Since receiving FDA approval in 1982, vacuum erection devices (VEDs) have benefitted millions of men suffering from erectile dysfunction (ED). Vacuum therapy has since been overshadowed by advances in pharmacologic and surgical therapies for ED; however, there has been a recent resurgence in the popularity of the VED. This is in large part due to its developing role in post-prostatectomy penile rehabilitation. As a treatment for erectile dysfunction, vacuum therapy remains notable as a noninvasive, nonpharmacologic, safe, cost-effective, and efficacious treatment option. This chapter will review the evolution of vacuum therapy as well as its mechanism of action, efficacy, safety profile, and expanding applications beyond the traditional realm of ED.