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Good question. I didn't even know the ring was supposed to be applied like that until I saw the other post here on this forum with the YouTube video showing how to use a pump for ED purposes.
45 years old happily married and living in Florida. I've had ED for over 20 years due to spinal cord injury. Viagra and Cialis work OK for me but Trimix injections work GREAT! I've also had to self cath for as long as I've had ED.
You size it by trial and error. Use the loosest ring that works to keep your erection.
You apply it in a multi-step process. In two different ways.
If you can get an erection with a ring on, you can slip the ring onto your penis and get an erection. The ring then prevents outflow of the blood in your penis that gives you the erection. This is fairly uncommon, I believe. It works because arterial blood flowing into your penis is centrally located in your penis, this not too restricted by the ring. Venous outflow is closer to the surface, so is more restricted. The erection can be obtained either by stimulation or vacuum.
If the first method does not work, you must apply the ring after erection. For that, you need to stretch the ring, of course. Most V.E.D.s have a tool used to put the ring onto the V.E.D. tube. Then you use the VED to get an erection. After that, you roll the ring off of the VED tube onto the base of your penis (when it does, expect it to sting a bit).
Like I said, use the loosest ring first. Use tighter rings if looser ones don't work. Some men require more than one ring, depending on their particular anatomy and degree of venous leakage.
Born 1948, After 30 yrs of progressive, unrecognized ED, I slowly accepted the reality (after a LOT of unproductive wishful thinking). Now successfully sexual with an AMS LGX implant 2017-11.