ED & Sexual Medicine — Southern California
ED is medical. Treat it that way.
ED is one of the most treatable problems in men's health — and most men who get evaluated leave with real options. Private, physician-led ED treatment at Dr. Vigor®: evaluation first, straight answers always, and a plan set by your own licensed clinician.
Ask for a private consult.
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Individual results vary. Treatment only after evaluation by a licensed clinician.
The results and experiences featured on this site are examples, not promises. Individual results and patient experience vary. A medical consultation and prescription are required before any medication is provided.
The Facts
Common. Explainable. And one of the most treatable problems in men's health.
Erectile dysfunction is a medical condition, it is common, and it is one of the most treatable problems in men's health.[2] It is common enough that most men will deal with it at some point — about one in five U.S. men over 20, rising to roughly half of men in their sixties and seven in ten past 70[1] — and it gets more common with each decade. It is not a character flaw, and it is not something to manage alone in a search bar at midnight.
Here's the part the search bar leaves out: most men who get properly evaluated end up with options that work for them.[2] Pills for some, a non-drug option for others, a hormonal fix for a few, counseling alongside for many — and often a combination. The realistic goal isn't just "function." It's a better sex life: confidence back, closeness back, and more satisfaction for you and your partner.[3] Individual results vary, and that's exactly why the plan gets built around you.
One more reason to take it seriously — and to take it to a physician: ED can be an early signal. Erection trouble often shows up before cardiovascular disease announces itself, because the blood vessels involved are small and show trouble first.[4] That's not a reason to panic. It's a reason to get evaluated by a doctor instead of a checkout page.
The Mechanics
How an erection works — and why that's good news
An erection is a vascular event, run by nerves and held by a seal. Those three jobs explain almost every case of ED — and, better, they explain where almost every ED treatment is aimed.
It starts with blood. Arteries open, and the two erectile chambers begin to fill.
Nerve signals release nitric oxide, the messenger that tells the smooth muscle inside those chambers to relax so filling can happen at all.
As the chambers expand, they compress the small veins that would otherwise drain blood back out — a built-in pressure seal that holds the erection.
Any link in that chain can weaken — the vessel lining, the muscle, the nerve signal, the seal — and different weak links produce the same result.[5] The good news is that each link has treatments aimed at it. Prescription options work on the relax signal. Blood-flow options work on inflow. Hormonal correction supports the whole system. That's why the evaluation matters more than the brand name on any treatment: find the weak link, and the right option usually follows.
The Causes
Why it happens — and why each cause has an answer
Every cause on this list has a treatment aimed at it. Most ED traces back to a short list of causes, and mixed cases — part physical, part psychological — are common.[6] The evaluation's job is to find yours.
The physical side
Blood flow
The most common driver with age. Vessels narrow, the vessel lining weakens, inflow drops. It's also the cause with the most options behind it — from prescription options to non-drug treatment.
Hormones
Low testosterone can lower desire and blunt the machinery itself. Confirming it takes The Two-Test Standard™: two separate blood tests confirming low testosterone, symptoms that match those numbers, and an in-person visit with vitals. When that's the story, correcting it is the Calibrated TRT® program's conversation. Explore Calibrated TRT
Nerves
Diabetes, surgery, spinal problems, and some neurologic conditions can quiet the signal. Many men in this group still have good options, and the evaluation sorts out which.
Medications
Blood-pressure drugs, antidepressants, and others can carry ED as a side effect. Never stop a medication on your own — bring the list to your consult. Sometimes the fix is a conversation with the doctor who prescribed it.
Lifestyle
Sleep debt, alcohol, nicotine, and inactivity each take a toll, and each one is changeable — which makes this the most fixable line on the list.
Structure
Scar tissue and curvature from Peyronie's disease can cause or complicate ED. It's physical, it has a name, and it has its own page. Learn about Peyronie's disease
The psychological side
Performance anxiety, stress, depression, relationship strain — these are real contributors, not imaginary ones. They can lock into a loop with the physical side: a few hard nights become worry, and worry makes the next night harder. The encouraging part is that the loop runs both ways. Untangle one side and the other tends to follow, which is why the workup looks at both from the start.
Two Different Problems
Low drive isn't the same problem as ED — and both have answers
Here's a distinction most men have never had explained. Low desire — libido, the want-to — is one problem. Erectile difficulty — the follow-through when desire is there — is another. They feel similar from the inside, they often get tangled together, and they call for different workups. This page treats the second.
When the real issue is drive, the trail usually leads to hormones or to the psychological side. Low libido is one of the symptoms most associated with low testosterone[7] — and it has other causes too, which is exactly why it gets tested rather than assumed. That conversation belongs to the Calibrated TRT® program, with the counseling conversation standing beside it when the story is more than hormonal. If that sounds more like you, start there — it's a well-mapped trail with real answers.
What We Do — and What We'll Say
Our lane is the physical side — and we're honest about the rest
The clinical focus at Dr. Vigor® is the physical side of ED: evaluation, labs, and physician-directed treatment of the drivers you can measure. That's the work this page describes, and it's where the evaluation usually starts.
And when the evaluation suggests the psychological side is doing real work — instead of the physical, or alongside it — we say so, and we can refer you to a licensed sex therapist or sex counselor. Counseling is guideline-supported care for many men with ED,[8] not a consolation prize. Plenty of men run both tracks at once.
The Options
More real options than most men know
Men are treated for ED successfully every day, and the menu is wider than the pill ads suggest.[9] Individual results vary, and no single treatment is right for every man — and a good clinic doesn't pretend otherwise. Your clinician's job is to match the option to the cause, with you in the room and the evidence on the table. Here's the landscape.
01 — Prescription options
The established first line
PDE5 inhibitors — the sildenafil and tadalafil family — are the established first-line medication for ED, and many men do well on them.[9] Individual results vary — an evaluation and a prescription are required, and fit varies by man and by cause. If pills are the right answer, you'll get straight guidance. If they've stopped being enough, that's worth investigating — because there's more on this list.
02 — The Firm Wave® treatment series
The drug-free option
Our own acoustic wave therapy series — a drug-free, non-surgical option built around how erections actually work, delivered in clinic over a recommended series of sessions. Studies report improved erectile-function scores, with the strongest signals in mild-to-moderate vascular ED.[10] Individual results vary, and candidacy is set by evaluation.
Acoustic wave therapy for ED is considered experimental and investigational. Its use for ED and Peyronie's disease is off-label and has not received specific FDA clearance or approval.
03 — The Vigor Shot™ procedure
Your own biology, put to work
A PRP treatment for ED — platelet-rich plasma prepared from your own blood and administered by a licensed clinician. Studies report improved erectile-function scores, with the better responses generally seen in men with partial, mild-to-moderate ED.[11] Individual results vary, and the research is still maturing — the full picture is on its page.
Autologous PRP preparations are not FDA-approved for sexual-medicine uses.
04 — The Peyronie's pathway
Curvature and pain have a name
Curvature, a new bend, or pain with erections has a medical name — Peyronie's disease — and a real set of options, established and investigational. If that's part of your story, start with the explainer.
When it's hormones. Low-testosterone correction sits beside this ladder, not on it. When labs and symptoms point that way, that's the Calibrated TRT® program's conversation — and for the men it fits, it's often the first thing to get right. Explore Calibrated TRT
Privacy
Built for the conversation you'd rather not have
Every consult happens in a private room with a licensed clinician — not at a counter, not within earshot of a waiting room. Scheduling and communications are handled discreetly. Prefer to start by phone? Call 949-570-0800 and ask for a private consult. And nobody ends up on a mailing list for asking a question.
FAQ
Questions, answered
Is ED normal at my age?
It's common at every age men actually get it — and more common with each decade — roughly one man in seven at 40 to 59, and about half by his sixties.[1] But normal isn't the useful question. Treatable is, and ED is one of the most treatable problems in men's health. ED at any age is a reason for an evaluation — both to fix the problem and to check what's behind it.
Do I have to talk about this in a waiting room?
No. Consults happen in a private room, one-on-one with a licensed clinician — and you can start the whole thing by phone instead. Call 949-570-0800 and ask for a private consult.
Will I just be handed pills?
No. Pills are one good option, not the default. The evaluation comes first — your history, your medications, labs where they're indicated — and then your clinician matches the treatment to the cause. Sometimes that's a prescription. Sometimes it's the Firm Wave® treatment series, the Vigor Shot™ procedure, a hormonal workup, a counseling referral, or a combination. The point is that it's a decision, not a dispenser — and you usually have more than one path.
What does the evaluation involve?
A private conversation with a licensed clinician, your health and medication history, vitals, and labs where they're indicated — testosterone included when the story points that way. Nothing is prescribed or performed before you've been evaluated. You'll leave with straight answers and a recommended path, and you take the next step on your timeline.
Does insurance cover this?
Dr. Vigor® is a concierge clinic group and doesn't bill insurance, which keeps pricing simple and the paper trail short. HSA/FSA funds are accepted for eligible services, and you'll know your full cost before you start.
What if it's all in my head?
Then you deserve real help for that — and "in your head" is the wrong frame anyway. Performance anxiety, stress, and relationship strain are real contributors with real treatments, and they usually travel with a physical piece. The evaluation looks at both. When counseling is the right move — instead of medical treatment or alongside it — we say so, and we can refer you to a licensed sex therapist or counselor. That's guideline-supported care, not a brush-off.
What does ED treatment cost?
It depends on the path — a prescription program, the Firm Wave® treatment series, and the Vigor Shot™ procedure are priced differently. So we do it the straight way: you'll know your full cost before you start, reviewed with you before you enroll. Call 949-570-0800 and ask — nobody will make you book to find out. HSA/FSA accepted for eligible services.
Can ED be related to low testosterone?
Yes. Low testosterone can lower desire and contribute to erectile difficulty, though it's rarely the whole story. If your labs and symptoms point that way, that conversation belongs to the Calibrated TRT® program — two separate blood tests confirming low testosterone, symptoms that match those numbers, and an in-person visit with vitals, before any prescription.
Is low desire the same thing as ED?
No — and the difference decides the workup. Low desire is about wanting to, and it's usually a hormonal or psychological story. ED is about follow-through when the desire is there. This page covers the second. If the first sounds more like you, start with the Calibrated TRT® program and the counseling conversation — that's where the drive side belongs.
Is the Firm Wave® series or the Vigor Shot™ procedure right for me?
That's an evaluation question — and a fair one. The Firm Wave® treatment series is acoustic wave therapy, a drug-free option with encouraging study results in mild-to-moderate vascular ED[10] — it is investigational and off-label for ED, and we say so. The Vigor Shot™ procedure is a PRP treatment with encouraging findings in men with partial ED[11] — PRP preparations are not FDA-approved for sexual-medicine uses, and we say that too. Individual results vary. Some men choose one, some pair options, many need neither. Whether either fits your case is a decision your clinician makes with you after the workup — and each has a full page that gives you the honest picture first.
Go Deeper
The ED guide library
Straight-answer explainers on the questions men actually search — written by the Dr. Vigor Editorial Team.
Citations & References
The research behind this page
Every clinical statement on this page is footnoted to peer-reviewed research, a professional-society guideline, or an official regulatory source. Each reference was resolved and checked against its published record before it was placed here.
- Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med. 2007;120(2):151–157. PMID 17275456. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54–61. PMID 8254833. NHANES 2001–2002: 18.4% of U.S. men aged 20 and older; 14.8% at 40–59, 43.8% at 60–69, 70.2% at 70 and older. MMAS: 52% of men aged 40–70 reported some degree of erectile dysfunction.
- Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633–641. PMID 29746858. Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med. 1998;338(20):1397–1404. doi:10.1056/NEJM199805143382001. The AUA guideline sets out a full treatment range—PDE5 inhibitors, vacuum devices, intraurethral and intracavernosal therapy, and prosthesis—matched to the man through shared decision-making.
- Heiman JR, Talley DR, Bailen JL, et al. Sexual function and satisfaction in heterosexual couples when men are administered sildenafil citrate (Viagra) for erectile dysfunction: a multicentre, randomised, double-blind, placebo-controlled trial. BJOG. 2007;114(4):437–447. doi:10.1111/j.1471-0528.2006.01228.x. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822–830. PMID 9187685. Randomized couples trial: treating the man’s ED improved partners’ reported sexual function and satisfaction. The IIEF measures intercourse satisfaction and overall satisfaction as distinct domains.
- Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294(23):2996–3002. PMID 16414947. Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes. 2013;6(1):99–109. doi:10.1161/CIRCOUTCOMES.112.966903. Gandaglia G, Briganti A, Jackson G, et al. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol. 2014;65(5):968–978. PMID 24011423. Incident ED predicted subsequent cardiovascular events in the Prostate Cancer Prevention Trial; pooled cohort data associate ED with higher risk of cardiovascular events and all-cause mortality.
- Yafi FA, Jenkins L, Albersen M, et al. Erectile dysfunction. Nat Rev Dis Primers. 2016;2:16003. PMID 27188339.
- Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633–641. PMID 29746858. The guideline describes ED etiology as often multifactorial, with psychological factors as primary or secondary contributors.
- Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. PMID 29562364. Wu FC, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123–135. PMID 20554979. EMAS: low libido is among the sexual symptoms most associated with low testosterone, while remaining non-specific on its own.
- Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633–641. PMID 29746858. Guideline statement: referral to a mental health professional should be considered to promote adherence, reduce performance anxiety, and integrate treatment into the sexual relationship.
- Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633–641. PMID 29746858. Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med. 1998;338(20):1397–1404. doi:10.1056/NEJM199805143382001.
- Sokolakis I, Hatzichristodoulou G. Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials. Int J Impot Res. 2019;31(3):177–194. doi:10.1038/s41443-019-0117-z. Ergun O, Kim K, Kim MH, et al. Low-intensity shockwave therapy for erectile dysfunction. Cochrane Database Syst Rev. 2025;7(7):CD013166. doi:10.1002/14651858.CD013166.pub3. PMID 40654049. Kitrey ND, Vardi Y, Appel B, et al. Low intensity shock wave treatment for erectile dysfunction—how long does the effect last? J Urol. 2018;200(1):167–170. doi:10.1016/j.juro.2018.02.070. Pooled RCT data show improved IIEF-EF scores versus sham; the 2025 Cochrane review rates the short-term effect small and the evidence low-certainty; men with milder ED were likelier to maintain response at two years.
- Poulios E, Mykoniatis I, Pyrgidis N, et al. Platelet-rich plasma (PRP) improves erectile function: a double-blind, randomized, placebo-controlled clinical trial. J Sex Med. 2021;18(5):926–935. PMID 33906807. Panunzio A, Labate C, Zacheo F, et al. Platelet-rich plasma intracavernosal injections for the treatment of primary organic erectile dysfunction: a systematic review and meta-analysis of contemporary controlled studies. Int J Impot Res. 2024;36(6):562–571. PMID 37993601. Double-blind RCT in men with mild-to-moderate ED; pooled placebo-controlled data show modest IIEF-EF gains at 1–6 months.
Getting Started
Start with a phone call. FINISH STRONG®.
Getting started is simple — and private.
Step 01
Talk
A focused consult — by phone or in person, virtual if you like.
Step 02
Test
An in-person visit: vitals and bloodwork before any products or services.
Step 03
Tune
Proven protocols do the groundwork. Your clinician makes the call — your plan, adjusted over time to your labs and how you actually feel.
Individual results vary. Prescriptions only when clinically appropriate.
Dr. Vigor® clinics in California are 100% physician-owned. Erectile dysfunction and sexual-medicine services are provided only after evaluation by a licensed clinician, and only when clinically appropriate. A medical consultation and prescription are required before any medication is provided. Treatment plans are set by the patient's own licensed clinician, who alone determines diagnosis, prescribing, dose, and course of therapy — protocols inform that judgment and never replace it. Acoustic wave therapy for erectile dysfunction, including the Firm Wave® treatment series, is considered experimental and investigational; its use for ED and Peyronie's disease is off-label and has not received specific FDA clearance or approval. Autologous platelet-rich plasma (PRP) preparations, including the Vigor Shot™ procedure, are not FDA-approved for sexual-medicine uses. Individual results vary. Not all men are candidates for every treatment. When evaluation suggests that counseling with a licensed sex therapist or counselor would help, instead of or alongside medical treatment, we say so and can provide a referral. Dr. Vigor is a concierge clinic group and does not bill insurance. HSA/FSA accepted for eligible services. Services available at Dr. Vigor clinic locations in California.
Dr. Vigor® clinics in California are 100% physician-owned. Erectile dysfunction and sexual-medicine services are provided only after evaluation by a licensed clinician, and only when clinically appropriate. A medical consultation and prescription are required before any medication is provided. Treatment plans are set by the patient's own licensed clinician, who alone determines diagnosis, prescribing, dose, and course of therapy — protocols inform that judgment and never replace it. Acoustic wave therapy for erectile dysfunction, including the Firm Wave® treatment series, is considered experimental and investigational; its use for ED and Peyronie's disease is off-label and has not received specific FDA clearance or approval. Autologous platelet-rich plasma (PRP) preparations, including the Vigor Shot™ procedure, are not FDA-approved for sexual-medicine uses. Individual results vary. Not all men are candidates for every treatment. When evaluation suggests that counseling with a licensed sex therapist or counselor would help, instead of or alongside medical treatment, we say so and can provide a referral. Dr. Vigor is a concierge clinic group and does not bill insurance. HSA/FSA accepted for eligible services. Services available at Dr. Vigor clinic locations in California.