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The SomaTherapy-ED Response II is a perfect blend of manual operation and unique design. This Ultra sleek system provides effortless operation; you can even operate it with just one finger. Utilizing over 25 years of research and development, Augusta Medical Systems has designed a state-of-the-art Vacuum Erection Device that is more than 95% effective to overcoming Erectile Dysfunction! We use medical grade plastic that is designed for many years of use. In addition to the very easy to use manually operated Negative Pressure Device, each Response II comes with: CarryingCase, SomaTherapy-ED Lubricant,Tensions Systems, Tension System Loading Cone, Cylinder Sizing Inserts, a Training Manual, and an instructional DVD