The vacuum constriction device has generally been regarded as a safe and effective alternative to pharmacologic intracorporal injections or surgical placement of a penile prosthesis for the treatment of erectile dysfunction. This paper serves to exemplify the potential complications of the device when used to treat erectile dysfunction in the spinal cord-injured (SCI) population. Two cases of subcutaneous penile hemorrhage in patients using anticoagulant therapy (one treated with subcutaneous heparin and one with coumadin) and one case of penile gangrene occurred in three different SCI males. Physicians managing erectile dysfunction in SCI patients should be aware of these potential serious morbidities. The management and means of prevention of these complications are presented.