Erectile Dysfunction

We offer a full range of evidence-based treatments for erectile dysfunction, from oral medication to injections and regenerative therapies. Every plan starts with finding out why ED is happening, because the cause decides which treatment will work best.

What causes erectile dysfunction?

An erection depends on healthy blood vessels, nerves, hormones and mood all working together. ED usually has more than one cause:

• Blood flow (vascular): the most common cause in men over 40. High blood pressure, high cholesterol, diabetes and smoking narrow the small arteries of the penis. Because these vessels are so small, ED can be an early warning sign of heart disease, often appearing years before other symptoms.
• Hormones: low testosterone reduces desire and can weaken erections. High prolactin and thyroid problems can also contribute.
• Psychological factors: stress, performance anxiety, depression and relationship strain. These are especially common in younger men and often overlap with physical causes.
• Medications and substances: some blood-pressure drugs, antidepressants, finasteride, heavy alcohol use, recreational drugs and a history of anabolic steroid use.
• Lifestyle: excess weight, lack of exercise and poor sleep, including untreated sleep apnea.

How we assess ED

Your first consultation is private and straightforward. Your doctor will ask about your symptoms, health and medications, check your blood pressure, and usually arrange a blood test. The blood test typically checks testosterone, blood sugar (HbA1c), cholesterol and, where relevant, prolactin and thyroid function. This tells us whether there is a hormonal or metabolic problem to treat alongside the ED itself.

Oral medication: Viagra and Cialis

Tablets called PDE5 inhibitors are the first-line treatment for most men and work for the majority. Sildenafil (Viagra) is taken about an hour before sex and lasts around four to six hours. Tadalafil (Cialis) lasts up to 36 hours, and a low daily dose removes the need to plan ahead (see daily tadalafil benefits). These medications only work with sexual stimulation, and they must never be combined with nitrate medicines for chest pain because of the risk of a dangerous drop in blood pressure. We prescribe Viagra and Cialis as part of a personalised treatment plan.

Trimix injections

Trimix is a combination of three medications (alprostadil, papaverine and phentolamine) injected directly into the side of the penis with a very fine needle. It works independently of nerve signals and produces a firm erection within 5 to 15 minutes, which makes it highly effective for men who do not respond to tablets, including many men with diabetes or after prostate surgery. Your doctor finds the right dose in the clinic and teaches you to self-inject at home. The main risk is an erection lasting too long: an erection lasting more than four hours (priapism) is a medical emergency and needs immediate treatment.

GAINSWave shockwave therapy

Low-intensity shockwave therapy, often known by the brand name GAINSWave, delivers gentle acoustic pulses to the penis. The aim is to stimulate new blood vessel growth and improve blood flow over time, rather than producing an erection on demand. A course usually involves six or more short sessions, without needles or downtime. The evidence is most encouraging for men with mild, blood-flow-related ED. Results vary, and major urology guidelines still consider it an emerging therapy, so we recommend it selectively and explain realistic expectations before you start.

P-Shot (Priapus Shot)

The P-Shot uses platelet-rich plasma (PRP) prepared from a small sample of your own blood, which is then injected into the penis under local anaesthetic. PRP contains growth factors intended to support tissue repair and blood flow. Some men report firmer erections and improved sensitivity, but research is still limited and it is considered an experimental treatment. It is sometimes combined with shockwave therapy. We will be clear about what the evidence does and does not show, so you can decide whether it is right for you.

Testosterone replacement therapy

Low testosterone is a common contributor to ED, particularly when libido is also low. If blood tests confirm it, testosterone replacement therapy can restore desire and improve how well other ED treatments work. Testosterone alone does not fix ED caused by blood-flow problems, which is why it is often combined with one of the treatments above.

Lifestyle changes that help

Losing excess weight, regular exercise, stopping smoking, cutting back on alcohol and improving sleep can all improve erections on their own, and they make every other treatment work better. For men with vascular ED, these changes also protect the heart. For a broader comparison of options, see our guide to the best ED options.

Which treatment is right for me?

Most men start with tablets, combined with treating any underlying cause such as low testosterone, diabetes or high blood pressure. If tablets do not work or are not suitable, Trimix injections are the most reliable next step. Shockwave therapy and the P-Shot may be options for men who want to improve natural function and understand the evidence is still developing. Your doctor will talk you through the choices and build a plan around your health, goals and preferences.

Frequently asked questions

Is ED treatment confidential?
Yes. Consultations are private, and you can contact us discreetly by WhatsApp to book.

Can young men get ED?
Yes. In younger men, ED is more often linked to stress, anxiety, lifestyle or past steroid use, but a physical cause should still be checked.

Is ED a sign of heart problems?
It can be. Because the penile arteries are small, blood-flow problems often show up there first. That is why we check blood pressure, blood sugar and cholesterol as part of your assessment.

How quickly do treatments work?
Tablets work within 30 to 60 minutes and Trimix within 5 to 15 minutes. Shockwave therapy and the P-Shot, if they help, build up over several weeks.

ED treatment is available at our clinics in Bali and Jakarta. According to the Urology Care Foundation, ED affects up to 30 million men in the US alone and is highly treatable with the right approach.