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Also known as
External penile prosthesis (EPP), penis sleeve, penile sleeve, penis extension, external erectile aid, penile support splint, penile cast, penile support apparatus, erectile support device, external penile rigidity device, strap-on dildo (in some contexts), penile traction device (for specific types), penile support ring system
Definition
Penile support devices are non-invasive, externally applied mechanical aids designed to provide physical support, rigidity, and/or length to the penis for men with erectile dysfunction (ED).1 These devices typically consist of rings, rods, sleeves, or casts that attach to or envelop the penis to enable sexual intercourse without requiring a natural erection.2 Unlike internal penile implants that require surgical intervention, external penile support devices are non-surgical alternatives that can be used by men with various forms of ED, including those resulting from prostate cancer treatment, diabetes, venous leakage, anxiety, paralysis, and Peyronie’s disease.3
The primary mechanism of action involves mechanical support to simulate penile rigidity sufficient for penetrative sexual activity. These devices function by providing external structural support to the penile shaft, effectively bypassing the need for the natural vascular engorgement process that creates an erection.1 This allows men with compromised erectile function to maintain sexual intimacy despite an inability to achieve or sustain a natural erection.2
Clinical Context
External penile support devices are clinically indicated for men with erectile dysfunction who seek non-pharmacological and non-surgical alternatives for maintaining sexual function.1 These devices serve an important role in the erectile dysfunction treatment algorithm, particularly for patients who:
- Do not respond to or cannot tolerate oral ED medications such as PDE5 inhibitors2
- Are not candidates for more invasive treatments like penile implant surgery1
- Seek to avoid medication side effects3
- Have contraindications to pharmacological treatments2
- Desire immediate results without waiting for medication to take effect3
- Experience ED from various etiologies, including post-prostate cancer treatment, diabetes, venous leakage, anxiety, paralysis, and Peyronie’s disease1
The clinical landscape of external penile support devices includes several distinct types, each with specific design features and applications:
1. Penile Support Devices (Rod-Based)
Devices like The Elator and Erektor consist of two custom-fitted rings connected by rigid rods.1 One ring is placed around the base of the penis and the other around the glans, with the rigid rod providing support along the shaft. These create a simulated erection that may be rigid enough for penetration while allowing for sensation. The device employs two custom-fitted rings that are placed around the base and glans of the penis, which are then connected by a rigid rod.1 This creates a simulated erection that may be rigid enough for penetration. It also provides the insertive partner greater stimulation than with a sleeve and a better chance for an orgasm.2
2. Penis Sleeves/Extensions
Hollow, penis-shaped devices that slip over the penis.3 They come in various shapes, sizes, and textures, including:
- Complete sheaths that extend from the base of the shaft and completely cover the glans of the penis3
- Partial sheaths that leave the glans exposed for increased stimulation3
- Harness sleeves (strap-ons) worn with a thong-like harness for additional security3
3. Penile Casts
External devices worn over the penis during intercourse, typically with small windows at the corona glans level to allow for sensation.1 While there’s limited research on how effective the penile cast is, the device is an option for people who don’t respond to ED medication or don’t want implants.3
Clinical studies, though limited, have shown promising results. A 2017 study published in Translational Andrology and Urology reported that some cisgender men can reach an orgasm when using a penis sleeve despite having severe ED.2 Additionally, a 2022 cross-sectional study found that patients’ willingness to try external penile prostheses increased with more information about the devices.2 The study also found that personalization of the EPP to match one’s own penis was preferred by 38.7% of participants, and referring to this aid as an ‘external penile prosthesis’ was significantly more preferred over alternative labels.2
From a psychological perspective, these devices may provide benefits by reducing performance anxiety related to maintaining an erection.3 This can help the patient avoid loss of confidence and improve overall sexual satisfaction for both partners.2