It is one of the first questions men ask when they come to see me about erectile dysfunction — and one of the most important to answer honestly.
The short answer is: it depends on the cause.
For some men with mild to moderate vasculogenic ED, focal shockwave therapy produces improvement that persists for 12-24 months without further treatment — representing genuine restoration of function rather than ongoing symptom management. For others, the condition requires long-term medical support. For a smaller group, reversing the underlying cause entirely — losing weight, stopping smoking, optimising cardiovascular health — produces meaningful improvement without any specific ED treatment.
"Cured" is a word I use carefully in medicine. But the honest clinical picture for erectile dysfunction is considerably more optimistic than most men believe when they first come through my door — and considerably more nuanced than the simple answer many clinics offer.
This article gives you the full picture. For the full breakdown of what causes ED in the first place, see our guide to erectile dysfunction causes.
"'Cured' is a word I use carefully in medicine. But the honest clinical picture for erectile dysfunction is considerably more optimistic than most men believe."
Understanding What "Cured" Means for ED
Before answering whether ED can be cured, it is worth being precise about what we mean. In medicine, "cure" typically refers to the complete and permanent resolution of a condition — the underlying cause eliminated, the symptoms gone, no further treatment required. By this strict definition, ED can be cured in some cases and not others, depending entirely on what is causing it.
A more useful clinical framing is to think in terms of three possible outcomes:
- Reversal — the underlying cause is identified and addressed, and erectile function returns to normal without ongoing treatment.
- Disease modification — the underlying pathology is improved (though not fully reversed), producing durable improvement in function that persists without ongoing medication.
- Symptom management — the underlying cause cannot be fully addressed, but function is restored with ongoing treatment (medication, vacuum devices, or other approaches).
Which of these outcomes is achievable depends on the cause of the ED — which is why proper clinical assessment matters far more than any specific treatment.
The Causes of ED and Their Reversibility
Vascular ED — Partially Reversible
The majority of ED in men over 40 has a vascular cause — endothelial dysfunction of the penile arteries reducing blood flow to the erectile tissue. This is the same mechanism responsible for cardiovascular disease.
Vascular ED is not fully reversible in most men — the underlying atherosclerotic changes cannot be completely undone. However, the condition is meaningfully disease-modifiable. Focal shockwave therapy stimulates angiogenesis (new blood vessel growth) and endothelial repair at the tissue level, improving penile blood flow in a way that persists after treatment. Clinical trials consistently show maintained improvement at 12-24 months following a course of focal shockwave therapy. (Kitrey ND et al., Journal of Urology, 2019)
Cardiovascular risk factor modification — blood pressure control, cholesterol management, smoking cessation, weight loss, exercise — can slow the progression of vascular ED and in some cases produce meaningful functional improvement independent of specific ED treatment. (Esposito K et al., JAMA, 2004)
Lifestyle-Related ED — Often Reversible
Where ED is primarily driven by modifiable lifestyle factors — obesity, sedentary behaviour, heavy alcohol consumption, smoking — addressing those factors can produce genuine reversal of the condition.
A landmark 2004 randomised controlled trial published in JAMA found that intensive lifestyle intervention in obese men with ED produced significant improvement in erectile function scores — with one third of participants recovering normal erectile function without any specific ED medication. (Esposito K et al., JAMA, 2004)
This is important. For men whose ED is primarily lifestyle-driven, the most effective treatment is not a tablet or a procedure — it is a change in how they live. This is a message that rarely gets delivered clearly enough in clinical practice.
Psychological ED — Highly Treatable
In younger men particularly, ED frequently has a primarily psychological cause — performance anxiety, depression, relationship difficulties, or the self-reinforcing cycle of anticipatory anxiety following one difficult experience.
Psychological ED is among the most treatable forms of the condition. With appropriate psychosexual assessment and management, many men with purely psychological ED recover fully. The key clinical indicator is preserved morning erections — if nocturnal and morning erections are present, the vascular mechanism is intact, and the cause is psychological rather than physical. (Althof SE et al., Journal of Sexual Medicine, 2014)
Hormonal ED — Reversible with Treatment
Where ED is driven by testosterone deficiency (hypogonadism), restoration of testosterone to normal physiological levels — through appropriate hormonal management — can produce significant improvement in libido and erectile function. See our Low Libido & Sexual Wellness service.
Testosterone replacement in confirmed hypogonadism is not "treating ED" in the conventional sense — it is correcting a hormonal deficiency that is impairing sexual function. With correction, function often improves substantially. (Corona G et al., Journal of Sexual Medicine, 2011)
Medication-Induced ED — Often Reversible
A significant number of commonly prescribed medications cause or worsen erectile dysfunction — including certain antihypertensives, antidepressants, and antiandrogens. Where medication is identified as the primary contributor, discussing alternatives with the prescribing doctor frequently resolves or substantially improves the ED.
This requires careful clinical assessment — stopping or changing medication should only be done with medical oversight, particularly for cardiovascular medications. A men's urology consultation is the right setting to review this alongside your other causes.
Post-Surgical ED — Partially Reversible
ED following radical prostatectomy for prostate cancer presents a specific clinical challenge. The cavernous nerves responsible for erectile function may be damaged or disrupted during surgery — even in nerve-sparing procedures. Spontaneous recovery of erectile function occurs in some men over 12-24 months, but the rate and completeness of recovery depend heavily on age, pre-operative function, and surgical technique.
Penile rehabilitation — using focal shockwave therapy, PRP therapy, vacuum devices, and medical management — aims to support nerve recovery and preserve erectile tissue oxygenation during the recovery period. Evidence for this approach is growing. (Frey A et al., Journal of Sexual Medicine, 2014)
What Focal Shockwave Therapy Achieves
For men with vasculogenic ED — the most common presentation — focal shockwave therapy represents the closest thing currently available to a disease-modifying treatment.
By stimulating angiogenesis (new blood vessel growth) and endothelial repair in the penile arterial tissue, focal shockwave therapy addresses the biological mechanism of vascular ED rather than overriding it pharmacologically. The results persist because they reflect genuine tissue-level change.
What the evidence shows:
The European Association of Urology formally recognises low-intensity shockwave therapy as a therapeutic option for vasculogenic ED in its 2024 guidelines. (EAU Guidelines, 2024)
What PDE5 Inhibitors (Viagra) Achieve — and What They Don't
PDE5 inhibitors — Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil) — are among the most studied drugs in medicine, with extensive evidence for efficacy and safety.
They do not cure ED. They manage the symptom.
By blocking the PDE5 enzyme, they allow cyclic GMP to accumulate, making it easier for blood to flow into the penis when sexual stimulation occurs. When the drug wears off, the underlying vascular condition remains exactly as it was. The same obstacle is present at the next encounter.
For many men, this is a perfectly acceptable long-term approach — medication taken when needed, side effects manageable, function reliable. There is no clinical reason to change a treatment that is working and well-tolerated.
The limitations become relevant when:
- The medication stops working as well over time (as vascular damage progresses)
- Side effects (headache, flushing, visual disturbance) are problematic
- The man is taking nitrate medications (absolute contraindication)
- The man wants spontaneous sexual function without planning around a tablet
An Honest Treatment Comparison
| Cause of ED | Most Appropriate Approach | Realistic Outcome |
|---|---|---|
| Lifestyle factors (obesity, smoking, alcohol) | Lifestyle modification | Often significant reversal |
| Mild-moderate vasculogenic ED | Focal shockwave therapy | Durable improvement 12-24 months |
| Severe vasculogenic ED | Shockwave + PDE5i combination | Meaningful improvement, may need ongoing support |
| Psychological ED | Psychosexual assessment | Highly treatable, often full recovery |
| Testosterone deficiency | Hormonal management | Significant improvement with correction |
| Medication-induced | Review with prescriber | Often reversible with medication change |
| Post-prostatectomy | Penile rehabilitation | Partial recovery, timeline varies |
| Severe refractory ED | Penile implant | Highly effective, irreversible |
The Most Important Thing: Proper Assessment First
The question "can my ED be cured?" cannot be answered without knowing what is causing it.
Men who present to me having self-prescribed Viagra online — without any investigation of the underlying cause — are managing a symptom they do not understand. In some cases, a simple blood test would reveal low testosterone that is entirely correctable. In others, lifestyle changes would produce more improvement than any medication. In most, a vascular cause is identified that is directly amenable to focal shockwave therapy.
The assessment is not a formality. It is the most clinically valuable part of the process — because the answer to "can this be cured?" depends entirely on what "this" actually is.
A Proper Specialist Assessment for ED Includes
- Comprehensive medical and psychosexual history
- Validated scoring (IIEF-EF questionnaire at baseline)
- Relevant blood tests — testosterone, thyroid, metabolic panel
- Cardiovascular risk assessment
- Where indicated — penile Doppler ultrasound to assess arterial blood flow directly
- Honest discussion of all treatment options and realistic outcomes
This is what I provide at Shockwave ReVibe Clinic. Not a prescription issued without assessment. Not a treatment sold before a diagnosis is established. See our full Erectile Dysfunction Treatment London service, or our guide to how many sessions you might need.
Dr Kishore Bahl
Every ED assessment at Shockwave ReVibe Clinic starts with the question of cause, not treatment. Read our complete guide to ED treatment →
Frequently Asked Questions
Can erectile dysfunction be cured permanently?
For some men — particularly those with lifestyle-related or psychological ED — full and permanent recovery is achievable. For men with vasculogenic ED, focal shockwave therapy produces durable improvement lasting 12-24 months that represents genuine disease modification rather than symptom management. For others, ongoing treatment support is required. The honest answer depends entirely on the cause — which is why proper assessment matters.
Can lifestyle changes cure ED?
Yes — in men where ED is primarily driven by obesity, sedentary behaviour, smoking, or heavy alcohol use. A 2004 JAMA study found that one third of obese men with ED recovered normal erectile function through lifestyle modification alone, without any specific ED treatment.
Can shockwave therapy cure ED?
Focal shockwave therapy produces durable improvement lasting 12-24 months in the majority of men with mild to moderate vasculogenic ED, without ongoing medication. Whether this constitutes a "cure" is partly semantic — the function returns, the biological cause is meaningfully addressed, and no further treatment is needed for a substantial period. It is the closest currently available treatment to disease modification for vascular ED.
Does ED get worse over time without treatment?
In vasculogenic ED, yes. The underlying vascular disease tends to progress without intervention — which is why ED that is mild and intermittent in the early stages can become consistent and severe over years. Early intervention produces better outcomes than waiting.
Can Viagra cure ED?
No. Viagra manages the symptom of ED — it lowers the threshold for an erection during its period of action (4-6 hours for sildenafil) but does not address the underlying cause. When the medication wears off, the underlying condition is unchanged. Repeated use does not produce cumulative improvement in the underlying vascular condition.
Is ED a sign of a serious medical condition?
It can be. Vasculogenic ED shares the same underlying mechanism as cardiovascular disease — endothelial dysfunction and arterial narrowing. A meta-analysis published in Circulation found that men with ED have a 44% increased risk of cardiovascular events, with ED typically preceding cardiac symptoms by three to five years. A comprehensive ED assessment should include cardiovascular risk evaluation.
At what age does ED become permanent?
ED is not made permanent by age itself. The causes of ED — vascular damage, hormonal changes, psychological factors, medication effects — are specific and addressable at any age. Men in their 70s and 80s respond to appropriate ED treatment. The question is not age but cause. See our guide to erectile dysfunction after 50.
How do I know if my ED is psychological or physical?
The most useful clinical indicator is morning erections. If you have regular morning or nocturnal erections but experience difficulty during sexual activity, the cause is more likely psychological. If difficulty is consistent regardless of context and morning erections are absent or significantly reduced, a physical cause is more likely. A proper clinical assessment — including the IIEF-EF questionnaire and relevant investigations — establishes this clearly.
Can ED be reversed without medication?
Yes — through lifestyle modification (in lifestyle-related ED), focal shockwave therapy (in vasculogenic ED), psychosexual assessment (in psychological ED), or hormonal management (in testosterone deficiency). Not all ED requires ongoing medication.
How do I book an appointment?
Call 020 3004 0564 or book online. Initial consultation: £59. No referral needed.
Clinical References
- Esposito K et al. (2004). Effect of lifestyle changes on erectile dysfunction in obese men. JAMA, 291(24): 2978-2984.
- Lu Z et al. (2017). Low-intensity extracorporeal shock wave treatment improves erectile dysfunction: a systematic review and meta-analysis. International Journal of Impotence Research, 29(3): 95-99.
- Kitrey ND et al. (2019). Penile low intensity shock wave treatment is able to shift PDE5i non-responders to responders. Journal of Urology, 201(1): 97-103.
- Gruenwald I et al. (2014). Shockwave treatment of erectile dysfunction. Therapeutic Advances in Urology, 5(2): 95-99.
- Vlachopoulos C et al. (2010). Prediction of cardiovascular events and all-cause mortality with erectile dysfunction. Circulation, 121(22): 2377-2385.
- Althof SE et al. (2014). An update of the international society of sexual medicine's guidelines for the diagnosis and treatment of premature ejaculation. Journal of Sexual Medicine, 11(6): 1392-1422.
- Corona G et al. (2011). Testosterone and erectile dysfunction: an update. Journal of Sexual Medicine, 8(1): 32-46.
- Frey A et al. (2014). Low-intensity extracorporeal shockwave therapy in the treatment of postprostatectomy erectile dysfunction. Journal of Sexual Medicine, 11(12): 2960-2967.
- European Association of Urology (2024). EAU Guidelines on Sexual and Reproductive Health. EAU Guidelines Office, Arnhem, The Netherlands.
Dr Kishore Bahl is a Specialist Grade Doctor in Urology (GMC Registration: 6070860) and founder of Shockwave ReVibe Clinic, 22 Notting Hill Gate, London W11 3JE. To book a consultation, call 020 3004 0564 or visit shockwave-revibe.co.uk.
Last reviewed: August 2026