ED Treatment Flow: Complete Guide to Diagnosis, Examination, and Prescription

Psychogenic ED is caused by psychological stress, anxiety, and pressure. It is more common in relatively younger men in their 20s to 40s, and is associated with factors such as the following:

• Work-related stress and overwork — Long working hours and interpersonal difficulties
• Performance anxiety — Fear of “What if I fail?”
• Relationship issues with partner — Lack of communication, routine fatigue
• Past negative experiences — Cases where a single failure becomes traumatic
• Depression and anxiety disorders — Underlying mental health issues may be a factor

A key characteristic of psychogenic ED is that erections occur normally during masturbation but not during sexual intercourse with a partner. Additionally, if morning erections (nocturnal penile tumescence) occur normally, psychogenic ED is considered more likely.

Psychogenic ED tends to respond well to ED medications, and by accumulating “successful experiences” with medication, many patients regain confidence and eventually improve without the need for medication.

Organic ED is caused by physical, functional problems in the body. It is more common in men over 50, though those with lifestyle-related diseases may develop it in their 40s.

To briefly explain the mechanism of erection: when sexual stimulation is received, signals are sent from the brain, causing blood to flow into the corpus cavernosum of the penis, resulting in an erection. When blood vessels do not dilate sufficiently and blood cannot adequately reach the corpus cavernosum, the result is an insufficient erection — this is the mechanism behind organic ED.

The main causes of organic ED include:

• Arteriosclerosis — Blood vessels harden due to aging and lifestyle diseases, reducing blood flow
• Diabetes — Damages both blood vessels and nerves, with a high rate of ED occurrence
• Hypertension and dyslipidemia — Reduce vascular flexibility
• Nerve damage following prostate surgery — Cases where nerves involved in erection are affected by surgery
• Smoking and excessive alcohol consumption — Risk factors for vasoconstriction and neuropathy

Even with organic ED, improvement can be expected through treatment with PDE5 inhibitors (ED medications such as Viagra, Cialis, and Levitra). PDE5 inhibitors work by helping to dilate blood vessels in the corpus cavernosum, directly addressing the “insufficient blood flow” that is the root cause of organic ED.

In actual clinical practice, the most common type is mixed ED, which involves both psychogenic and organic factors.

For example, when erectile function begins to decline slightly due to aging (an organic factor), anxiety about sexual performance develops (adding a psychogenic factor), which in turn further worsens ED — creating a vicious cycle.

For mixed ED, the standard treatment approach is to first restore erectile function with ED medications while simultaneously working on lifestyle improvements and stress management. Even if you are unsure which type of ED you have, please rest assured that you can still receive ED treatment without any issues.

While there is a common perception that “ED is a problem for middle-aged and older men,” it can actually occur at any age.

Regardless of age, ED is a treatable condition. There is no need to give up, whether you think “I’m too young for this” or “It’s just part of aging.” ED medications are highly effective regardless of age.

The main topics covered during an ED medical interview and counseling include:

• Current symptoms — When ED symptoms began and how frequently they occur
• Erectile status — Whether you are unable to achieve an erection at all, lose it during intercourse, or experience insufficient rigidity
• Medical history — Whether you have conditions such as heart disease, diabetes, or hypertension
• Current medications — Particularly whether you are taking nitrates (angina medication), as these are contraindicated
• Allergies — Whether you have any drug allergies
• Lifestyle habits — Smoking, alcohol consumption, exercise habits, etc.

The medical interview is conducted as an in-person conversation. At Men’s Care Clinic, male staff members handle all consultations, so you can speak openly without concern about being seen by female staff. Even if you are at the stage of “I’m not sure if it’s ED, but I’d like to discuss it,” please feel free to take advantage of our counseling services.

Many clinics also use a written questionnaire format, so those who find it difficult to explain in detail verbally need not worry. Men’s Care Clinic offers free initial consultations and counseling, so there are no cost concerns either.

In short, physical examinations and genital inspections are typically not required for ED treatment.

The standard ED treatment process involves prescribing appropriate medication based on information obtained during the medical interview. There are no examinations that involve exposing or touching the genital area, so there is absolutely no need to hesitate about seeking treatment due to “embarrassment.”

However, additional tests may be conducted in cases such as:

• Patients with severe diabetes or heart disease
• Cases where ED medications have been ineffective
• Cases where other urological conditions are suspected

Even in such cases, the physician will explain the test details in advance, so please rest assured. Some patients may wonder what medical specialty to visit for ED treatment — in addition to urology, ED-specialized clinics are also available. Men’s Care Clinic specializes in ED treatment, allowing a seamless process from consultation to prescription.

Estimated time: Until arrival

First, make an appointment at the clinic. Men’s Care Clinic offers three booking methods: online booking, LINE booking, and phone booking.

• Online booking — Available 24 hours. Simply select your preferred clinic location and date/time
• LINE booking — Add us as a friend on LINE, then book via chat
• Phone booking — Please call during clinic hours

There is nothing special you need to bring to your visit. Since ED treatment is self-pay, a health insurance card is not required. If you have a medication record book, bringing it can help streamline the process by allowing us to verify your current medications.

Men’s Care Clinic operates three locations: Shimbashi, Akihabara, and Omotesando. All three locations offer the same ED treatment. Each clinic is within walking distance from the nearest train station, making it convenient to visit after work or on weekends.

Estimated time: Approximately 5 minutes

Upon arrival, you will first receive counseling. If you have any concerns or questions about ED treatment, you can ask anything at this point.

During counseling, the following topics are typically covered:

• A review of your ED symptoms
• An explanation of the treatment process and costs
• Your preferences (which medication you may be interested in, etc.)

Counseling at Men’s Care Clinic is completely free of charge. Even if you haven’t decided whether to proceed with treatment, or you just want to learn more, please don’t hesitate to visit. Male staff members handle all interactions, ensuring your privacy and comfort throughout the consultation.

Estimated time: Approximately 5 to 10 minutes

After counseling, you will be seen by a physician. As mentioned earlier, the ED examination is primarily a medical interview.

The physician mainly checks the following three points:

• Safety of prescribing — Presence of heart disease, use of nitrates, etc.
• Which medication is most suitable — Recommendations based on the severity of symptoms and your lifestyle
• Risk of side effects — Review of medical history and allergies

The medical interview is conducted while you remain fully clothed, and physical examinations and blood tests are typically not required. There is no need to undress, so you can approach the consultation without any apprehension.

Patients currently taking nitrates (such as nitroglycerin) for heart conditions should be aware that these medications are contraindicated with ED medications, and a prescription may not be possible. If this applies to you, please consult your primary care physician in advance.

Estimated time: Approximately 3 to 5 minutes

Once the examination confirms that ED medication can be safely prescribed, you will choose the right medication in consultation with the physician.

Men’s Care Clinic offers all three types of ED medications — Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil) — as well as their generic equivalents. If you are unsure which medication is right for you, the physician will recommend the most suitable option based on your symptoms and lifestyle.

Prescriptions are available starting from a single tablet. You will never be asked to sign up for a treatment course or make a bulk purchase. Even if you want to “just try one tablet first,” you can do so with confidence.

Estimated time: Approximately 3 minutes

Once your medication has been selected, payment and medication pickup are completed on-site.

• Payment methods — Cash and credit cards accepted; pay-per-visit
• Initial consultation and counseling fees are free — You only pay for the medication
• In-house dispensing — No need to visit a pharmacy. Medication is dispensed on-site

A follow-up visit is not mandatory. You can return when you need more medication, or you can receive additional prescriptions via online consultation. From the second visit onward, the consultation becomes even more streamlined, taking approximately 5 to 10 minutes to complete the prescription.

The total time from arrival to prescription is approximately 15 to 30 minutes. This is short enough to fit into a break during work or on your way home.

*Individual results may vary. At Men’s Care Clinic, physicians recommend the most suitable medication based on your symptoms and lifestyle. Prescriptions start from 1 tablet with pay-per-visit billing.

Viagra was approved in Japan in 1999 as the world’s first ED medication. Its active ingredient is sildenafil, with over 20 years of clinical experience.

• Onset of action: Takes effect approximately 30-60 minutes after ingestion
• Duration: Approximately 4-6 hours
• Usage tips: Highly affected by food; taking on an empty stomach is recommended
• Common side effects: Facial flushing, headache, nasal congestion, etc. (all temporary and mild)

Viagra is the most well-known ED medication and is likely the first name that comes to mind. Its generic version (sildenafil tablets) is widely available and can be prescribed at a lower cost than the brand-name product.

Levitra was approved in Japan in 2004 as an ED medication with excellent rapid onset of action. Its active ingredient is vardenafil.

• Onset of action: Approximately 15-30 minutes after ingestion — the fastest among the three medications
• Duration: Approximately 5-8 hours
• Usage tips: Less affected by food than Viagra, but it is better to avoid fatty meals beforehand
• Common side effects: Facial flushing, headache, palpitations, etc. (all temporary and mild)

Levitra’s strength lies in its ability to accommodate situations where the need arises unexpectedly during a date, or when it is difficult to predict when to take the medication in advance. Note that the brand-name Levitra is currently discontinued, but its generic version (vardenafil tablets) remains available for prescription.

Cialis was approved in Japan in 2007 and is an ED medication whose standout feature is its exceptionally long duration of action. Its active ingredient is tadalafil, and it is currently the most prescribed ED medication worldwide.

• Onset of action: Approximately 1-3 hours after ingestion (somewhat slower)
• Duration: Approximately 24-36 hours — overwhelmingly the longest
• Usage tips: Minimally affected by food; effectiveness is maintained even when taken after meals
• Common side effects: Headache, dyspepsia, back pain, myalgia, etc. (all temporary and mild)

The greatest appeal of Cialis is that “you don’t need to worry about timing.” Taking it on a Friday evening provides effectiveness through Sunday, earning it the nickname “the weekend pill.” It is especially popular among those who prefer a natural flow leading to sexual activity.

The patents for Viagra, Levitra, and Cialis have all expired, and generic medications (generic equivalents) are available for all three.

Generic medications contain the same active ingredients and provide the same effects as brand-name products, with the key advantage being that they cost approximately half the price of brand-name medications.

Men’s Care Clinic offers both brand-name and generic medications. Whether you prefer to “start with an affordable generic” or “try the brand-name after confirming effectiveness,” we can flexibly accommodate your preferences.

Warning about personally imported ED medications

ED medications available through personal importation from overseas carry an extremely high risk of being counterfeit. Studies have found that approximately 40% of personally imported ED medications circulating in Japan are counterfeit. Counterfeit products may not only lack effective ingredients but may also cause health hazards. Always obtain your prescription from a licensed medical institution.

Blood tests check for underlying conditions that may be causing ED.

• Blood glucose and HbA1c — To check for diabetes
• Lipid levels (LDL cholesterol and triglycerides) — To assess the risk of arteriosclerosis
• Testosterone levels — To determine if low male hormone levels are contributing to ED
• Liver and kidney function — To check the status of organs involved in drug metabolism

Blood tests involve a simple blood draw and are not a major burden. Results are typically available within a few days to one week.

An electrocardiogram or blood pressure measurement may be performed for patients with a history of heart disease or elevated blood pressure.

Because ED medications (PDE5 inhibitors) have a vasodilating effect, they may not be prescribed for patients with severe heart conditions. Electrocardiograms and blood pressure measurements are conducted to determine whether ED medications can be safely used.

While rarely performed in standard ED treatment, the following specialized tests may be conducted for refractory ED or special cases:

• Doppler ultrasound examination — Measures penile blood flow using ultrasound to evaluate the extent of vasculogenic ED
• Nocturnal penile tumescence (NPT) test — Records erections during sleep to differentiate between organic and psychogenic ED
• Neurological examination — Evaluates the function of nerves involved in erection

These specialized tests are not performed at general ED clinics. They are typically conducted at university hospitals or specialized medical institutions when PDE5 inhibitor treatment has proven ineffective. Men’s Care Clinic is affiliated with Toyosu Hospital (Showa University system), enabling smooth referrals to specialized institutions when necessary.

ED treatment is generally self-pay (not covered by insurance). This means the full cost of treatment is borne by the patient.

While “self-pay” may sound expensive, the cost of ED treatment primarily consists of the medication fee, which ranges from a few hundred to approximately 2,000 yen per tablet. At Men’s Care Clinic, the initial consultation and counseling fees are free, so you only pay for the medication.

We do not offer any course contracts or upsell additional options. We prescribe only what you need, on a pay-per-tablet, pay-per-visit basis.

Since April 2022, insurance coverage has been extended to ED treatment specifically for the purpose of fertility treatment.

The conditions for insurance coverage are as follows:

• You must be undergoing fertility treatment (timed intercourse method) with your partner
• The prescription must be obtained from a urology department or an ED-treating medical institution
• Only Viagra (sildenafil) and Cialis (tadalafil) are covered under insurance
• Levitra (vardenafil) is not eligible for insurance coverage

Under insurance coverage, the patient’s co-pay is 30%. However, there are limits on the quantity and frequency of prescriptions, so please consult your physician for details.

At Men’s Care Clinic, initial consultation fees, follow-up consultation fees, and counseling fees are all free. You only pay for the ED medication.

*Specific medication prices vary by type and dosage. Please feel free to inquire during your counseling session.

Patients who wish to receive insurance-covered ED treatment can also confirm their eligibility during their counseling session.

The online consultation process consists of the following four steps:

1. Booking — Schedule an online consultation via the website or LINE
2. Video call examination — Conduct a medical interview with a physician via video call using your smartphone or PC (approximately 10 minutes)
3. Prescription and payment — Upon completion of the examination, the prescription is confirmed and payment is processed online
4. Medication delivery — ED medication is delivered to your designated address (as early as the next day)

The same medications available through in-person visits can also be prescribed via online consultation. The medical interview content is identical to that of an in-person visit.

For first-time ED treatment, an in-person visit provides greater reassurance. However, for repeat prescriptions from the second visit onward, online consultation is more convenient. You can choose whichever option best suits your lifestyle.