Physiological Effects of Xialla: An Overview

Xialla is a silicone constriction ring designed to treat erectile dysfunction caused by venous leak, also called veno-occlusive dysfunction. This article explains how the device works, what follows from its design, and what the published evidence does and does not currently show.

The primary function: reducing venous outflow

An erection depends on blood flowing into the penis and being retained there. As the erectile tissue expands, it compresses the draining veins against the surrounding tunica albuginea. When that compression is incomplete, blood drains as quickly as it arrives, and the erection is difficult to maintain.

A constriction ring at the base of the penis slows venous return mechanically. This addresses the retention side of the mechanism, which is what distinguishes it from oral medication, injections, and pumps, all of which act primarily on inflow.

Conventional constriction rings have two recognized limitations. They must be tight to occlude effectively, which affects comfort, and they can move out of position during intercourse, at which point occlusion is reduced.

Xialla addresses both through its anchoring design: a loop passes around the scrotum and connects to a band anchored to an adhesive pad on the lower back. The ring is held in position by rearward traction rather than by circumferential tightness. Because it does not rely on compression to stay in place, it can occlude at lower pressure than a conventional ring.

Further detail: how Xialla reduces venous outflow.

Secondary effects of the design

The anchoring mechanism produces several further effects. These are consequences of how the device sits and functions, not separate technologies. They fall into three groups.

Effects of improved blood retention

When venous outflow is reduced, blood volume and pressure in the penis are higher than they would otherwise be. This affects the erectile chambers and also the outer tissue layers, which can produce a measurable increase in girth and firmness. It may also affect filling of the corpus spongiosum and glans, which is relevant to men with soft glans syndrome.

• Girth and firmness
• Soft glans syndrome

Effects of skin tension

Rearward traction on the ring draws the penile skin taut. Three consequences follow. Stretch-sensitive nerve endings in the skin are stimulated. Slack in the shaft skin is reduced, which changes how the skin moves during intercourse. In uncircumcised men, the foreskin is drawn back, leaving the glans exposed.

• Stretch-sensitive nerves
• Skin slack and friction
• Foreskin retraction and glans exposure

Effects of scrotal positioning

The loop holds the scrotum in a rearward position. This limits testicular ascent during arousal, which some men find uncomfortable. It exposes more of the shaft, which changes appearance without changing the penis itself. And it places light pressure on the perineum, which some men report affects ejaculatory sensation following prostate surgery.

• Testicular ascent and comfort
• Appearance and shaft exposure
• Ejaculatory sensation after prostate surgery

What the evidence shows

Xialla's published evidence addresses erectile function and blood retention. A clinical trial led by Dr. Anthony Bella, presented at the World Meeting on Sexual Medicine in 2016, reported improved erectile function in 14 of 21 patients. A subsequent trial reported satisfactory treatment salvage in 6 of 11 men with veno-occlusive dysfunction. A further trial examined climacturia, the involuntary loss of urine during sexual activity following prostate surgery.

These are small studies. The perspective article on Xialla published in the International Journal of Impotence Research notes that larger multicentre trials are needed to confirm the device's role in ED management.

The secondary effects described above follow from the device's mechanics and are supported by user reports. With the exception of blood retention and erectile function, they have not been measured in published studies. We think it is more useful to say that plainly than to present them as demonstrated outcomes.

Using Xialla alongside other treatments

Because Xialla acts on outflow, it can be used alone or in combination with a treatment that acts on inflow, such as oral medication, intracavernosal injection, or a vacuum device. It can be applied to a flaccid or erect penis. It can be used with a penile implant, though this should be confirmed with your surgeon.

Safe use

Xialla is a constriction device and the standard limits apply: a maximum of 30 minutes of continuous wear, removal before sleeping, and immediate removal if numbness, coldness, discolouration, or pain occurs.

Men taking anticoagulant or antiplatelet medication, men with sickle cell disease or another bleeding or clotting disorder, and men with reduced penile sensation should consult a physician before use. A device that feels tight is the wrong size; size exchanges are free.