Incorrectly used, a cock ring can cause damage. During an erection the blood supply in the penis is periodically exchanged ie: blood is brought back into the body and sent to be freshened (with oxygen) and new blood is pumped into the penis.
When a cock ring is on for longer than thirty minutes the blood held in the penis can coagulate and damage the very fine capillaries that engorge the corpus cavernosa and spongiosum. I have met men who have suffered from this type of damage.
On the other hand, cock rings are recommended for men who suffer from erectile dysfunction due to various health complications.
In response to sexual thoughts (...mmmm) nitric oxide is released from the Central Nervous System. The smooth muscle, which normally is contracted and keeps blood out of the penis, relaxes and blood flows into the chambers. When a penis is erect the blood vessels are stretched and shut themselves off trapping blood in the penis.
Damage to the Central Nervous System (auto-immune disorders, cocaine and ecstasy use, head and spinal injury) will fuck this all up, as will poor diet and lack of exercise.
With a cock ring the penis will feel cold, and it often creates a 'hinge' at the base of the penis, so it will flop about, and can cause a lot of 'missing' during rapid thrusting coitis.
But, for those who find viagra does not help with maintaining an erection, cockrings are excellent...30 minute maximum! (also, for premature ejaculators, a ring can slow things down and create a longer plateau phase before orgasm)
My first experience (with a porcelain ring placed just under the head) was painful, and it took years to try it again.
I would be cautious using this with clients. It would depend on the experience and temperament of the gentleman.