Erectile problems without medication
For men who do not want pills, men for whom the pill no longer works, or men looking for a solution that goes beyond symptom management. An honest overview of what is possible, and what is not.
Three problems with medication
1. Side effects
PDE5 inhibitors are effective in 60 to 70% of men, but not without drawbacks. The most common side effects: headache in 16% of users, flushing (facial redness) in 10%, stomach complaints, nasal congestion, and dizziness. In men who use nitrates for heart conditions, PDE5 inhibitors are contraindicated due to the risk of severe blood pressure drops.
2. No lasting result
Medication works as long as you take it. Stop the pill, and the effect disappears. There is no build-up, no recovery, no improvement over time. You depend on a tablet for every sexual encounter. For some men, that is fine. For others, it feels like a limitation that undermines spontaneous desire.
3. The cause remains
PDE5 inhibitors treat the symptom, not the underlying vascular damage, hormonal decline, or tissue changes. The deterioration continues unabated. This explains why many men need a higher dose after a few years, and why some eventually stop responding altogether.
Regenerative alternatives
There are two regenerative treatments with clinical evidence for erectile dysfunction: focused shockwave therapy and platelet-rich plasma (PRP).
Shockwave therapy
Low-intensity focused shockwaves stimulate the formation of new blood vessels (neovascularisation) and activate the eNOS enzyme for increased nitric oxide production. The goal: restoration of the vascular function that underlies the erection.
The 2025 Cochrane review summarises the evidence: 21 randomised studies with a total of 1,357 patients. The conclusion is an average IIEF improvement of 3 to 5.25 points, with the caveat that the evidence level is classified as "low".
PRP (platelet-rich plasma)
With PRP, a small volume of your own blood is centrifuged to obtain a concentrate of growth factors. This is injected into the erectile tissue to stimulate tissue repair and vascular growth. The EAU currently classifies PRP as experimental, but the evidence is growing.
Poulios et al. (2021) showed improvement in 69% of the PRP group versus 27% in the placebo group in a controlled study.
What REVIVO does differently
- Always a physician: your treatment is carried out under the direct responsibility of a registered urologist. No technician, no therapist without a medical background.
- Tailored: the protocol is adapted based on your specific diagnosis, severity, and response. No one-size-fits-all package.
- Measured results: IIEF measurement at baseline and at 1, 3, 6, and 12 months. So you and your doctor can objectively assess whether the treatment is working.
Source
Cochrane Systematic Review: Low-intensity extracorporeal shockwave therapy for erectile dysfunction (2025). 21 RCTs, 1,357 participants. Evidence level: low. Average improvement: mild.