Erectile Dysfunction: Treatment in Moscow Without Stereotypes
Erectile dysfunction (ED) is a persistent or systematically recurring inability to achieve and maintain an erection sufficient for full sexual intercourse. A diagnosis is established if the problem persists for at least three months.
ED is not synonymous with impotence: the outdated term implied a complete inability to achieve an erection, while the modern concept encompasses a full range of disorders, from weak to completely absent erections.
In 80% of cases, the cause of ED is organic, meaning it can be treated without psychotherapy.
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Important Figures
| Fact | Data |
|---|---|
| Men in Russia suffer from ED to varying degrees | ~49% (data from the Russian Ministry of Health, Kyrgyz Republic 2025) |
| Of these, less than 25% seek medical attention | Less than 25% |
| Treatability with timely treatment | up to 90% |
| Urologists at K+31 | 19 specialists, including 2 professors, 5 doctors of medical sciences |
| Years of experience in robotic-assisted surgery at K+31 | >14 years |
Important: Erectile dysfunction is not a death sentence or "male shame." It is a medical diagnosis with proven treatment methods, approved by the Russian Ministry of Health in 2025. Restore your confidence and a fulfilling intimate life under the supervision of urology and andrology professors at the K+31 Clinic.
Risk factors that aggravate the situation:
- Smoking (impairs microcirculation)
- Alcohol and psychoactive substances
- Obesity, physical inactivity
- Age (risk increases sharply after 40)
- Irregular sex life
Doctors' position K+31: ED is often the first symptom of cardiovascular disease. Timely diagnosis can literally save lives.
Symptoms - When to See a Doctor
7 Signs You Shouldn't Ignore
- An erection develops but disappears before completing intercourse
- The erection is significantly weaker than before
- No morning erections (or they are infrequent)
- Decreased libido, no desire for sex
- Rapid or, conversely, absent ejaculation
- Difficulty achieving an erection only with a partner (with a persistent erection during sleep – psychogenic form)
- Any of the listed symptoms lasts more than 3 months
Important: Don't wait for it to "go away on its own." Every month of delay means the underlying condition is progressing.
Diagnostics at K+31
K+31 uses a diagnostic protocol for ED developed in accordance with the 2025 clinical guidelines of the Russian Ministry of Health and the standards of the European Association of Urology (EAU).
First visit - a complete picture in one visit:
| Stage | What happens |
|---|---|
| History Collection | Confidential Interview: Sexual, Medical, and Psychological History |
| IIEF-5 Questionnaire | Validated Questionnaire for Objectivizing the Degree of ED |
| Physical Examination | Assessment of Secondary Sexual Characteristics, Prostate Palpation |
| Minimum Laboratory Tests | Testosterone, Glucose, A1C, Lipid Profile, Complete Blood Count |
Advanced diagnostics (as indicated):
- Penile Doppler ultrasonography with pharmacological stress is the "gold standard" for assessing blood flow.
- Pelvic ultrasound — prostate and bladder structure.
- Night-time monitoring of nocturnal erections (Rigiscan / LOD device) — differentiating organic and psychogenic ED.
- Pelvic MRI — if anatomical changes are suspected.
- Cavernosography — assessing venous leakage.
- Extended hormonal profile: LH, FSH, prolactin, estradiol, SHBG.
Result: An accurate diagnosis indicating the cause of ED — as early as the first visit or after 2-3 days of waiting for test results.
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- Urologist consultation
- Full diagnostics
- Individual treatment plan
General information
Treatment Methods
ED Treatment at K+31: From Pills to Surgery – Everything in One Clinic
International standards prescribe a stepwise approach: from the least invasive methods to surgical ones. K+31 offers a full range of treatments—you won't find yourself in a situation where you're told, "They don't do it for us, go somewhere else."
Stage 1 — Conservative Treatment
Lifestyle and risk factor modification: Weight management, smoking cessation, and treatment of hypertension and diabetes often restore erections on their own—without a single pill.
Drug therapy:
- PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) are first-line drugs with proven efficacy.
- Testosterone replacement therapy—for confirmed hypogonadism.
- Intracavernous prostaglandin E1 injections—highly effective for unresponsiveness to Tablets
Stage 2 — Hardware Methods (Non-Surgical)
LPD Therapy (Penile Vacuum Therapy): Localized negative pressure increases blood flow in the corpora cavernosa. A safe, painless method, especially effective for mild to moderate organic ED. A course at K+31 consists of 10–15 sessions.
Shock Wave Therapy (LI-ESWT): Low-intensity acoustic pulses stimulate angiogenesis—the growth of new blood vessels in the corpora cavernosa. This is the only method aimed at eliminating the cause, rather than temporarily restoring erectile function. According to double-blind studies, the effectiveness rate is up to 80%. Course: 6–12 sessions, 15–20 minutes each, without anesthesia.
Physiotherapy: Magnetic laser therapy, electromagnetic stimulation of the pelvic floor muscles — as part of a comprehensive treatment for neurogenic and mixed ED.
Stage 3 — Surgical Treatment
Revascularization Surgeries: Microsurgical techniques for restoring penile blood flow — indicated for men under 40 with vascular ED without systemic atherosclerosis.
Phalloplasty (penile endoprosthetics): Installation of a three-component hydraulic prosthesis is a radical and definitive method when all conservative options have failed. Provides a physiologically natural erection on request. The surgery is performed in the K+31 hospital by top-category surgeons, Doctors of Medical Sciences. The risk of complications with proper patient selection is less than 5%.
Principle K+31: We don't prescribe surgery where a pill will suffice. And we don't limit ourselves to a pill where surgery is needed.
Frequently Asked Questions (FAQ)
What is considered normal and what is pathological?
Isolated failures in intimate life are the norm. Pathology is erectile dysfunction, which recurs at least in 25% of attempts and lasts more than 3 months. If this is your situation, it's time to see a doctor.
At what age does ED start?
ED can occur at any age, but its incidence increases after age 40: approximately 40% of men aged 40–60 have some form of disorder. After age 70, the incidence rises to 70%. Important: this is not a "normal part of aging," but a reason for treatment.
Can ED go away on its own?
In the psychogenic form, sometimes yes, especially after the stressor has been eliminated. In the organic form (vascular, hormonal, neurogenic), it progresses without treatment. Delay worsens the prognosis.
Is this treatable or just masked with pills?
It's treatable. Modern urology offers methods to address the cause of ED: shock wave therapy stimulates the growth of new blood vessels, hormonal replacement restores testosterone, and revascularization surgeries restore blood flow. Pills are just one tool, and far from the only one.
Do I need to do anything to prepare for my first appointment?
No special preparation is required. It's a good idea to review any medications you're taking and prepare answers to questions about the duration and nature of any symptoms. Doppler ultrasound may require you to abstain from smoking for two hours and from penile injections.
Will I feel awkward at the appointment?
K+31 urologists see patients with this problem daily. The conversation takes place in a confidential, non-judgmental setting. The doctor asks the necessary questions professionally and tactfully.
Which doctor should treat ED: a urologist or an andrologist?
At K+31, we have urologists and andrologists—specialists with dual specializations who focus specifically on men's health. You won't have to see several doctors one after the other.
Do I need to do all the tests that are prescribed?
The scope of diagnostic tests is determined individually. The minimum required package includes testosterone, glucose, and lipid profile. Extensive tests are prescribed only when indicated, to avoid wasting your money.
How effective is shock wave therapy?
According to clinical studies, the effectiveness of shockwave therapy for ED of vasculogenic origin is up to 80%. It is the only non-invasive method aimed at restoring vascular function rather than providing temporary stimulation. Results last for 12–24 months or more.
What to do if pills (Viagra, Cialis) don’t help?
This means you have a severe organic form of ED. K+31 provides the following steps for such patients: intracavernous injections, LNP therapy, ESWT, or surgical treatment. With modern medical technology, there are virtually no incurable forms of ED.
What is penile prosthesis and is it scary?
Phalloplasty is the insertion of a hydraulic implant into the corpora cavernosa. The procedure takes 60–90 minutes and is performed under general anesthesia. The implant is activated by a pump hidden in the scrotum, creating a natural-feeling erection. 95% of men who undergo penile prosthesis are completely satisfied with the results. At K+31, surgeons with over 10 years of experience perform these procedures.
Is ED treatment compatible with treatment of prostatitis or prostate adenoma?
Yes. K+31 uses a multidisciplinary approach: a urologist manages both areas simultaneously, adjusting treatment strategies based on all diagnoses. This is a real advantage of a professorial clinic.
Is it possible to cure ED after prostate surgery (PCa, BPH)?
Post-prostatectomy ED is treatable. There are specialized protocols: nerve-sparing techniques, early rehabilitation with injections and vacuum therapy, and, if necessary, penile prosthesis. The sooner rehabilitation begins, the higher the likelihood of restoring spontaneous erections.
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Causes and risk factors
An erection is the result of a complex interaction between the nervous, vascular, endocrine and psychological systems. A disorder in any link leads to ED.
Organic causes (~80% of cases):
Psychogenic causes (~20–40% of cases):