; if you haven't had any response at all so far, you are unlikely to find yourself with a huge truncheon immediately you take some extra tablets.