Exploring the latest treatments for erectile dysfunction: A doctor’s perspective

Written in association with: Mr Gerasimos Fragkoulis
Published: | Updated: 23/01/2025
Edited by: Karolyn Judge

Erectile dysfunction (ED) is a common condition affecting men of all ages, particularly as they get older. It can significantly impact quality of life and self-esteem. Advances in medical science have introduced a range of treatments that offer hope and effective solutions. From lifestyle changes to cutting-edge therapies, understanding the available options is vital for improving outcomes.

 

Man considering the latest treatments for ED.

 

What causes erectile dysfunction?

 

Erectile dysfunction occurs when there is difficulty achieving or maintaining an erection firm enough for sexual activity. Common causes include:

  • Physical factors: Cardiovascular disease, diabetes, obesity and hormonal imbalances.
  • Psychological factors: Stress, anxiety, depression or relationship issues.
  • Lifestyle factors: Smoking, excessive alcohol consumption and a sedentary lifestyle.

A thorough medical assessment is essential to identify the underlying cause and guide treatment.

 

 

First-line treatments for ED

 

  • Lifestyle modifications:
    • Adopting a healthier lifestyle, such as regular exercise, weight management, and a balanced diet, can improve vascular health and erectile function.
    • Quitting smoking and reducing alcohol intake are also crucial.
  • Oral medications:
    • PDE5 inhibitors: Medications like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) enhance blood flow to the penis, making it easier to achieve an erection. These are effective for most men but require sexual stimulation to work.
    • Side effects may include headaches, flushing or indigestion.

 

 

Cutting-edge treatments

 

  1. Low-intensity shockwave therapy (LiSWT):
    • This non-invasive treatment uses sound waves to improve blood flow and promote tissue regeneration in the penile area.
    • It is particularly promising for men with mild to moderate ED caused by vascular issues.
  2. Platelet-rich plasma (PRP) therapy:
    • PRP involves injecting a patient’s own plasma, enriched with growth factors, into the penile tissues.
    • This therapy aims to repair damaged tissues and enhance erectile function, with several studies showing a definite improvement.
  3. Testosterone replacement therapy (TRT):
    • For men with low testosterone levels, TRT can improve libido and erectile function.
    • It is available in various forms, including injections, gels, and patches, but requires careful monitoring by a doctor.
  4. Vacuum erection devices (VEDs):
    • A non-invasive option that uses a vacuum pump to draw blood into the penis, creating an erection.
    • A constriction ring is placed at the base of the penis to maintain the erection during intercourse.

 

 

Advanced medical and surgical options

 

  • Penile injections: Medications like alprostadil can be injected directly into the penis to induce an erection.
  • Urethral suppositories: Alprostadil may also be administered via a small pellet inserted into the urethra.
  • Penile implants:
    • For men who do not respond to other treatments, surgically implanted devices can provide reliable results.
    • Implants are available in inflatable or semi-rigid forms and are customised to suit the patient’s needs.

 

 

Psychological support and counselling

 

Since psychological factors often contribute to ED, addressing mental health is an essential part of treatment. Options include:

  • Cognitive behavioural therapy (CBT): To manage anxiety or performance-related concerns.
  • Couples therapy: To improve communication and address relationship issues.

 

 

The importance of consulting a specialist

 

Seeking help from a urologist or sexual health specialist is critical for tailored treatment. They can perform tests, such as hormone level assessments or vascular evaluations, to determine the most suitable therapy.

 

By exploring the latest treatments and addressing underlying causes, men can regain confidence and enjoy an improved quality of life. Consulting a medical expert is the first step toward effective management and long-term solutions for erectile dysfunction.

By Mr Gerasimos Fragkoulis
Urology

Dr Gerasimos Fragkoulis is a consultant urological surgeon in London, who specialises in General Urology, Andrology and Robotic surgery He privately practises at Moorgate Andrology and also has his own private practice in Athens, Greece.

Dr Fragkoulis has extensive training and experience in urology and andrology, having performed over 4,000 surgical and non-surgical procedures. His expertise spans minimally invasive surgery, robotic surgery and aesthetic andrology.

His advanced training includes two fellowships in robotic pelvic uro-oncology, one at the Royal Surrey County Hospital in Guildford and the other at Bradford Royal Infirmary. During these fellowships, he focused on robotic surgery and the management of malignancies of the prostate, bladder, and kidney. He also gained certification in robotic surgery through the European Association of Urology (EAU) protocol at the ORSI Academy in Belgium and completed advanced courses in laparoscopic urology in Strasbourg with scholarship from the Hellenic Urological Society.

Dr Fragkoulis began his medical career with a Degree in Medicine from the University of Patras, followed by a Master's degree in minimally invasive surgery, robotic surgery, and telesurgery from the University of Athens. He completed his PhD in Medicine at the National and Kapodistrian University of Athens, with his research focusing on cutting-edge developments in urology. His specialist training in general urology, uro-oncology, and andrology was undertaken at the General Hospital of Athens, where he later worked as a consultant urologist for three years before moving to the UK.

In addition to his clinical work, Dr Fragkoulis is actively involved in education and research. He trains junior urologists and medical students, having taught students at the University of Surrey and the University of Leeds. He has also published numerous articles in peer-reviewed journals and regularly presents at national and international conferences on topics such as robotic surgery, gynaecological urology, and andrology. He serves as a reviewer for the Journal of Robotic Surgery and the Journal of Clinical Urology.

Dr Fragkoulis is particularly sought after in the UK for his expertise in penis enlargement surgery and non-surgical procedures such as penis fillers, platelet-rich plasma (PRP) therapy, shockwave therapy, and botulinum toxin injections for erectile dysfunction. His vast experience in this area has made him one of the leading specialists in aesthetic andrological treatments in the country.

A member of several prestigious professional organisations, Dr Fragkoulis is a Fellow of the European Board of Urology and the European Committee of Sexual Medicine. He is also affiliated with the Hellenic Urological Society, the European Urological Association, the Société Internationale d’Urologie (SIU), the International Society for Sexual Medicine (ISSM), and the European Society for Sexual Medicine (ESSM).

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