Wearable penile devices: the TechRing

Introduction

The integration of technology into healthcare has revolutionized patient monitoring and treatment across various medical disciplines (1). Wearable devices, in particular, have gained significant traction, offering capabilities for real-time data collection and continuous monitoring (2). In the field of urology, these devices present novel opportunities for tracking urological conditions including sexual function, in particular, erectile activity (3). Wearable penile devices (WPDs) enable real-time insight into erectile function, specifically, the number, rigidity, and duration of nocturnal erections and also intra-coital activity. Such information may inform clinicians of underlying early erectile function changes which might be a harbinger of occult vascular or neurological pathology (4).

A key area of focus is the ability to monitor nocturnal penile tumescence (NPT)—the spontaneous episodes of penile erection during sleep (5). While a physiological phenomenon, NPT patterns can serve as a marker of the integrity of erectile machinery. Disruption in NPT characteristics such as reduced frequency, duration, and rigidity of erection can be associated with underlying pathologies contributing to erectile dysfunction (ED) (6). Furthermore, research has shown that ED often precedes cardiovascular events, suggesting its potential role as an early indicator of cardiovascular disease (7). While specific validation studies using the TechRing for ED or cardiovascular disease diagnosis have not yet been conducted, its ability to provide continuous, real-world NPT data holds promise for earlier detection of these conditions, pending appropriate clinical validation.

The relationship between ED and cardiovascular disease is particularly significant from a preventive medicine perspective. ED and cardiovascular disease share common risk factors and pathophysiological mechanisms, primarily endothelial dysfunction (8). Studies have demonstrated that men with ED have a significantly higher risk of cardiovascular events, with ED symptoms often manifesting before overt cardiovascular disease (9,10). This temporal relationship presents a unique opportunity for early cardiovascular risk assessment and intervention. The ability to continuously monitor erectile function through NPT and other metrics could potentially provide early warning signs of declining vascular health, though this application requires further validation through prospective studies.

The device

The FirmTech TechRing (FirmTech Inc., Bozeman, MT, USA), is a novel WPD that holds promise in improving the supervision of erectile health. Equipped with sensors, it monitors key indicators of erectile fitness with a pressure sensor to measure firmness and a strain gauge to quantify girth expansion. The device’s exterior is crafted entirely from medical-grade elastomer, a material selected for its adaptability to body contours. This design prioritizes user comfort, allowing the device to conform to the wearer rather than forcing the body to adapt to it. Such flexibility ensures comfort during extended periods of use, including overnight wear.

The TechRing utilizes a hook-and-loop design for safety (Figure 1). To operate, the user first pairs the device with a smartphone application via Bluetooth. Once paired, the ring is placed on the body, and erection recording is initiated through the app. To conclude a session, the user holds the power button until the device powers off. Data is then uploaded by re-pairing the device with the phone. The application processes the recorded data and prompts the user to categorize detected erectile events (nocturnal, self-stimulated erection, partner-based erectile activity). The device can be used for both short-term monitoring of erectile events and long-term tracking, including overnight sessions to assess nocturnal erectile integrity. The ring’s status is communicated to the user through a series of colored light indicators, providing user feedback on its operational state, battery level, and recording status.

Figure 1 FirmTech TechRing.

The safety and efficacy of the TechRing for extended use, including overnight wear, have been thoroughly evaluated. In a comprehensive 14-month study, 5,204 unique recordings were obtained from users, with no reports of priapism or skin reactions (11). Only two users reported mild discomfort after more than 4 hours of use, which was easily resolved upon device removal. The documentation of multiple erections during extended wear periods has confirmed sustained physiological levels of blood flow to the penis, addressing a primary safety concern for prolonged use of penile constriction devices. This provides strong evidence for the safety of the TechRing during long-term use, further supporting its potential as a novel WPD for improving the assessment of erectile fitness.

The application

The associated application functions as a medium for interpreting and displaying data sourced from the TechRing (Figures 2,3). By consolidating and analyzing this multifaceted dataset, both users and healthcare professionals can glean actionable insights, facilitating proactive health management approaches.

Figure 2 FirmTech mobile application dashboard.

Figure 3 FirmTech mobile application session details.

The TechRing connects to the application via Bluetooth, although it is off during recording, so there is no risk of Bluetooth radiation. The app takes the data from the ring and runs it through a proprietary algorithm to analyze each recording. The user may also categorize erectile activity into specific categories (partnered sex, solo, sleep), allowing the app to provide statistics about different types of erectile activity. The data is stored and deidentified in a Health Insurance Portability and Accountability Act (HIPAA)-compliant database, using Amazon Web Services (AWS). AWS provides the infrastructure and services that can be used in a HIPAA-compliant manner, ensuring the secure handling of protected health information (PHI) (12).

Comparison of WPD

Conventional diagnostic approaches like RigiScan^® and the historical lab-based NPT testing involve the use of specialized equipment and an environment prone to sleep interference and neither can be utilized to monitor erectile during sexual activity (13,14). In contrast, the TechRing is designed for personal health monitoring for consumers. Its user-friendly design features a latch-and-loop mechanism, minimizing sleep interference while maximizing comfort and data reliability.

The key distinction lies in their intended use: RigiScan^® is a medical device primarily used in clinical settings to diagnose and assess ED. TechRing, on the other hand, is a consumer device aimed at tracking and maintaining erectile fitness rather than diagnosing ED. This positions FirmTech’s product as a tool for proactive health monitoring rather than a diagnostic instrument. From a cost perspective, traditional diagnostic modalities frequently require expensive specialized equipment and professional oversight, increasing overall expenses (15). As comparison, the Rigiscan^® has a market price of up to $16,800 and is exclusively available to healthcare providers, whereas the consumer-oriented TechRing is priced at $275 and accessible to the general public (16). Wearable devices compatible with consumer-grade technology, like the TechRing, can provide a more cost-effective alternative, enhancing accessibility for erectile function assessments. Moreover, traditional ED assessment relies heavily on patient self-reporting through validated questionnaires and clinical visits. However, research indicates that men typically delay seeking medical attention for ED after symptom onset (17). This delay can miss critical opportunities for early intervention. Continuous monitoring through wearable devices offers potential advantages over episodic clinical assessment, as demonstrated in other fields of medicine where wearable technology has improved early detection of different diseases (18-20).

The validation of the TechRing’s clinical utility requires addressing several key research priorities. Studies must examine the accuracy and reliability of TechRing measurements compared to established clinical standards. Research should evaluate the device’s effectiveness across different patient populations and settings, as well as its impact on treatment-seeking behavior. Furthermore, investigation is needed to determine whether earlier detection through continuous monitoring leads to improved clinical outcomes, and to establish the role of the device in supporting clinical decision-making.

Future directions

Future directions for WPD in the field of ED diagnosis and management could potentially involve advancements in assessing blood volume changes in the corpora cavernosa, measuring penile diameter, and detecting calcifications in penile vessels. Enhanced sensors could provide precise data on blood flow dynamics within the corpus cavernosum, offering deeper insights into the vascular health and functionality of penile tissue. Additionally, integrating technology to measure changes in penile diameter during erections could aid in evaluating the mechanical aspects of erectile function, providing a comprehensive view of physical changes associated with sexual arousal.

Furthermore, the incorporation of imaging capabilities to detect calcifications in penile vessels could serve as an early warning system for vascular conditions contributing to ED, allowing for more timely and targeted therapeutic interventions or even calcified Peyronie’s disease plaques. Further developments in oxygen sensor technology may permit TechRing to evaluate cavernosal oxygenation, for example in the post-radical prostatectomy rehabilitation population and perhaps even incorporation of ultrasound technology into the TechRing may supplant the need for expensive office-based duplex Doppler units, facilitating ease of access to this technology to a far greater number of clinicians. By encompassing advanced monitoring features, future wearable devices could significantly improve the accuracy and effectiveness of ED diagnosis and personalized treatment plans.

While the TechRing represents an advancement in erectile function monitoring, several limitations warrant discussion. A primary challenge lies in the reliance on user self-reporting for event categorization. Users must manually classify detected erectile events as nocturnal, self-stimulated, or partner-based, introducing potential recall bias and misclassification. Data quality also depends on consistent app usage and proper device placement, with irregular monitoring potentially impacting trend analysis. Additionally, the current algorithm’s ability to distinguish between different types of erectile events has not been validated against objective measures, potentially affecting data interpretation accuracy.

Technical limitations include the device’s current inability to measure blood flow dynamics or tissue oxygenation directly. While future iterations have been proposed to incorporate oxygen sensors for evaluating cavernosal oxygenation and ultrasound technology for vascular assessment, these suggestions require careful consideration of technical feasibility, size constraints, and cost implications. The integration of such features would necessitate significant miniaturization of current medical technologies and validation against existing diagnostic tools. For example, the incorporation of ultrasound capability would require development of micro-transducers capable of operating within the device’s form factor while maintaining adequate imaging resolution—technology that currently exists only in early experimental phases.

Any proposed advancement must balance enhanced functionality with practical considerations of user comfort, battery life, and cost accessibility. Future development should prioritize validating existing capabilities and improving algorithmic accuracy in event classification before pursuing more advanced sensor integration. Additionally, prospective studies comparing TechRing data with established diagnostic methods are needed to establish its clinical utility in ED and cardiovascular risk assessment.

Conclusions

While WPDs like the TechRing show promise in providing new approaches to erectile health monitoring, their role in clinical practice remains to be fully established through rigorous research. The potential advantages of accessibility and continuous monitoring must be balanced against the need for clinical validation and evidence of improved health outcomes. Future studies will be crucial in determining the optimal use of these devices in both personal health tracking and clinical care settings.

Acknowledgments

None.

Footnote

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-24-548/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-24-548/coif). R.D. is an employee of FirmTech Inc. M.K. is a consultant for Abbvie, Boston Scientific, Acerus, Coloplast, Endo, Tolmar, Marius, Petros, Halozyme, the President of SMSNA, and an investor on Sprout and Vault. J.P.M. is an advisor for FirmTech Inc. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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