What is erectile dysfunction?
Erectile dysfunction (ED) is the persistent difficulty getting or keeping an erection firm enough for satisfying sex. It is very common, especially with age, and it is a medical condition, not a personal failing. The NHS erectile dysfunction guide explains causes and treatments.
Symptoms
- Difficulty getting an erection
- Difficulty keeping an erection
- Reduced firmness
- Sometimes reduced sexual desire (which may suggest low testosterone or other causes)
Occasional problems are normal. ED is usually diagnosed when difficulties are persistent over several months.
Causes
An erection depends on healthy blood vessels, nerves, hormones and mental wellbeing. Common causes:
- Vascular: narrowed arteries from high blood pressure, high cholesterol, smoking or diabetes
- Diabetes: affects both blood vessels and nerves (see type 2 diabetes)
- Nerve damage: prostate cancer surgery, pelvic surgery, spinal cord injury, multiple sclerosis
- Hormonal: low testosterone, thyroid disease
- Medicines: some blood pressure medicines, antidepressants, anti-androgens
- Psychological: stress, anxiety, depression, relationship issues
- Lifestyle: obesity, inactivity, heavy alcohol use
- Peyronie’s disease (penile curvature from scar tissue)
ED and heart health
ED can be an early warning sign of cardiovascular disease. Because penile arteries are small, they may narrow before the coronary arteries cause symptoms. Any man with new ED should have heart risk factors checked. This is also why our medical team asks about heart health before any treatment.
Diagnosis
| Test | Purpose |
|---|---|
| Medical and sexual history, IIEF-5 questionnaire | Assess severity and likely cause |
| Blood pressure, BMI | Cardiovascular risk |
| Blood sugar (HbA1c), cholesterol | Diabetes and vascular risk |
| Morning testosterone | Hormonal causes |
| Penile Doppler ultrasound | Blood flow to and from the penis |
| Cardiac assessment | When heart risk is raised |
If you have recent blood tests or a Doppler ultrasound, you can send your reports for a confidential doctor review.
Proven treatments first
- Lifestyle changes. Weight loss, exercise, stopping smoking and reducing alcohol can improve erectile function.
- Treat underlying conditions. Diabetes, blood pressure, cholesterol, low testosterone.
- PDE5 inhibitors. Sildenafil, tadalafil, vardenafil, avanafil. Not safe with nitrate medicines.
- Vacuum erection devices.
- Penile injections or urethral alprostadil.
- Psychosexual therapy, especially when anxiety or relationship issues play a role.
- Penile prosthesis (implant) for men who do not respond to other options; high satisfaction rates.
- Penile rehabilitation after prostate surgery.
Regenerative options: what the evidence shows
| Option | Rationale | Evidence level |
|---|---|---|
| Stem cell therapy | Cells may release growth factors supporting blood vessels and nerves | Small phase 1/2 studies; experimental |
| PRP injections | Platelet growth factors may improve blood vessel function | Mixed randomised trials; experimental per guidelines |
| Low-intensity shockwave therapy | May stimulate new small blood vessels | Several trials; weak guideline recommendation for mild vasculogenic ED |
| Exosomes | Cell-derived signals | Animal studies only |
Stem cells
Stem cell therapy for ED has been tested in small groups, including men after radical prostatectomy (Haahr et al., EBioMedicine, 2016) and men with diabetes. These studies reported acceptable safety and some improvement in erectile function scores, but they lacked placebo groups and were small. Systematic reviews conclude that larger controlled trials are needed.
PRP
PRP therapy for ED has the most trial data among regenerative options, but findings conflict. A randomised placebo-controlled trial by Poulios and colleagues (2021) reported improvement in mild to moderate ED, while a later randomised trial by Masterson and colleagues (2023) found no significant difference from placebo. The American Urological Association guideline considers PRP for ED investigational.
Regulatory status
No stem cell product is approved for ED by the US FDA, the UK MHRA or Australia’s TGA. The FDA warns about unapproved stem cell therapies. Many men from the UK, Australia and the US explore these options abroad, and should do so with clear expectations.
Who may be a candidate, and who should not
May be considered for review:
- Mild to moderate ED, especially of vascular origin
- Partial or no response to tablets, or side effects from them
- Heart risk factors checked and stable
- Realistic expectations; willing to continue lifestyle change
Should not:
- Unexplained new ED without heart risk assessment
- Unstable heart disease or recent heart attack or stroke
- Active infection, penile or urinary tract infection
- Active cancer, including untreated prostate cancer
- Bleeding disorders or anticoagulants that cannot be managed
- Severe Peyronie’s disease (needs urology review)
Risks
- Pain, bruising or swelling at the injection site
- Infection (rare)
- Penile curvature or scarring (rare)
- Prolonged erection (priapism, rare, more with other injections)
- No improvement
Cells are prepared in ISO 9001:2015-certified partner laboratories.
What a Bangkok program looks like
- Send your records confidentially. Blood tests, testosterone, any Doppler ultrasound, medication list.
- Doctor review. An honest opinion on causes and options, which may include standard treatment.
- Private assessment in Bangkok. Examination, blood tests and heart risk review.
- Treatment plan, if suitable, often combined with metabolic and vascular health support through our longevity program.
- Follow-up with progress questionnaires.
See how it works for travel and privacy details.
Aftercare
- Avoid sexual activity for the period your doctor advises after injections
- Mild bruising is common; seek care for severe pain, swelling or an erection lasting more than 4 hours
- Continue exercise, healthy eating and avoid smoking
- Keep managing blood pressure, blood sugar and cholesterol
- Track changes with a standard questionnaire such as IIEF-5
Sources
- NHS: Erectile dysfunction (impotence)
- Haahr MK, et al. Safety and potential effect of a single intracavernous injection of autologous adipose-derived regenerative cells in patients with erectile dysfunction following radical prostatectomy. EBioMedicine, 2016.
- Poulios E, et al. Platelet-rich plasma for the treatment of erectile dysfunction: a prospective, randomized, double-blind, placebo-controlled trial. Journal of Sexual Medicine, 2021.
- Masterson TA, et al. Platelet-rich plasma for the treatment of erectile dysfunction: a prospective, randomized, double-blind, placebo-controlled clinical trial. Journal of Urology, 2023.
- American Urological Association. Erectile Dysfunction Guideline.
- U.S. FDA: Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes
Frequently asked questions
Do stem cells work for erectile dysfunction?
Evidence is early. Small phase 1 studies, such as one in men after prostate removal (Haahr et al., EBioMedicine, 2016), reported acceptable safety and improvement in some participants. There are no large randomised trials proving benefit.
Does PRP work for erectile dysfunction?
Results are mixed. One randomised placebo-controlled trial (Poulios et al., Journal of Sexual Medicine, 2021) reported benefit in mild to moderate ED, while another (Masterson et al., Journal of Urology, 2023) found no significant difference from placebo. Urology guidelines regard PRP for ED as experimental.
Is erectile dysfunction a sign of heart disease?
It can be. The blood vessels in the penis are small, so ED can appear years before heart symptoms. Men with new ED should have blood pressure, cholesterol, blood sugar and heart risk checked.
What is the most effective treatment for ED?
PDE5 inhibitors such as sildenafil and tadalafil work for many men. If they do not, penile injections, vacuum devices or a penile implant are effective options. Treating underlying causes and lifestyle changes also help.
Is shockwave therapy for ED worthwhile?
Low-intensity shockwave therapy has some positive trials in mild vasculogenic ED, but results vary and long-term data are limited. European urology guidelines give it a weak recommendation for selected men.
Is a consultation confidential?
Yes. Your messages and reports are reviewed confidentially by a doctor. You can send your test results on WhatsApp for a free, private review and a personalised program.
This page is general information, not medical advice, and does not replace a consultation with your own doctor. Results vary and no treatment outcome can be guaranteed. We are a patient coordination service and may receive a referral fee from partner medical providers. See our medical disclaimer and referral disclosure.