What is in the box, and what each part is for
- The cylinder
- A clear tube that seals against the body. Transparency matters — you need to see what is happening to judge when you have enough and to spot anything going wrong.
- Two pump heads
- The reason to buy the Deluxe over the Standard. The battery head runs itself, which matters if arthritis, neuropathy or a stroke has affected grip. The manual head gives finer control over how fast pressure builds and never runs out of charge at an unhelpful moment.
- The vacuum limiter
- The single most important safety component, built into the pump. It caps how much negative pressure can be generated so you physically cannot over-pump. This is what makes a device medical-grade rather than a novelty.
- Seven tension rings
- Assorted sizes. Getting this right is most of the difference between an erection that holds and one that drains, and between comfort and pain. Start mid-range and adjust from there.
- The loading cone
- A tapered guide that gets the ring onto the base of the cylinder ready for transfer. Fiddly the first time, trivial the fifth.
Why it works when tablets have stopped
Understanding this properly changes how you think about the whole category. Sildenafil and its relatives do not create an erection. They block the enzyme that breaks down the chemical messenger your body releases during arousal, which means the signal lasts longer and works harder. If arousal is not producing that signal — because nerves were damaged during prostate surgery, or diabetic neuropathy has degraded them, or the arteries cannot deliver enough blood regardless — then there is nothing for the drug to amplify. This is precisely why men reach the point where tablets 'stop working'.
A vacuum device does not join that chain anywhere. It moves blood into the tissue with negative pressure and traps it with a ring. Nerves, arteries and hormones are not consulted. That is the entire reason the success rate stays near 90% in populations where drug response has collapsed.
| Situation | PDE5 tablets | Vacuum device |
|---|---|---|
| Taking nitrates for angina | Absolutely contraindicated | Completely safe |
| After radical prostatectomy | Often ineffective while nerves recover | Works, and is used in rehabilitation protocols |
| Advanced diabetic neuropathy | Response often poor | Unaffected — mechanism is mechanical |
| Severe vascular disease | Limited by the arteries themselves | Draws blood in regardless |
| Spontaneity | Take a tablet in advance | Interrupts the moment |
| Cost over five years | $1,200+ on subscription | About $130 once |
The first month, which decides everything
A 90% success rate and a sub-50% continuation rate is not a contradiction — it is a description of a learning curve that most men quit halfway up. Treat the first sessions as equipment practice with no expectations attached.
- Practise alone, three or four times. The aim is competence, not an occasion. Every difficulty below is easier to solve without an audience.
- Lubricate the base of the cylinder generously, water-based. Almost every failed first attempt is a seal failure rather than a device failure. Trimming pubic hair at the base genuinely helps the seal.
- Pump slowly and in stages. Rapid pumping is uncomfortable and no quicker in practice. Pause as pressure builds and let the tissue respond.
- Size the ring properly. Start in the middle of the seven supplied. Too loose and the erection drains within a minute; too tight and it hurts and the thirty-minute limit becomes something you feel.
- Start the clock when the ring goes on. Thirty minutes, maximum.
- Expect it to feel different. Rigidity stops at the ring, so the erection pivots at the base. It may feel cool or slightly numb. Both are normal and neither means anything is wrong.
- Bring your partner in early. Men who present this as a shared piece of equipment rather than a private humiliation are far more likely to be using it a year later. Our guide on talking to your partner is genuinely useful here.
Paying for it: Medicare, insurance and FSA
- Commercial insurance
- Some plans cover VEDs, usually requiring a prescription and often documented failure of oral therapy first. One phone call before you buy is worth the fifteen minutes. If you are denied, our insurance appeals guide covers the process.
- FSA and HSA
- Generally an eligible medical expense, especially with a prescription or a letter of medical necessity. This is the most reliable route to paying with pre-tax money and applies to the full purchase.
- VA benefits
- Separate from Medicare, and veterans have historically been able to obtain devices through VA care. Ask your VA provider directly.
- Cash
- The default, and at around $130 for something with no running cost it is the cheapest effective treatment on this site by a wide margin over any multi-year period.
One reason to get a prescription even though you do not need one: it means a clinician has sized the device, checked nothing rules it out, and put it on your record. That is worth having independently of reimbursement, and it costs you an appointment you arguably should be having anyway.
FAQ
Frequently asked questions
How well do vacuum erection devices work?
Around 90% of men achieve an erection sufficient for intercourse. That success rate holds in situations where drugs have failed — after prostate surgery, in advanced diabetic neuropathy, in severe vascular disease — because the mechanism is mechanical rather than pharmacological.
Does Medicare pay for one?
No. The ABLE Act of 2014 ended Medicare coverage for vacuum erection devices, and for dates of service on or after 1 July 2015 the codes are statutorily non-covered. Medicare Advantage plans cannot cover them either. Some commercial plans do, and FSA and HSA funds are generally eligible.
Do I need a prescription to buy the Encore Deluxe?
No, it can be bought over the counter. Getting a prescription anyway helps with insurance, FSA and HSA reimbursement, and it means a clinician has sized it and confirmed nothing rules it out for you.
Battery or manual pump — which should I get?
The Deluxe includes both, which is why it is the configuration worth buying. Use the battery head if grip strength or dexterity is limited by arthritis, neuropathy or a stroke; use the manual head for finer control over how quickly pressure builds. Having both means the answer can change.
Why do men stop using them?
Because it interrupts sex and takes practice — not because it stops working. Continuation is often under 50%, and nearly all of the dropout happens in the first few weeks. Practising alone three or four times before using it with a partner is the single strongest predictor of persisting.
How long can the tension ring stay on?
Thirty minutes maximum, the same as any constriction ring. Remove it immediately for pain, numbness, coldness or colour change, and never fall asleep wearing one.
Will it feel like a normal erection?
Not exactly, and knowing that in advance helps. Rigidity stops at the ring, so the erection pivots at the base rather than being rigid all the way through, and it can feel cool or slightly numb. Ejaculation may feel restricted or be partially trapped by the ring. None of that indicates a problem.
Is it safe with nitrates?
Yes. There is no drug involved and therefore no interaction. For men on nitrate therapy for angina, where every PDE5 inhibitor is absolutely contraindicated, a vacuum device is one of the few genuinely effective options available.
What is the difference from a cheap pump online?
The vacuum limiter. Medical-grade devices cap the negative pressure they can generate; many cheap pumps do not, and over-pumping can rupture blood vessels and cause bruising or lasting damage. Ring quality and sizing range are the other differences, but the limiter is the one that matters.
Sources
What this is based on
We link to primary sources — clinical guidelines, regulator publications and peer-reviewed research — wherever possible. Links open on third-party sites we do not control.
- [01]American Urological Association. Erectile Dysfunction: AUA Guideline (2018).
- [02]National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Erectile Dysfunction.
- [03]Urology Care Foundation. What is Erectile Dysfunction?.
- [04]National Library of Medicine. PubMed — search the primary literature.
- [05]U.S. Food and Drug Administration. Device registration and listing — what it does and does not mean.