3. Erectile Dysfunction Treatment Available at Radiant STD Clinic

Treatment is individualized according to the cause, severity, medical history and patient preference.

A. Oral medicines for erectile dysfunction

Oral PDE5 inhibitors, such as sildenafil and tadalafil, are established first-line treatments for most men with ED. They improve blood flow to the penis during sexual stimulation.

• Sildenafil: commonly used for on-demand treatment.

• Tadalafil: may be used on demand or as a daily regimen in selected patients.

A doctor should assess contraindications, other medicines and cardiovascular risk before prescribing. These medicines must not be combined with nitrate medications because of the risk of dangerous hypotension.

B. Low-intensity shockwave therapy

Low-intensity extracorporeal shockwave therapy (Li-ESWT) is a non-invasive treatment being studied for men with predominantly blood-flow-related ED. It uses acoustic waves applied to penile tissue, with the aim of improving vascular function.

Some clinical guidelines allow consideration of this treatment in selected patients with mild vasculogenic ED. However, evidence remains inconsistent, and the 2026 sexual medicine position statement recommends against routine use of energy-based restorative treatments outside research. Patients should understand the uncertainty before choosing it.

C. P-Shot (Platelet-Rich Plasma)

The P-Shot is a procedure involving injection of platelet-rich plasma (PRP) into penile tissue. It is promoted as a regenerative treatment, but current evidence is insufficient to establish reliable benefits or standardized treatment protocols.

PRP should be discussed as an experimental option rather than a proven cure. It should not replace established ED treatment or evaluation of underlying disease.

D. Pelvic floor exercise training

Pelvic floor muscle training may help selected men improve erection control and pelvic muscle function. Training generally involves identifying and contracting the correct muscles, holding contractions briefly, relaxing fully and practicing consistently.

A structured program may include:

• Correct identification of pelvic floor muscles.

• Controlled contractions and complete relaxation.

• Gradual progression in duration and repetitions.

• Guidance from a trained professional when needed.

Exercises should not involve repeatedly stopping urine flow as a regular workout. Pelvic floor training is a supportive treatment and may be combined with medical management.

E. Lifestyle changes and psychological support

Regular physical activity, smoking cessation, moderation of alcohol, adequate sleep, weight management and good diabetes control can support erectile function. When anxiety, depression or relationship stress contributes to ED, psychosexual counselling or cognitive behavioural therapy may be helpful.

4. Diagnosis and Evaluation Before Treatment

A consultation for ED may include:

1. Medical, sexual and medication history.

2. Assessment of erection quality, duration and frequency.

3. Blood pressure and relevant physical examination.

4. Blood glucose or HbA1c and lipid profile.

5. Morning total testosterone when indicated.

6. Further investigations if the history or examination suggests a specific cause.

This assessment helps distinguish vascular, hormonal, medication-related and psychological contributors and guides appropriate treatment.

5. Why Choose Radiant STD Clinic in Kathmandu?

Radiant STD Clinic offers a setting for men seeking consultation about erectile dysfunction and sexual health concerns. Under the care of Dr. Kamal Raj Dhital, MD Dermatology, who has a fellowship in Sexual Medicine from India (2018) and over 10 years of experience, patients can discuss their symptoms and treatment options.

Reasons to consider a consultation include:

• Individualized assessment: Treatment choices based on the patient’s symptoms, health and expectations.

• Medical treatment: Discussion of established oral medicines and other appropriate options.

• Multiple treatment approaches: Consultation about shockwave therapy, P-Shot and pelvic floor training, with clear explanation of evidence and limitations.

• Sexual health consultation: An opportunity to discuss sensitive concerns in a clinical setting.

• Follow-up: Review of treatment response, side effects and any need for further evaluation.

No treatment can guarantee a cure, and the appropriate option depends on the individual diagnosis. The aim is to support informed decisions and address both sexual function and underlying health.

6. Frequently Asked Questions

Is erectile dysfunction common in young men?

Yes. Younger men can experience ED, often with psychological, lifestyle or mixed contributors, although physical causes can also occur.

Can erectile dysfunction be permanently cured?

Some reversible causes can be corrected, while chronic conditions may require ongoing management. Outcomes depend on the cause and general health.

Is shockwave therapy painful?

It is generally described as a non-invasive procedure, but comfort and response vary. Its long-term effectiveness remains uncertain.

Does the P-Shot increase penis size?

There is no reliable evidence establishing the P-Shot as a method for permanent penile enlargement.

When should I consult a doctor?

Seek assessment if erection difficulties are persistent, recurring, distressing or associated with other symptoms. Sudden ED with chest pain or significant cardiovascular symptoms warrants urgent medical attention.