Treatment Options for Erectile Dysfunction
Erectile dysfunction (ED) is one of the most common men’s health concerns, affecting millions of men worldwide. While it is often under-discussed due to stigma and embarrassment, ED is often a treatable condition, and addressing it can significantly improve both physical and emotional well-being. ED can arise from a range of health issues including a decline in vascular health and endothelial function, hormone changes and dysregulation, psychological components, pharmacologic factors, or neurological issues. Because the etiology is often multifactorial, a multimodal approach looking at pathophysiology of ED as well as metabolic, lifestyle and hormone health is essential for targeting effective treatment.
Kass Precision Medicine helps patients navigate the erectile dysfunction treatment landscape.
This blog will outline the standard of care treatments for ED in addition to investigational and alternative treatments.
1. Oral Medication Interventions
Oral medications - known as PDE5 inhibitors - are often the first-line treatment for erectile dysfunction. These medications work by enhancing the natural effects of nitric oxide, a chemical the body produces to relax the blood vessels in the penis. This relaxation improves blood flow, helping achieve and maintain an erection during sexual stimulation.
Oral PDE5 inhibitors do not automatically cause an erection - they simply enhance your ability to initiate and maintain an erection, but still require both physical stimulation and mental arousal.
Common PDE5 inhibitors include:
Sildenafil (Viagra)*
Tadalafil (Cialis)*
Vardenafil (Levitra)*
Avanafil (Stendra)*
* Sometimes we combine these oral medications together - such as a Viagra/Cialis tablet - or augment traditional PDE5s with alternative erectile enhancers like apomorphine.
At KPM, we partner with specialty pharmacies to offer customized formulations, including combination PDE5 medications and rapid-dissolve or sublingual tablets designed for faster absorption and more convenient use.
These medications are typically taken by mouth 1–2 hours before sexual activity. Their effects can last anywhere from 12 to 36 hours, depending on the specific drug and dose.
You can learn more about oral medications on our Review of Oral and Injectable Medications blog post.
2. Penis Pump (Vacuum Erection Device)
Our clinic often incorporates vacuum erection devices (VEDs) as part of a comprehensive strategy to improve erectile function and overall penile health. Vacuum erection devices can be prescribed by a doctor and used with a ring at the base of the penis to sustain an erection during sex. We more frequently prescribe the use of a penis pump WITHOUT a ring as a therapeutic exercise. When used as a therapeutic exercise (NO ring) rather than solely for intercourse, these devices help train the vascular and smooth muscle tissues of the penis much like physical therapy for any other body part. Over time, this therapeutic exercise may support stronger, more natural erections.
Regular, properly guided use of a penis pump gently draws oxygen-rich blood into the erectile chambers (the corpora cavernosa), helping maintain elasticity of the tissue and preventing fibrosis—a common cause of diminished erectile quality or shrinkage over time. By expanding and relaxing the penile tissue under mild, controlled negative pressure, the device encourages microvascular repair and may stimulate the formation of new capillaries. This repeated engorgement helps preserve (and in some cases improve) penile length and girth by keeping the erectile structures well-oxygenated and pliable.
Beyond its standalone benefits, VED therapy is particularly valuable as a complementary tool following regenerative treatments such as low-intensity shockwave therapy or platelet-rich plasma (P-Shot) injections. Using the device between sessions promotes consistent blood flow and maximizes tissue responsiveness, supporting the body’s natural healing and vascular remodeling processes. Over time, patients often report stronger, more spontaneous erections and improved confidence in sexual function.
Our team provides individualized coaching on proper technique, device selection, and frequency of use to ensure both safety and effectiveness.
For a deeper dive into evidence-based uses, visit our Penis Pumps for Erectile Dysfunction: Fact vs. Fiction blog post.
3. Injectable Medications
Injectable Intracavernosal Medications
For men who do not respond well to oral medications or experience extreme side effects, intracavernosal injections can be a highly effective alternative. These medications - such as Alprostadil, Trimix, and Bimix - are injected with a fine insulin needle at the base of the penis, typically about 10–15 minutes before sexual activity.
These injections work by directly relaxing the smooth muscle and increasing blood flow to the penis, often producing a reliable and firm erection. While generally safe when used as directed, potential side effects can include mild pain, bruising, or scar tissue formation at the injection site. Priapism, i.e., an erection that lasts more than four hours, is a more common risk of this medication compared to oral medications like Viagra.
We provide detailed instruction and support to ensure patients feel comfortable and confident administering these medications safely and effectively.
Emerging and Alternative Injectable Treatments
Bremelanotide, also known as PT-141, represents a new class of injectable medications for sexual dysfunction. Unlike traditional erectile dysfunction treatments that focus on improving blood flow to the penis, PT-141 acts on the central nervous system, stimulating melanocortin receptors in the brain that play a role in sexual desire and arousal.
PT-141 is administered as a subcutaneous injection, typically into the lower abdomen or thigh, about 1-2 hours before sexual activity. While the medication is FDA-approved for premenopausal women with low sexual desire, it is not yet approved for men. However, early studies and clinical use suggest potential benefits in enhancing libido and improving sexual response, particularly in men who have not responded to conventional ED therapies. There are challenges with this mediation, including timing, and side effects like nausea and darkening of the skin.
At our clinic, PT-141 may be discussed as an off-label, experimental option for carefully selected patients seeking an alternative or complementary approach to traditional ED treatments.
You can learn more about injectable medications on our Review of Oral and Injectable Medications and Understanding Trimix and Intracavernosal Injections blog posts.
4. Investigational / Regenerative Treatments
Since most cases of erectile dysfunction are linked to declines in vascular health and blood flow, therapies that enhance blood vessel function and penile tissue health can be particularly effective. Recent advances in medical research have highlighted several innovative treatment options that go beyond traditional oral medications and are demonstrating promising results in clinical studies.
ED Low-Intensity Shockwave Therapy (GAINSWave Therapy)
Low-Intensity Shockwave Therapy (LiSWT), also known as GAINSWave Therapy, is a non-invasive treatment for erectile dysfunction that has gained attention for its ability to improve vascular health in the penis. While it is considered investigational for ED, this technology has a long track record in orthopedics, sports medicine, and urology, and numerous clinical studies suggest it can enhance blood vessel density and function, leading to stronger, more sustainable erections.
LiSWT works by delivering high-frequency acoustic waves to the penile tissue, stimulating revascularization (the formation of new blood vessels and improved blood flow). Men with ED, and those looking to enhance performance, might recognize fuller and firmer erections following a series of shockwave treatments.
More than twenty randomized controlled trials have demonstrated improvements in erectile function scores, particularly in men with mild to moderate vascular ED. Clinical research highlights several mechanisms by which shockwave therapy improves erectile function:
Angiogenesis (neovascularization): Shockwave causes micro-stress in the penile tissues, upregulating growth factors such as VEGF, eNOS, and PCNA. These growth factors stimulate neovascularization, or the growth of new blood vessels in the penis.
Enhanced endothelial function : The endothelium is the inner lining of the blood vessel and is critical for creating erectile rigidity because it releases nitric oxide, the chemical that causes blood vessels to dilate and relax. Via growth factors and recruitment of stem and Progenitor cells, shockwave therapy appears to improve the function of the endothelium and the production of nitric oxide.
Neurogenic regeneration (potential nerve repair): May stimulate nerve tissue formation, improving sensitivity. Data on this mechanism is early and limited in humans.
Antifibrotic tissue and tissue remodeling effect: Chronic ED often involves fibrosis and reduced compliance (ability of the tissue to stretch and expand) of the penile tissue. There is some evidence that LiSWT may exert some antifibrotic effects in the penile tissue.
According to the 2018 American Urological Association guidelines, LiSWT remains an investigational therapy, but ongoing research continues to support its potential benefits.
At Kass Precision Medicine, we have been providing LiSWT for over ten years, performing thousands of treatments since introducing GAINSWave in the U.S.
Visit our What is Low-Intensity Shockwave Therapy and How Shockwave Therapy Works pages to learn more.
Platelet-Rich Plasma for Erectile Dysfunction (The Priapus-Shot / P-Shot)
The Priapus Shot, or P-Shot, uses platelet-rich plasma (PRP) derived from your own blood to enhance erectile function, penile health, sensation, and stamina, leading to stronger and more frequent erections.
PRP therapy was first popularized in orthopedic and sports medicine to accelerate tissue healing, and it has since been adapted for erectile dysfunction. During the procedure, blood is drawn from your arm, and growth factors are separated from out and re-injected into the penile tissue. These growth factors help mobilize local stem cells, promoting tissue regeneration and the formation of new vascular networks, which improves blood flow and erectile quality. PRP appears to have some synergistic effects when combined with LiSWT. Kass Precision Medicine frequently combines these modalities.
The P-Shot is a minimally invasive treatment that is frequently added onto a shockwave therapy day. The injection itself takes a few minutes and is generally received with little to no discomfort.
You can learn more on our P-Shot page.
Therapeutic Botox for Erectile Dysfunction
Medical research suggests that Botox may be a safe and potentially effective treatment for ED. A single intracavernosal injection (directly into the penis) has been shown to improve vascular function and penile health and improved responsiveness to medication.
In a placebo-controlled trial involving 176 men, Botox injections were associated with improvements in erectile responsiveness, medication effectiveness, and even the size of both the flaccid and erect penis.
At KPM, we work closely with patients to determine whether they are suitable candidates for therapeutic botox, which is considered an investigational treatment. Therapeutic botox is an investigational treatment for ED and is not considered a first-line treatment or conventional treatment for erectile dysfunction. However, it may be an option for men seeking innovative approaches when conventional treatments have been insufficient.
Visit our Therapeutic Botox for ED page to learn more.
5. Penile Implants
Penile implants are a surgical option for men with erectile dysfunction who have not responded to medications, injections, regenerative treatments, or other less invasive therapies. Penile implants can provide a reliable solution for severe or treatment-resistant ED.
There are two main types of implants:
Inflatable implants: These devices can be manually inflated to create an erection and deflated afterward. They offer a natural look and feel.
Semi-rigid (malleable) implants: These rods remain firm but flexible, allowing the penis to be positioned as needed.
Penile implant surgery is typically performed on an outpatient basis and has a high rate of patient and partner satisfaction. This is a permanent and irreversible treatment for ED. We do offer referrals to penile implant surgeons in the Seattle area when appropriate.