Erectile Dysfunction

What is Erectile Dysfunction

Erectile dysfunction often referred to as ED, is the inability to achieve and sustain an erection suitable for sexual intercourse. The prevalence of erectile dysfunction increases with age and whilst around 20% of adult men suffer from erectile dysfunction that increases to 50% for men aged 40 and above.

Can erectile dysfunction be treated?

Modern treatment protocols mean that majority of our patients are able to successfully achieve penetrative sex irrespective of the underlying causes.

Key figures

  • Our network of physicians have successfully treated over 30,000 patients to date
  • A majority of our patients will be able to have successful intercourse from the first day of their treatment
  • Our treatment protocol aim is to provide an individualised treatment plan that will completely address any erection issues, whilst resolving the underlying conditions leading to erectile dysfunction


I am suffering from Erectile Dysfunction, what should I do next?

We advise you to book a consultation with our highly experienced doctors. The first step towards an accurate diagnosis is an investigation of possible causes by our specialists.

After this, our doctors will aim to do two things:

  • design a treatment plan that will allow you to immediately achieve a strong erection to continue normal sexual activities.
  • design a treatment plan to address the underlying causes of your erectile dysfunction. this means that each treatment we offer in our clinic is highly personalised.

Erectile Dysfunction Frequently Asked Questions


What Causes Erectile Dysfunction?


In order for men to achieve an erection a number of actions need to be in place:

-The nerves of the penis must be functioning properly

-The blood circulation into the penis must be adequate and the erection mechanism must be intact

-The veins must be able to “trap and keep” the blood inside the penis

-There must be a stimulus signal from the brain

Any interference with the above might result to sporadic or permanent erection problems.

Common causes of erectile dysfunction include diseases that affect blood flow, such as atherosclerosis (hardening of the arteries) or endothelium dysfunction; nerve diseases; psychological factors, such as stress, depression, and performance anxiety; and injury to the penis. Chronic illness, certain medications, and a condition called Peyronie’s disease (scar tissue in the penis) can also cause erectile dysfunction. Sporadic erectile dysfunction (less than 1 in 5 intercourses) might also be a result of alcohol, substance abuse or fatigue and is not something worrying.  

However, experience suggests that even a single episode of a weak erection can induce stress and performance anxiety that will in turn lead to further episodes of erectile dysfunction, creating a so called vicious cycle.

You can always contact us to discuss your concerns and particular circumstances before booking a medical appointment.

If you have a family history of cardio-vascular disease and experience an episode of erectile dysfunction we highly recommend that you visit a doctor, as studies have shown that erectile dysfunction is often an early sign of cardio-vascular disease.


Erectile Dysfunction Treatment Options


With the proliferation of oral medications such as Viagra and other PDE-5 inhibitors, the public awareness and treatment options for erectile dysfunction have increased significantly. However, one must differentiate between addressing erectile dysfunction as a symptom as opposed to treating the underlying causes, which would lead to permanent results. The table below provides a comprehensive list of the available treatment options categorised based on the desired treatment outcome. For more information on each treatment option please follow the appropriate links.

Treatment Categories:


  • Achieving on Demand Erections:


The treatments in this category allow patients to achieve on demand erections before and during sexual intercourse. There are four broad options:

  • Oral Medication (belonging to a category called PDE-5 inhibitors) such as Viagra, Cialis etc
  • Topical medication such as:
    • Penis Injections
    • MUSE urethral pellets
    • Vitaros cream
  • Vacuum Erection Devices
  • Penile Prosthesis Surgery


  • Erection Rejuvenation/Physiotherapy:


In addition to on demand treatments that can help patients achieve erections, there are other treatments options that can rejuvenate or help patients improve their natural erection mechanism including:

  • Shockwave Therapy
  • Pelvic floor exercises
  • Vascular surgery to increase blood flow or reduce venous leak



  • Control of risk factors:


The close links of erectile dysfunction to diabetes, hyper-tension, cardio-vascular disease and hypogonadism are very well documented and controlling, with appropriate medication and lifestyle modifications, these risk factors can be controlled and hence natural erections improve significantly.

Similarly, there are certain categories of medication that can lead to erectile dysfunction; stopping or changing these drugs can also help. Your doctor will advise you extensively during your consultation about these risk-factors and how they can be altered to support your treatment.



  • Psycho-sexual counselling:


Erectile dysfunction in most men is multi-factorial and the result of ongoing interacting relations among biological, cognitive, emotional and behavioural, contextual, and interpersonal contributing factors. Consequently, psycho-sexual counselling can work in conjunction with other treatment options in order to improve a patient’s sexual function. During your consultation, your doctor will evaluate you medical and personal history and may refer you for further psycho-sexual counselling and support if this is deemed necessary.



  • Lifestyle Modification:


Though there are medical conditions that can contribute to erectile dysfunction, for a lot of men, it is a few poor habits that are to blame. Several prescription medications exist to help treat ED, but sometimes making a few lifestyle changes can make all the difference. The most common risk factors are:

  • Poor diet
  • Smoking
  • Sedentary lifestyle
  • Excessive drinking
  • Stress

Whether it’s smoking or your poor eating and drinking habits leading to decreased blood flow or inactivity and relationships problems interfering with your energy and arousal levels—these can all contribute to ED.


What is Shock Wave Therapy For Erectile Dysfunction?


Shockwave therapy is the latest treatment modality for patients suffering from erectile dysfunction and it is one of the few treatments options that improves natural erections and can potentially rejuvenate the erection mechanism. In addition, shockwave therapy has the following advantages:

  • Non invasive treatment lasting 20 minutes in a treatment room – walk in and walk out within 30 minutes
  • No medication required
  • Fewer complications than other treatment modalities
  • Significant clinical benefit often seen within 6-8 weeks after treatment

The results of our patients to date are very encouraging and in our opinion, this treatment option completely changes the landscape of erectile dysfunction management.


Shock Wave Therapy FAQs


How does it work?

Extracorporeal Shock Wave Therapy (EWST) works by passing shock waves, an intense but short energy wave that travels faster than the speed of sounds into the tissues. Originally used to treat kidney stones in the 1970’s known as lithotripsy, using acoustic shockwaves to break up the stones without the need of surgery. Clinicians soon discovered that whilst patients were being treated for kidney stones they reported that other non-related medical conditions either improved or had disappeared entirely. This is turn lead to the discovery that shockwaves had a healing impact on pain and chronic conditions in the musculoskeletal system. Devices were then developed to treat a range of tissue injurys on all different parts of the body. Today Shockwave therapy is widely used to treat all kinds of indications from soft tissue injuries (tendinopathies) in humans and horses to diabetic foot ulcers to erectile dysfunction and even cellulite.

Shockwave treatment initiates a proflamatory response in the tissue where the shockwaves have been applied. The body responds by increasing the blood circulation and metabolism in the impact area which in turn accelerates the body’s own healing processes.

In the specific case of Erectile Dysfunction, shockwave improves erections via two mechanisms:

  1. Promotes angio-genesis (development of new blood vessels) in the penis which means that the blood flow to the penis increases and hence stronger erections are achieved; and
  2. Rejuvenation of penis smooth muscle – the majority of patients suffering from ED do so because the smooth muscle in their penile arteries has been damaged thus inhibiting the functioning of the so called veno-occlusive mechanism. Shockwave therapy has been shown to induce the body to repair the smooth muscle in the penis and thus improve the function of the veno-occlusive mechanism.


Am I candidate for Shockwave Therapy?

Theoretically, shockwave therapy can help all patients suffering from ED and even improve erections in men with no issues or in order to prevent erectile dysfunction. However, given that it is a new treatment modality, scientific evidence is still being gathered and we only recommend the treatment to patients that actually suffer from erectile dysfunction.

As explained in our Treatment Protocols  section, we apply shockwave therapy together with on demand first line and second line treatments.

Patients that do not respond to an intra-cavernosal injection test, are NOT good candidates for shockwave therapy, since this will generally mean that their erection mechanism is significantly damaged and it is unlikely that they will benefit from this treatment modality.

A full pre-treatment diagnostic evaluation is always advised before a patient proceeds with this option in order to establish if it is appropriate and also determine the optimum treatment protocol.


What are the expected benefits?

There is a growing body of scientific evidence that shockwave therapy for ED can help in the following ways:

  • Patients with mild to moderate ED that respond well to PDE-5 inhibitors, might be able to regain their natural erections and no longer need – or reduce their dependence on medication.
  • Patients with moderate to severe ED that do not respond to PDE-5 medication and rely on injections or other topical treatments, may become respondent to PDE-5 medication after shockwave therapy.
  • Shockwave therapy will in most cases improve the outcome of any other treatment modality.


What should I expect during my treatment session?

Each treatment session lasts around 20 minutes. When you arrive at the clinic a nurse will take you to the room with the shockwave machine where you will lie on the treatment bed. The medical practitioner will then apply the treatment using a special probe on different parts of your penis and perineum. Most patients experience very little discomfort or pain during the session. It is important that if you do not feel comfortable you let your medical practitioner know and the shockwave intensity will be adjusted accordingly. You can see a video of a session below:


What is the best Shockwave Therapy treatment protocol?

This is an area of very active research. A number of treatment protocols have been suggested, some lasting only 4 sessions and some as long as 12 sessions and the clinical trials investigating these protocols are quite different in a number of ways (energy of the shockwaves applied, number of shockwaves, number of sessions, duration of treatment and time between sessions and the technology of the shockwave machines).

Whereas all these trials have proven the treatment benefits, there is no clear protocol that applies to all patients. Our own experience and the studies so far indicate that the there is no one size fits all protocol and the number of sessions will depend on the severity of ED, the presence of comorbidities and the response to the treatment. At our clinic, as a minimum, we recommend 6 twenty-minute sessions over a three-week period.

Regarding the number of pulses, the range should be between 3000 and 5000 shock waves per session and there is evidence to suggest that administering more shock waves leads to greater improvements. It also seems beneficial to deliver treatment to multiple sites to reach the vascular bed of the erection mechanism.

At our clinic, your treatment physician will be constantly monitoring the progress of the patient, adjusting the protocol according to the response of your body and taking into account all the different parameters that are explained here.


Can I repeat the treatment on a regular basis?

As the method seems to have a physiologic effect on the erection mechanism, repeating the treatment after a certain period of time seems logical; however, the question regarding a possible saturation effect remains unanswered and requires further investigation.


Are the results permanent?

The biological effects of shockwave therapy are permanent and have been established on the basic science level. However, erectile dysfunction depends on the lifestyle of patients and is usually a symptom of underlying health issues which lead to ED. Because ED usually gets worse in patients with comorbidities, this means that the improvements after the treatment might be reversed over time if the underlying conditions are not addressed.

Given that the treatment is relatively new, the longest period that patients have been followed up, after treatment in a systematic way as part of a clinical trial, was 12 months. The results from this study indicate that the treatment benefits were preserved after one year from the treatment but further studies are required to investigate the efficacy after a longer period of time.


Is the Shockwave Therapy treatment itself painful?


At times the treatment might be a bit painful, but most people can stand these few intense minutes without medication. If patients are in pain during the treatment, they are to notify the medical practitioner as there are some adjustments that can be made to reduce the discomfort, however, having some pain during the treatment indicates that shockwaves are having a positive effect.


Will there be pain after the treatment?


Normally patients experience a reduced level of pain or no pain at all immediately after the treatment, but a mild and diffused pain may occur a few hours later. This dull pain can last for a day or so.


What if there is pain after the treatment?


Shockwave therapy treatment initiates a pro-flammatory response in the tissue that is being treated. If necessary patients may use ordinary prescription-free pain killers. Do not use anti inflammatory medication or ice on the treated area as both may interfere with the body’s self healing process.


What if the shockwave therapy treatment doesn’t work?


Usually the response to shockwave therapy treatment is good, however it may take several months before maximum effect is achieved. If after 3-4 months the patient still does not experience a pronounced improvement, then other treatment modalities will need to be considered.


Can Surgery Treat Erectile Dysfunction?


Even though conservative treatments for ED have recently become very advanced, there are still some patients who do not respond to pharmacological therapy and a surgical treatment is the only option.

Overall there are two broad categories of surgeries for erectile dysfunction. The first is vascular surgery, which aims to increase blood inflow to or reduce blood outflow from the penis. The second, is the penile prosthesis surgery, which offers a final and permanent solution to erectile dysfunction irrespective of the underlying causes.


Vascular Surgery

This type of surgery is only appropriate for a few select cases of patients with very specific symptoms.

Venoligation or Sclerotherapy

This type of operation aims to decrease the blood outflow from the penis during erections and it is only appropriate for young men with primary (i.e. lifelong) erectile dysfunction that exhibirt abnormal ultrasound parameters suggestive, of specific venous leak (increased End Diastolic Velocity). In such cases and before considering an implant, it might be appropriate to ligate or embolise the deep dorsal vein or a particular abnormal vein, established through cavernosography.


Penile Revascularisation

This type of operation aims to increase the blood inflow to the penis by increasing the level of vascularization. Appropriate candidates for this operation are patient suffering from lifelong ED and abnormal ultrasound parameters (decreased Peak Systolic Velocity) and localised stenosis, which has been established through an arteriography.


Penile Prosthesis Surgery

Penile prosthesis surgery involves replacing the damaged natural erection mechanism (corpora cavernosa), with a mechanical device, the penile prosthesis, that in effect allows the patient to induce erections on demand.

You can read more in our dedicated section that contains extensive information on penile prosthesis – please click on the link below for more information:

Penile prosthesis


What is the Cost of Erectile Dysfunction Treatment?


Unfortunately, most insurance companies do not cover sexual dysfunction or male fertility consultations and most of our patients are self-paying. If your insurance company covers the cost of treatment or diagnostic tests, then we would be glad to assist you with the refund claim or claim directly from your insurance company on your behalf.

Surgical Treatment Costs

Surgical treatment costs will depend on the type of operation, the medical material used and the specific circumstances of each patient. Following your consultation and if you are a candidate for a surgical treatment, an all inclusive cost will be quoted (covering medical material, hospital fees, anaesthetist fees and surgeon’s fee and all the follow up consultations).