P-Shocks for Erectile Dysfunction in London: Assessment
Updated: Aug 19
P-Shocks is the name used at Holistic Andrology for an assessment-led pathway for men with erectile dysfunction. It is not a single universally standardised medical treatment. Depending on the diagnosis and the patient’s preferences, a consultation may cover lifestyle and cardiovascular risk, medicines, vacuum therapy, low-intensity shockwave therapy, injections, psychosexual support and other options.
The evidence is not equal for every component. Some erectile-dysfunction treatments are established in clinical guidelines. Low-intensity shockwave therapy has a weak recommendation for selected men with mild vasculogenic erectile dysfunction, while platelet-rich plasma remains investigational because evidence is insufficient for routine use.
Why erectile dysfunction needs a diagnosis
Erectile dysfunction means a persistent difficulty achieving or maintaining an erection sufficient for satisfactory sexual activity. It is common, but it is not one disease. Causes may be vascular, metabolic, hormonal, neurological, medication-related, structural or psychological, and several factors often overlap.
New or persistent erectile dysfunction can precede cardiovascular symptoms. An assessment should therefore look beyond sexual performance and consider blood pressure, diabetes risk, cholesterol, smoking, weight, sleep, exercise and family history. This is especially important for younger men or when symptoms start suddenly.
What happens at a P-Shocks consultation in London?
1. A confidential history
The consultation usually covers when the problem began, whether erections occur during sleep or masturbation, libido, ejaculation, pain, penile curvature, urinary symptoms, fertility plans, medical conditions, previous pelvic treatment, medicines, alcohol, smoking, recreational drugs, stress and relationship context.
2. Focused examination
A focused examination may include blood pressure, body composition, genital examination and assessment for penile plaques or curvature when clinically relevant. The purpose is to identify signs that alter the diagnosis or treatment plan.
3. Targeted tests
Tests are chosen according to the history. Common examples include glucose or HbA1c, a lipid profile and fasting morning testosterone. If testosterone is low, European guidance recommends confirmation on a separate morning sample before diagnosing hypogonadism. Additional hormone tests or penile Doppler ultrasound are reserved for selected situations.
How treatment options are compared
A responsible plan begins with the likely cause, treatment goal, medical risk, patient preference and strength of evidence. It should not begin with a fixed package or a promise of regeneration.
Established options
• Lifestyle and risk-factor management, including exercise, weight, smoking, sleep and control of diabetes, blood pressure and cholesterol.
• PDE5 inhibitor tablets such as sildenafil or tadalafil when safe and appropriate.
• Vacuum erection devices, which can help create an erection mechanically.
• Intracavernosal injections for men who do not respond to or cannot use tablets.
• Penile prosthesis surgery for selected men with severe erectile dysfunction after other options have failed or are unsuitable.
Low-intensity shockwave therapy
Low-intensity shockwave therapy aims to deliver acoustic energy to penile tissue. Studies suggest a mild average improvement in selected men with vasculogenic erectile dysfunction, particularly mild cases or poor responders to PDE5 inhibitors. Results are variable, devices and protocols differ, and the recommendation in European guidance is weak. It should not be presented as a guaranteed cure.
Platelet-rich plasma (PRP or P-Shot)
PRP injections use a concentrate prepared from the patient’s blood. Small studies have explored PRP for erectile dysfunction, but current evidence is insufficient for routine recommendation. It should be described as investigational, with explicit discussion of uncertainty, injection risks, alternatives and cost.
What P-Shocks does not mean
The name does not guarantee that a patient needs shockwave therapy, PRP or both. It does not replace a diagnosis, and it should not imply permanent benefit, penile enlargement or a treatment without side effects. A patient may be better served by conventional medication, risk-factor management, psychosexual care, a vacuum device, injections or surgery.
Who may not be suitable for a procedure?
Suitability depends on the component being considered. Active genital infection, significant bleeding risk, unstable cardiovascular disease, severe uncontrolled illness or unexplained penile pain, a mass or rapidly changing curvature require appropriate evaluation. Men taking nitrates must not use PDE5 inhibitors. Prescribed anticoagulants or antiplatelet medicines must not be stopped without guidance from the clinician responsible for them.
What to bring to the appointment
• A current list of medicines and supplements, including erectile-dysfunction treatments already tried.
• Relevant blood-test results, clinic letters or imaging.
• A short timeline of symptoms and any change in morning erections, libido, ejaculation, pain or curvature.
• Information about cardiovascular conditions, diabetes, pelvic surgery or radiotherapy.
• Your priorities: spontaneity, firmness, avoiding medication, fertility plans, side effects, recovery time and budget.
Questions to ask before agreeing to treatment
• What is the working diagnosis and what supports it?
• Which part of the plan is guideline-supported and which part is investigational?
• What benefit is realistic for someone with my type and severity of erectile dysfunction?
• How will progress be measured, and when will treatment stop if it is not helping?
• What are the risks, alternatives, total costs and arrangements for complications?
Frequently asked questions
Do all patients receive the same P-Shocks programme?
No. Erectile dysfunction has different causes and severities. A plan should be individualised, and some patients will not be advised to have a procedure.
Is shockwave therapy the same as PRP?
No. Shockwave therapy uses acoustic energy delivered externally. PRP is a blood-derived product injected into tissue. They have different risks, evidence and roles.
Can P-Shocks cure erectile dysfunction?
No treatment should be guaranteed to cure erectile dysfunction. Outcomes depend on the cause, severity, general health, adherence and the treatment selected.
Where is the consultation?
Consultations with Dr Fabio Castiglione are available at Holistic Andrology, 9 Harley Street, London W1G 9QY. An appointment is an assessment and does not commit a patient to a procedure.
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About the author
Dr Fabio Castiglione
Consultant Urologist and Andrologist in London. Holistic Andrology, 9 Harley Street, London W1G 9QY.
GMC reference number: 7541824
Medical review and sources
Medically reviewed by Dr Fabio Castiglione on 19 August 2026. This article is general information, not a diagnosis or a guarantee of benefit. Recommendations may change as new evidence emerges.
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