Physio For The Penis Post CES

We have interviewed Elliot from iMEDicare to bring to the attention of men with Cauda Equina Syndrome the need to consider a vacuum pump to help with their condition.


Hi Elliot, thank you for speaking with me! To be honest I knew very little about what happens to men during CES, but I do know that a lot of men who suffer CES often end up having an inability to gain an erection. Why is that?

Hi Catrina, the cauda equina conveys sensory fibres from the sacral dermatomes, motor nerve fibres innervating lower sacral myotome skeletal muscles, and sacral parasympathetic fibres all needed to gain and hold an erection, can be affected. In patients with CES, the finding of pronounced sexual dysfunction and perineal sensory deficit is not unexpected.

A recent published study has demonstrated a severe sexual dysfunction was reported by 35% of patients, moderate dysfunction by 24%, and slight dysfunction by 26%; normal sexual function was reported by 15%.


So those numbers indicate this is an important issue within the CES community, but it can be a sensitive topic to discuss openly. What do you recommend to male CES suffers to help with this problem?

Patients should discuss their sexual dysfunction issues with their GP. Referral to a Urology department that provides andrological healthcare should be explored if the GP’s first line of solutions such as lifestyle changes or medication have not worked.

Some areas will offer access to psychosexual therapists. These can also be sourced privately online via COSRT (College of Sexual and Relationship Therapists)


So presuming a CES patient has been through the GP and they are recommended to try a pump, where do they start? Your company offers several erectile dysfunction pumps what are the main differences between the models?

Our pumps are the market leading ones with the majority of hospitals suggesting our devices and services within clinical environments.

Typically we offer 5 different sizes of cylinders (A, B, C, XL.& XXL) to allow for the perfect size to fit element for maximum success – penile size when erect can vary enormously and it is important to optimise comfort and efficacy. The most popular models are that of the SOMAcorrect XTRA (A, B & C) and SOMAerect Response 11 (C – Large).

vacuum pump photo


So how long after decompression surgery would you recommend CES suffers begin using the pump?

We recommend a minimum period of 8 weeks after all pelvic surgeries to ensure suture lines have robustly– although this will depend on specific cases and the surgeons recommendations


So how does the pump actually work and how long does it take to gain an erection?

The vacuum works using negative pressure controlled and increased by the patient. For most patients it will take 2-3 minutes in the early stages of practice, but this will quickly speed up to 10-30 seconds after several months of regular use.


What is the recommended use schedule? Do you encourage use only for sexual situations or to use almost on a schedule to improve the results?

As a company we recommend regular use to obtain the best results very much like physiotherapy for the penile tissue.

For the first four weeks for 10 minutes daily where patients are advised to obtain between 10 to 20 erections within the cylinder – like penis press ups – drawing in oxygenated blood and stimulating tissue growth and repair by virtue of regular mechanical exercise effect.

Following the first four weeks we suggest using the vacuum device a minimum of 2-3 times a week to maintain penile health. If patients can get natural erections and more nocturnal erections that are firm and rigid, then exercise can be reduced further.


That sounds encouraging that ability to gain an erection can improve over time! Can a CES sufferer do anything else to facilitate the best results?

In a sexual context, it is important to try to feel relaxed (although the pump works well regardless of state of mind). It is definitely helpful to feel sexual and ideal if the partner assists – pump usage can then be viewed as part of the love making process. Little tricks like a TWO ring technique will optimise penile rigidity and erection duration (up to 30 mins at a time)


Does the process hurt?

The vacuum pump is extremely non-invasive, the protocol itself most definitely shouldn’t be painful in anyway. However, if a patient has sustained penile shrinkage as a consequence of chronic erectile dysfunction, it is important not to go to far too soon. The first 4 weeks are essential to get used to the extra filling and stretching of penile tissue. Tension discomfort will stop being an issue after this initial rehabilitation phase. Also important to ensure non-penile skin isn’t sucked in to the open end of the pump. Hence the need for a hand in glove approach to cylinder sizing.


So how long will an erection last, may the pump be needed again during coitus?

The erection can last up to 30 minutes following gaining an erection within the cylinder and applying the maintenance ring. Maintenance rings MUST be removed at the 30 minute point. Users can remove the erection ring at any moment and the erection will subside – in other words they have total control over when they start and stop their erectile activity.


Some men may worry and have negative feelings about having the need for a pump, what would you say to alleviate those natural fears?

These are medical grade devices recommended as a first line approach by the British Society of Sexual Medicine. The prevalence of ED rises with age and at least 40% of men over 40 will have erectile issues. In the UK this translates into millions of men. Many of who will not be successful with PDE5 medication (Sildenafil / Tadalafil) – hence the need a non-invasive and reliable alternative solution. Many many men over the age of 60 will have a medical grade pump tucked neatly under their beds in anticipation, they may not talk about it publicly , but they are used by millions of men across the globe.


That’s really interesting to know. Do you provide support to the users if they experience any issues?

Absolutely. We offer a free demonstration service in most NHS Hospitals or by Home visit. We also offer confidential telephone / email and or Skype support as the patient user wishes.


That’s fantastic to hear! Will the user notice a difference in their erection, to their experience of them prior to CES?

Recovery may be possible depending on the severity of local neurological compromise. Moderate erectile dysfunction is often exacerbated enormously by penile inactivity leading to penile non-use atrophy and shrinkage. A bit like not taking exercise yet expecting to be able to run a marathon…isn’t going to happen. The penis needs regular mechanical and sexual stimulation to recover and sustain normal function. A medical grade pump is ideal for regular safe and reliable erections and sexual activity.


Is it possible for men to use the pump to facilitate reproduction?

The pump is very popular within fertility centres up and down the country not only to aid penile health but to allow patients to hold an erection artificially through utilising the rings within the pack. This can facilitate normal sexual activity and an increased chance of conception. Orgasmic dysfunction can also be an issue for some men with CES. This may necessitate the use of a medical grade penile vibratory device.

Within the pack we offer a wide range of different rings in which vary in sizes and tensions. However, the most popular ring we have for obtaining a full controlled ejaculation is that of the fertility ring. Hopefully allowing for the patient to tear apart when looking to achieve organism. Also possible to just stretch a loose soft silicone ring at the point of ejaculation to allow semen to escape with force.


That’s really great to hear that there is hope for those wanting to have children post CES. Have you had any feedback on how users have found the experience for an extended period of time?

Patients love the versatility of the vacuum device not only for maintaining penile health through regular exercise but also the ease of holding the erection with the use of the maintenance rings.

Recovery isn’t always possible when there is a localised neurological deficit, but even without resumption of spontaneous erections, regular use of a medical grade vacuum erection device allows the user to intimate more or less on demand within seconds with very high self and partner satisfaction rates (89 and 92% respectively). Compliance over 5 years is also extremely high when the device has been correctly customised and mastered from the technical point of view from the outset.


So how do CES patients go about getting an erectile dysfunction pump?

As a company we offer a free home visit service in which can be arranged through our area representatives across the country by contacting the iMEDicare Ltd customer service team on 01923237795 or visit

Within the home visits we provide full education on the vacuum device and leave all the relevant documentation for hopefully obtaining the device through their GP’s. Due to having a spinal cord injury this entitles you to get the free prescription under the schedule 11 protocol. GP referral to a tertiary centre may be required – usually the local Hospital Urology department.


Wow, thank you Elliot for your time that was really educational and I know it will help a lot of people!

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