The vacuum therapy has been suggested for several years to be a potential treatment for Peyronie’s disease to stretch the scar tissue and thereby result in straightening. Unfortunately, there are only anecdotal, unpublished reports on this approach. Currently there is a study in Chicago comparing the results of verapamil alone to verapamil plus vacuum therapy, using the three piece vacuum system. The results of this study are not yet available, but in my opinion, it does seem to make sense to combine medical therapy with the hope that the drug may affect fibroblast behavior, which is responsible for the scarring, as well as applying mechanical forces to stretch the tissue and to encourage further remodeling and straightening of the penis. The key is that the device needs to be applied daily for no longer than 30 minutes per treatment, but these treatments can be done 2-3 times per day if the time is available to do so. So far there have been very few reports in the medical literature that a vacuum device would cause Peyronie’s disease, but again it is unlikely that the device so much causes it as it does result in an erection which can then be injured activating Peyronie’s disease in the susceptible individual. Currently I am using combination therapy of verapamil injection with external vacuum therapy using the three cylinder VED device.