The use of vacuum therapy has been considered a treatment option for some years without documented evidence of benefits. Several unpublished reports from physicians and patients have suggested that they have seen improvements with chronic use of a vacuum device. The suggested mechanism is that stretching the penile tissue on a regular basis encourages the remodeling of the tunica albuginea and this straightens the penis. Years ago the Russians used the principle of stretching bones with a surgically placed device and that this in turn results in bone growth to lengthen shortened limbs. The problem is being able to provide prolonged pressure to the penis that such a change could occur. The recommended approach that I have used with patients (without any clear evidence of benefits as of yet) is to apply the vacuum once to twice per day in a progressive fashion until they could tolerate leaving the device in place for thirty minutes. Using a pulse of vacuum for short term (i.e. 5 minutes) may not be beneficial and may potentially cause injury. Leaving the device on for any longer than thirty minutes is dangerous as it can cause a low oxygen state, which may cause vascular and internal damage. Studies that I conducted in the past using a vacuum device revealed that the apparent straightening of the penis with the vacuum on is due to the expansion of tissues deep to the skin, but superficial to the tunica albuginea. As a result of having girth enhancement around the scar tissue within the tunica, a masking effect of the deformity occurs which results in what appears to be a more full and straight penis. My opinion is that this straightening is not real and yet a multi-centered study is being developed to test the benefits of chronic use of vacuum therapy to straighten the penis.