On this page Jump to a section
- Key facts
- How vacuum erection devices work
- Choosing a device
- How often to use a vacuum pump
- Who should avoid it; side effects
- Vacuum device vs ED pills vs injections
- What each path includes
- Using a pump with ED pills
- Safety checks before ED medication
- If you would rather start with a tablet
- Mendoxa plans and prices
- FAQ
- How we wrote this
- Sources and references
Key facts at a glance
- Device category
- Pumps and erection rings are Class II medical devices; the 510(k) exemption has limitations21 CFR 876.5020, eCFR
- Ring limit
- 30 minutes maximum; allow at least 60 minutes between uses; never sleep with the ring onFDA device guidance
- Buying a pump
- Available without a prescription; ask a provider to recommend a model with a vacuum limiterMedlinePlus: vacuum erection devices
- Mendoxa visit
- Prescription required · Independent licensed providers. The compounded tablet is not FDA-approvedFDA: compounded drugs are not FDA-approved
How vacuum erection devices work
A vacuum erection device (VED), also called a penis pump or vacuum constriction device, uses a tube placed over the penis, a pump to remove air and a ring at the base to retain blood (FDA device guidance).
The sequence is pump, slide the ring onto the base, then remove the tube; follow your device’s instructions and use only the pressure needed for an erection (FDA device guidance; MedlinePlus). A VED may take practice, according to NIDDK. For the broader treatment picture, see our erectile dysfunction guide.
How to choose a vacuum pump for ED
Start with safety features and usable instructions. FDA device guidance recommends a vacuum-limiting safety valve and a quick way to release suction and remove the ring.
| Check | What to look for |
|---|---|
| Pressure control | An automatic safety valve that limits vacuum pressure (FDA device guidance) |
| Ring removal | A quick-release mechanism you can operate (FDA device guidance) |
| Instructions | Clear directions for sizing, placement, removal and cleaning (FDA device guidance) |
| Regulatory category | Class II external penile rigidity devices under 21 CFR 876.5020; exemption from 510(k) notification is subject to limitations |
Sources: FDA device guidance; 21 CFR 876.5020. Accessed Oct 22, 2026.
A prescription is not required to buy a VED, but MedlinePlus advises asking your provider to prescribe or recommend a model. Class II status describes the device category; it does not establish that a particular pump is the best choice.
How often should you use a vacuum pump for ED?
Use the ring for no more than 30 minutes and allow at least 60 minutes between uses. Never sleep with it on; these are FDA labeling recommendations, not a daily or weekly treatment schedule (FDA device guidance).
Use the minimum effective suction and stop if it hurts (FDA device guidance). Follow the manufacturer’s instructions; MedlinePlus advises water-soluble lubricant and avoiding petroleum jelly, which can damage the device.
What about erection rings without a pump?
A ring can be used alone when an erection can be achieved but not maintained; the same time limit applies, and prolonged wear can cause permanent injury (FDA device guidance).
Who should check with a clinician before using a pump?
Ask a clinician before use if you have a bleeding disorder or take blood thinners (FDA device guidance; MedlinePlus). FDA’s example pump labeling says not to use it with sickle cell disease, a history of prolonged erections or large quantities of aspirin or other blood thinners (FDA device guidance).
FDA also advises against use with reduced penile pain sensation or reduced hand strength, which can make injury harder to detect or the device harder to remove (FDA device guidance).
Bruising, a cold or numb feeling and changes in ejaculation can occur (NIDDK; FDA device guidance). Contact your provider for pain, serious bruising, blood blisters or decreased sensation, and discontinue use if complications continue (MedlinePlus; FDA device guidance).
Vacuum device vs ED pills vs injections
Compare the setup you would need for sex, then discuss suitability with a clinician. These are recognized treatment options (NIDDK); the medicine rows describe standalone products, not the Mendoxa combination.
| Question | Vacuum erection device | ED pills (sildenafil, tadalafil) | Penile injection (alprostadil) |
|---|---|---|---|
| How it is obtained | Over the counter; also by prescription (FDA guidance) | Prescription (Viagra (sildenafil) label; Cialis (tadalafil) label) | Prescription; first injections in the provider’s office (Caverject (alprostadil) label) |
| Timing | Set up the tube, pump and ring each time (FDA device guidance) | Sildenafil 30 minutes to 4 hours before sex; tadalafil as needed or once daily (Viagra (sildenafil) label; Cialis (tadalafil) label) | Injected into the penis; NIDDK describes a quick, automatic erection (Caverject (alprostadil) label; NIDDK) |
| Needs sexual stimulation? | No; vacuum draws blood in mechanically (NIDDK) | Yes (Viagra (sildenafil) label; Cialis (tadalafil) label) | NIDDK describes an automatic erection (Caverject (alprostadil) label; NIDDK) |
| Use limits | Ring no longer than 30 minutes; 60 minutes between uses (FDA guidance) | Sildenafil at most once per day (Viagra (sildenafil) label) | No more than 3 times weekly, 24 hours apart (Caverject (alprostadil) label) |
Sources: Viagra (sildenafil) label; Cialis (tadalafil) label; Caverject (alprostadil) label; FDA device guidance; NIDDK. Accessed Oct 22, 2026.
More detail: ED medications compared, the ED shot and the latest ED treatments.
What each path includes
Start with the question that brought you here:
- Prefer to explore a tablet? An online Mendoxa visit is a practical next step to ask about prescription care. Independent licensed providers assess suitability. Prescription required.
- Prefer equipment without medication? Ask about a VED with a vacuum limiter and a ring you can remove easily (FDA device guidance).
- Already tried pills? Bring the name and how you used them to your clinician; the Viagra (sildenafil) label requires sexual stimulation. Our guide to ED pills not working helps prepare that conversation.
- Considering injections? The Caverject (alprostadil) label requires the first injections in the provider’s office; read our ED injection guide before that visit.
Device coverage: CMS lists vacuum erection systems and tension rings as statutorily non-covered by Medicare for service dates on or after July 1, 2015 (CMS vacuum erection device policy). Check any other coverage directly with your insurer.
Could Mendoxa ED care fit you?
Online ED visit · Prescription required · Independent licensed providers · Not available in California
Can you use a vacuum pump with ED pills?
Do not add a pump to prescribed medication without discussing it with your clinician. The ISSM describes combining a VED with medication for partial responders; that does not replace the contraindications in the Viagra (sildenafil) label and Cialis (tadalafil) label or the precautions in FDA device guidance.
Safety checks before ED medication
- Sildenafil and tadalafil are contraindicated with organic nitrates or riociguat (Viagra (sildenafil) label; Cialis (tadalafil) label).
- An erection lasting more than 4 hours needs immediate medical care (Viagra (sildenafil) label; Cialis (tadalafil) label).
- Stop and seek care for sudden vision loss or sudden decrease or loss of hearing (Viagra (sildenafil) label; Cialis (tadalafil) label).
- Common adverse effects include headache and flushing with sildenafil, and headache, indigestion and back pain with tadalafil (Viagra (sildenafil) label; Cialis (tadalafil) label).
- The APOKYN (apomorphine) label contraindicates use with 5HT3 antagonists such as ondansetron and warns about nausea and fainting.
Give the prescriber your full medicine list. See ED medication and nitrates for more detail.
Prefer to explore a tablet? Start with the online visit
If setting up a tube, pump and ring feels cumbersome, a tablet may be the simpler starting point to discuss. The Mendoxa online visit lets you ask Independent licensed providers whether its compounded tablet suits your needs. Prescription required.
The tablet combines sildenafil, tadalafil and apomorphine; it is not FDA-approved. Ingredient references are the Viagra (sildenafil) label, Cialis (tadalafil) label and APOKYN (apomorphine) label; APOKYN is an injectable Parkinson’s treatment, and its label is not approval of this ED combination.
The Viagra (sildenafil) label does not recommend combining sildenafil with other PDE5 inhibitors or ED therapies because combination safety and efficacy have not been studied and blood pressure may fall further. Discuss this label limitation and FDA-approved alternatives with the prescriber before considering the compounded combination.
Have your medicine list and details of previous ED treatments ready. Read about the combination ED tablet before starting. Available quantities and costs are below.
Mendoxa ED plans and prices
The Mendoxa ED tablet is a compounded rapid-dissolve tablet with sildenafil (the active ingredient in Viagra), tadalafil (the active ingredient in Cialis) and apomorphine (APOKYN label). It dissolves under the tongue. A licensed clinician decides if it fits you and selects the strength. Compounded medicines are not FDA-approved.
| Tablets per month | 1-month total | Per tablet (1 month) | 3-month total | Per tablet (3 months) |
|---|---|---|---|---|
| 6 tablets / month | $129 | $21.50 | $329 | $18.28 |
| 10 tablets / month | $149 | $14.90 | $379 | $12.63 |
| 20 tablets / month | $179 | $8.95 | $449 | $7.48 |
The 3-month total covers three months at the monthly tablet quantity shown.
If prescribed · Cancel anytime · Available in 49 states (not California). Prices from the Mendoxa intake at try.mendoxa.co/f/ed on Oct 22, 2026. The intake always shows the current price.
FAQ
Do vacuum erection devices work for ED?
Yes. A VED draws blood into the penis, and its ring helps maintain the erection; it may take practice to use (FDA device guidance; NIDDK). Choosing one depends on your preferences and medical history.
How often should you use a vacuum pump for ED?
FDA recommends no more than 30 minutes of ring wear and at least 60 minutes between uses, with no sleeping in the ring (FDA device guidance). This does not establish a daily or weekly schedule; ask your clinician about your intended use.
Do you need a prescription for a penis pump?
No. You can buy one without a prescription, but ask a provider to recommend a model with a vacuum limiter (MedlinePlus; FDA device guidance). Prescription required for Mendoxa medication.
What are the side effects of a penis pump?
Possible effects include bruising, coldness or numbness, and weaker ejaculation (NIDDK; FDA device guidance). Contact your provider for pain, serious bruising, blood blisters or decreased sensation (MedlinePlus; FDA device guidance).
Can you use a vacuum pump with Viagra?
ISSM describes combined use for some partial responders, but ask your clinician before combining treatments (ISSM; Viagra (sildenafil) label). The Viagra (sildenafil) label contraindicates sildenafil with nitrates or riociguat.
Does Medicare cover vacuum erection devices?
No. CMS lists vacuum erection systems and tension rings as statutorily non-covered for service dates on or after July 1, 2015 (CMS vacuum erection device policy). Ask your insurer directly about other coverage.
Ready to see if the Mendoxa ED tablet fits you?
From $129/month if prescribed · Cancel anytime · Available in 49 states (not California)
How we wrote this
Written by the Mendoxa editorial team · Sources: DailyMed/FDA. Medical facts on this page come from the FDA-approved labels on DailyMed and Drugs@FDA; each drug name links to its label. We checked device guidance, NIH patient information and the linked drug labels on Oct 22, 2026. The comparison describes treatment setup and labeled use, without product rankings or company efficacy claims; standalone drug labels do not establish the safety or effectiveness of a compounded combination. The AUA guideline abstract supports discussing available options; we do not assign an unverified guideline recommendation grade.
Updated Oct 22, 2026. This page is general information, not medical advice. A licensed clinician decides what fits you.
References
- DailyMed: VIAGRA (sildenafil citrate) tablet, film coated, label revised 12/2017. Accessed Oct 22, 2026.
- DailyMed: CIALIS (tadalafil) tablet, film coated, label revised 3/2026. Accessed Oct 22, 2026.
- DailyMed: APOKYN (apomorphine hydrochloride) injection, label revised 6/2022. Accessed Oct 22, 2026.
- FDA (Drugs@FDA): VIAGRA (sildenafil) prescribing information, NDA 020895. Accessed Oct 22, 2026.
- FDA (Drugs@FDA): CIALIS (tadalafil) prescribing information, NDA 021368. Accessed Oct 22, 2026.
- FDA: Compounding and the FDA, questions and answers. Accessed Oct 22, 2026.
- 21 CFR 876.5020: external penile rigidity devices. Accessed Oct 22, 2026.
- FDA: external penile rigidity device guidance. Accessed Oct 22, 2026.
- MedlinePlus: vacuum erectile devices. Accessed Oct 22, 2026.
- NIDDK: treatment for erectile dysfunction. Accessed Oct 22, 2026.
- AUA guideline abstract, PubMed. Accessed Oct 22, 2026.
- CMS: vacuum erection devices policy. Accessed Oct 22, 2026.
- DailyMed: Caverject (alprostadil). Accessed Oct 22, 2026.
- ISSM: vacuum erection devices. Accessed Oct 22, 2026.
- Mendoxa ED care (product, format, max 1 dose per 24 hours). Accessed Oct 22, 2026.
- Mendoxa ED intake: plan prices (term_options). Accessed Oct 22, 2026.
About Mendoxa
Mendoxa (mendoxa.co) is a US telehealth brand. Independent licensed providers (licensed clinicians in the LocumTele network) review each online visit, and prescriptions are filled by Rush Pharmacy, a licensed US pharmacy. Available in 49 states (not California).
- Prescription required. A licensed clinician reviews every visit and can say no. A prescription is not automatic.
- A compounded medicine is not an FDA-approved finished product (FDA compounding Q&A).
- Plans: 1 month or 3 months, from $129. If prescribed · Cancel anytime · Available in 49 states (not California).
Compounded medication prescribed only if a licensed U.S. clinician decides it is appropriate. Not FDA-approved as a finished product. Not available in California. This site is not for emergencies. Call 911 if you need urgent care.