ED CONSULTATION & TREATMENT
ED consultation and treatment with Pichan
Tablets and vacuum device therapy. We help you consider suitable options.
Reviewed by Koshiro Nishimoto, MD
Updated October 1, 2026
Are you finding it harder to get an erection, achieve sufficient firmness or maintain an erection?
Erectile dysfunction (ED) means difficulty achieving or maintaining an erection sufficient for sexual activity. It includes erections that are not firm enough or do not last long enough.
Our clinic offers oral tadalafil treatment and vacuum erection device therapy. We discuss your symptoms, health conditions and preferences to choose a suitable approach.
VACUUM ERECTION DEVICE
Vacuum erection device therapy
If tablets have not worked well enough, another treatment option may be available.
A vacuum erection device uses a cylinder and pump to draw blood into the penis. A ring at the base helps maintain the erection. It works through a physical mechanism.
Our clinic provides assessment and guidance for the Vigor 2020 device. We check your conditions and medicines before deciding whether it is suitable and explaining its use.
How is it used?
For use with the ring, it is fitted at the base of the penis before suction. The cylinder and pump create a vacuum. Once an erection is achieved, the vacuum is released and the cylinder removed; the ring helps maintain firmness. Remove the ring after use. Follow the clinician’s instructions and the product manual for the complete procedure.
Using and fitting the device takes practice. Do not apply excessive suction or continue through pain.
Using it safely
Pain, bruising, numbness and difficulty ejaculating may occur. Prolonged suction or constriction can damage penile tissue.
- Do not maintain suction for 15 minutes or longer, or wear the ring for 30 minutes or longer.
- Do not use the device while intoxicated or fall asleep with it in place.
- Follow the clinician’s guidance and product instructions, including timing and intervals.
Who should not use it, or needs assessment first?
The device may be unsuitable in the following situations:
- Penile inflammation, injury or amputation, or a sexually transmitted infection
- Peyronie’s disease with severe curvature, or severe multiple sclerosis
- A condition, such as heart or cerebrovascular disease, that makes sexual activity unsafe
- Difficulty removing the ring
- A mental disorder that prevents safe operation
- Complete loss of vision, unless assisted by a caregiver trained in its use
- Penile size beyond the device’s limits (erect circumference over 15.7 cm or length over 19.5 cm)
A clinician must also assess anticoagulant treatment, previous priapism, sickle cell anemia, removal of a penile prosthesis, fibrosis after injection treatment, alcohol dependence and habitual stimulant or narcotic use.
This list is not exhaustive. Please seek medical assessment rather than deciding on your own. [3]
See device and consultation feesMedication at our clinic
Tadalafil 5 mg
Tadalafil is a PDE5 inhibitor that supports blood flow to the penis. Sexual stimulation is needed; it does not automatically cause an erection or increase sexual desire. [2]
Medical conditions, other medicines and kidney or liver function may make treatment unsuitable. Dosing is explained during the consultation.
Possible side effects
Headache, flushing, indigestion, nasal congestion, back or muscle pain, dizziness and visual changes may occur. Contact us if symptoms persist or concern you. [2]
Priapism, a prolonged erection, has been reported very rarely. Seek immediate medical care if an erection lasts 4 hours or more, whether or not it is painful.
Stop taking the medicine and seek urgent medical care if you experience sudden loss or marked reduction of vision. [2]
Medicines that must not be combined
Nitrates and nitric oxide donors: Some heart medicines, including nitroglycerin, can cause a dangerous fall in blood pressure when combined with tadalafil. Tablets, medicines dissolved under the tongue and patches all need checking. Do not stop these medicines yourself to take ED treatment.
Riociguat (Adempas): This is a different medicine used for certain pulmonary vascular conditions. Combining it with tadalafil can lower blood pressure excessively and is contraindicated. [2]
Certain antibiotics, antifungals, HIV medicines and medicines for blood pressure or urinary symptoms also need review. Tell us about all prescribed and non-prescription medicines and supplements.
If you seek emergency care for chest pain or another problem, tell the medical team that you take tadalafil and when you last took it.
Health conditions, food and alcohol
Heart or cerebrovascular disease, abnormal blood pressure, severe kidney or liver disease and certain eye conditions may prevent use. Tell us about your medical and treatment history.
Food has little effect on tadalafil. Alcohol is not universally prohibited, but avoid excessive drinking, which may cause dizziness or lightheadedness. [2]
Check erection hardness with one question
Your selected category will appear here.
This check does not send or save your answer. It disappears when you leave or reload the page.
How this check relates to the study
Tsujimura and colleagues used the Erection Hardness Score (EHS), which describes erection hardness in five categories from 0 to 4. This check follows those same categories. In their analysis, scores of 0–2 were counted as erectile dysfunction (ED).
The wording on this page was written by our clinic to explain these categories. It is not a reproduction of an official questionnaire or a validated translation. Survey conditions also differ, so an individual result cannot be directly equated with the study findings.
ED also affects younger adults
In this Japanese survey, 26.6% of respondents aged 20–24 — about one in four — had EHS scores of 0–2.
The online survey was conducted in May–June 2023 among 6,228 respondents aged 20–79 registered with a survey company (response rate 16.6%). It was a self-reported, cross-sectional survey; the result does not represent all young adults in Japan or establish an increase over time.
If hardness or difficulty maintaining an erection concerns you, please discuss it with a clinician regardless of your age or score. Your symptoms, health conditions and medicines are assessed during the consultation.
Reference
Tsujimura A, et al. Erectile Function and Sexual Activity Are Declining in the Younger Generation: Results from a National Survey in Japan. World J Mens Health. 2025;43(1):239–248. doi:10.5534/wjmh.240137.
Read the study (full text)Consultation and tests
ED can be related to aging, diabetes, high blood pressure, abnormal blood lipids, smoking, low testosterone, stress and medicines. Several factors may coexist. [1]
We ask about your erections, when symptoms started, your conditions and medicines. Please bring your medicine record and recent health-check or blood-test results. Tests may be offered according to your preferences and clinical assessment.
| Assessment | Tests |
|---|---|
| Anemia and blood cell counts | Complete blood count |
| Kidney function | BUN and creatinine |
| Liver function | AST, ALT, γ-GTP and ALP |
| Blood lipids | LDL and HDL cholesterol, triglycerides |
| Blood glucose | Fasting blood glucose and HbA1c |
| Male hormone level | Total testosterone (TT) |
| Prostate assessment | PSA (age 50 and over) |
| Urine abnormalities | Protein, glucose and blood in urine |
Testosterone is generally measured in a morning blood sample while fasting. We explain preparation when arranging the test. Do not stop your usual medicines without instructions. [1]
If testosterone is low
Testosterone replacement therapy (TRT) may be an option when low testosterone contributes to symptoms. It is not decided by a blood result alone: symptoms, medical conditions, expected benefits and risks are assessed. Ongoing treatment needs regular review and tests. Suitability, availability at our clinic and costs are discussed during consultation. [1]
Lifestyle also matters
Stopping smoking, appropriate exercise, weight management, rest and treatment of diabetes, hypertension and lipid disorders are important. Stress and low mood can also contribute. Please discuss any concerns. [1]
Fees
All listed prices include consumption tax.
Tadalafil 5 mg
30-day supply
¥3,300Vigor 2020 vacuum erection device
- Device (purchased directly from the supplier)
- Explained during consultation
- Clinic consultation
- ¥10,000
The device is purchased directly from the supplier. Its price is explained during consultation. Pay the device cost to the supplier and the consultation fee to our clinic.
Any additional blood or urine test costs are explained before testing. Any separate consultation costs for medication treatment are explained before prescribing.
Self-pay services and feesConsidering a consultation?
You are welcome to consult us even if it is difficult to explain your symptoms or you are unsure whether to seek help. If tablets have not worked well, tell us about your previous treatment. We can consider suitable options, including a vacuum device.
This page provides general information. Tests and treatment are decided after clinical assessment.