In a single lymphedema treatment facility, 128 consecutive patients with lower limb lymphedema were retrospectively analyzed for the development of genital edema. The patients were separated for analysis on the basis of who used or did not use compressive pump therapy. Of the 128 patients with lower limb lymphedema, 75 received no pump therapy, and 53 used pumps. Of the 75 who did not use pump compression, only 2 had genital edema. Of the 53 patients who used pump compression, 23 patients developed genital edema after pump therapy (p < .0001). The incidence of genital edema was unaffected by age, sex, grade or duration of lymphedema, whether lymphedema was primary or secondary, whether a single or sequential pump was used, the pressure level applied, or duration or hours per day of pump therapy. Compressive pump therapy for lower limb lymphedema produces an unacceptably high incidence of genital edema.