Erectile Dysfunction Clinic in London: What to Expect
Updated: Aug 19
An erectile dysfunction clinic in London should do more than offer a procedure. A careful assessment looks for vascular, metabolic, hormonal, medication-related and psychological contributors, then explains established treatments before discussing newer options such as low-intensity shockwave therapy or platelet-rich plasma.
The goal of a first consultation is to understand why erections have changed and to agree a safe, evidence-based plan—not to assume that every patient needs the same treatment.
When should you see an erectile dysfunction specialist?
Occasional erection difficulty is common. Assessment is sensible when the problem persists, causes distress, affects a relationship or appears together with other symptoms.
Erections are consistently difficult to achieve or maintain.
The change was sudden, unexplained or followed surgery, pelvic treatment or injury.
There is penile pain, a new lump or curvature suggesting Peyronie’s disease.
Libido, energy or morning erections have changed and a hormonal cause is possible.
There are cardiovascular risk factors such as diabetes, high blood pressure, smoking or high cholesterol.
Tablets have not worked, caused side effects or may be unsuitable.
Erectile dysfunction can sometimes be an early sign of vascular disease. It is therefore important to assess general health rather than treating ED as an isolated symptom.
What happens at an ED consultation in London?
1. Confidential medical and sexual history
The consultation usually covers the pattern and duration of symptoms, morning erections, libido, ejaculation, relationship factors, previous treatments, current medicines and relevant medical conditions. Questions are direct but confidential and help separate likely physical and psychological contributors.
2. Cardiovascular and metabolic risk review
Blood pressure, weight, diabetes risk, cholesterol, smoking, sleep, exercise and family history may be relevant. Where indicated, the doctor may coordinate further cardiovascular assessment because sexual and vascular health are closely connected.
3. Examination and targeted tests
Examination is guided by symptoms and may include the penis, testes, prostate or vascular findings. Blood tests can include glucose or HbA1c, lipids and morning testosterone; other tests are selected only when clinically useful. Penile Doppler ultrasound is not necessary for everyone but can help in selected cases.
Evidence-based erectile dysfunction treatments
Lifestyle and reversible contributors
Regular physical activity, weight management, stopping smoking, moderating alcohol, improving sleep and controlling diabetes or blood pressure can support erectile function and overall health. Medicines that may contribute to ED should be reviewed with the prescribing clinician rather than stopped without advice.
PDE5 inhibitor tablets
Medicines such as sildenafil or tadalafil are established first-line options for many men. Correct timing, dose, sexual stimulation and repeated properly supervised use matter. They must not be combined with nitrate medicines, and suitability depends on cardiovascular health and other treatments.
Psychosexual support
Performance anxiety, stress, depression and relationship difficulties can cause or amplify ED. Psychosexual therapy can be used alone or alongside medical treatment and is especially helpful when symptoms vary by situation.
Vacuum devices, injections and surgery
Vacuum erection devices and intracavernosal injections are established options for selected patients. Penile prosthesis surgery may be considered when less invasive treatments are ineffective or unsuitable. The choice depends on goals, dexterity, medical history and tolerance of risk.
Low-intensity shockwave therapy
Low-intensity shockwave therapy has been studied mainly for mild vasculogenic erectile dysfunction. European guidance gives a weak recommendation for selected patients because average benefit is modest and results vary. Device type, energy settings and protocol should be explained clearly.
Read the detailed guide to shockwave therapy for erectile dysfunction.
PRP, P-Shot and the P-Shocks approach
A P-Shot is a marketing name commonly used for penile PRP injections. PRP is prepared from the patient’s own blood, but autologous treatment is not risk-free. Evidence remains insufficient for routine ED care, and European guidance limits PRP to clinical-trial settings.
P-Shocks is the clinic’s name for an individually planned combination that may include assessment, shockwave therapy, PRP, a vacuum device and established treatments. The combination itself has not been proven to create a synergistic benefit. Each component should therefore be discussed separately, with alternatives, uncertainty, risks and costs made clear.
Compare the components in P-Shocks vs P-Shot: evidence, differences and risks.
Erectile dysfunction and Peyronie’s disease
ED and Peyronie’s disease can occur together. A new bend, indentation, penile shortening, palpable plaque or painful erection needs a focused assessment. Shockwave therapy may reduce pain in some men with Peyronie’s disease, but it has not reliably corrected curvature or plaque.
See the guide to non-surgical treatments for Peyronie’s disease.
How to choose an erectile dysfunction clinic
Check that the treating doctor is appropriately registered and experienced in male sexual medicine.
Ask whether the consultation investigates cardiovascular, metabolic, hormonal and psychological contributors.
Expect established treatments and no-treatment options to be discussed before experimental procedures.
Request realistic information about benefits, uncertainties, risks, total cost and follow-up.
Be cautious of guarantees, dramatic size claims, fixed packages offered before assessment or pressure to pay immediately.
Preparing for your appointment
Bring a list of medicines, supplements, allergies and previous ED treatments.
Note when symptoms began and whether morning or masturbation erections are different.
Bring recent blood-test or cardiovascular results if available.
Write down priorities such as spontaneity, firmness, curvature, fertility or recovery after surgery.
If comfortable, a partner can attend, but this is not required.
Frequently asked questions
Can erectile dysfunction be reversed?
Sometimes. Improvement depends on the cause. Lifestyle change, better control of diabetes or blood pressure, medication review, psychological support and appropriate treatment can all help, but no responsible clinic can promise a permanent cure.
Does ED mean I have heart disease?
Not necessarily, but ED and cardiovascular disease share risk factors. New or unexplained ED can justify a cardiovascular risk review, particularly in men with diabetes, smoking, high blood pressure or a family history.
Is shockwave therapy suitable for every patient?
No. Evidence is most relevant to selected men with vasculogenic ED. It is less certain for severe ED, major nerve injury or advanced structural disease, so assessment matters.
Is PRP or the P-Shot an established ED treatment?
No. Small studies exist, but evidence is not strong enough for routine recommendation. Patients should understand the investigational status and compare it with established options.
Private ED assessment at 9 Harley Street
Dr Fabio Castiglione provides confidential assessment for erectile dysfunction at Holistic Andrology, 9 Harley Street, London W1G 9QY. The consultation is designed to identify likely causes, review proven options and decide whether any newer treatment is appropriate for the individual patient.
For clinic information or to request an appointment, visit P-Shocks London.
Medical review and evidence
Medically reviewed by Dr Fabio Castiglione, Consultant Urologist and Andrologist. Last reviewed: 19 August 2026.
Erectile dysfunction can have vascular, metabolic, hormonal, medication-related and psychological contributors. Assessment and established first-line options should be discussed before any procedure.
This article is for general education and is not a diagnosis or individual medical recommendation. A consultation should review medical and sexual history, current medicines, examination findings and tests when clinically indicated.
Clinical sources
European Association of Urology: Management of Erectile Dysfunction
About the author
Dr Fabio Castiglione
Consultant Urologist and Andrologist in London. Holistic Andrology, 9 Harley Street, London W1G 9QY.
GMC reference number: 7541824
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