A Vacuum constrictor device (VCD) was tested in 90 patients with organic erectile failure, some of whom had positive and some, negative responses to intracavernous self-injection of vasoactive drugs. Acceptance of the VCD overall was 37%. Among the 49 patients who did not respond to intracavernous injection of vasoactive drugs, acceptance was 45%, clearly higher than among the 41 responders to the injections, only 27% of whom accepted the VCD. Isolated subcutaneous hematomas were the only noteworthy complications observed with long-term therapy (up to 3 years). In cases of so-called venous leakage, the degree of venous outflow disturbance limited the use of the VCD, even in combination with self-injection therapy. The VCD is a successful alternative therapeutic option for the treatment of organic erectile failure, with a lower primary acceptance than corpus cavernosum self-injection therapy.