Your First ED Consultation in Tokyo: What to Expect, Step by Step
Seeking help for erectile dysfunction (ED) can feel like a significant step, and for English-speaking patients in Tokyo — whether expatriates, medical tourists, or long-term residents — navigating the Japanese healthcare system adds an extra layer of uncertainty.
This guide explains exactly what happens at a first ED consultation in Tokyo: what questions will be asked, which tests may be run, and what treatment options are likely to be discussed.
What you’ll learn in this article:
- What a first ED consultation involves and how to prepare
- Which assessments and tests are typically conducted
- What treatment options are available — including oral medication and injection therapy
- Realistic costs for ED treatment in Tokyo
- Where English-speaking consultations are available in Tokyo
Have a question about this treatment?
Message us on LINE or WhatsApp — our English-speaking team usually replies the same day.
Understanding ED: A Brief Overview Before Your Appointment
Erectile dysfunction is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. It is far more common than many men realise: clinical studies suggest that ED affects approximately 30–40% of men over 40, and epidemiological data from Japan indicate prevalence rates consistent with those reported in Western populations.
ED is not a character flaw or simply a consequence of ageing — it is a medical condition with recognised physiological causes, including cardiovascular disease, diabetes, hormonal imbalance, neurological factors, and medication side effects.
Psychological factors such as anxiety and relationship stress can also play a significant role, and in many cases both physical and psychological elements are present simultaneously.
Identifying the underlying cause is central to effective treatment, which is why a thorough first consultation matters as much as the prescription itself.
What Happens at a First ED Consultation in Tokyo
Before You Arrive: What to Prepare
At BIOTOPE CLINIC in Shirokanedai, patients are encouraged to arrive ready to discuss their medical history openly. This includes any existing conditions (particularly cardiovascular disease, diabetes, hypertension, or neurological disorders), current medications (especially nitrates, alpha-blockers, or antihypertensives), and lifestyle factors such as smoking, alcohol consumption, and exercise habits.
There is no need to prepare anything elaborate. The consultation is confidential, conducted in English, and approached without judgment. A brief note of when symptoms began and whether they occur with a partner, alone, or in both situations can be genuinely useful for the doctor.
The Consultation Itself
The first consultation typically lasts 20–30 minutes. The physician will take a structured medical and sexual history, exploring the onset, frequency, and severity of symptoms — often using a standardised questionnaire called the International Index of Erectile Function (IIEF), a validated clinical tool used worldwide.
Physical examination may be recommended depending on the history gathered. This may include assessment of blood pressure, body mass index, and — if clinically indicated — examination of the genitalia and secondary sexual characteristics to screen for anatomical or hormonal issues.
Diagnostic Tests
Blood tests are frequently recommended at a first ED consultation, particularly to screen for conditions that commonly underlie ED. These may include fasting glucose or HbA1c (to assess for diabetes), a lipid panel (to evaluate cardiovascular risk), total testosterone levels, and a basic metabolic panel. At BIOTOPE CLINIC, pre-consultative blood work can be arranged on-site, supporting a more complete clinical picture from the outset.
Results of blood tests are typically reviewed either at a follow-up appointment or, if relevant, discussed in the same consultation if same-day results are available for certain markers. The physician will explain the significance of any findings in plain language.
Dr. Karibe’s Note
Many of our international patients are surprised to find that an ED consultation is a genuinely open, clinical conversation — not an uncomfortable or hurried process. A common question I receive is whether Japanese clinics approach men’s health topics differently. In my experience, the framework is consistent with international men’s health guidelines: we look for the cause, assess cardiovascular and metabolic health, and select the most appropriate treatment for the individual patient. Patients who come prepared with a basic timeline of their symptoms tend to get the most from the first appointment.
Treatment Options Discussed at a First Consultation
Oral PDE5 Inhibitors
For the majority of patients, first-line treatment involves a class of oral medications called PDE5 inhibitors (phosphodiesterase type 5 inhibitors). These work by relaxing smooth muscle in the blood vessels of the penis, increasing blood flow in response to sexual stimulation. The two most commonly prescribed are sildenafil (commonly known by the brand name Viagra) and tadalafil (Cialis).
Clinical reports indicate that PDE5 inhibitors are effective in approximately 60–70% of men with ED across a range of underlying causes, with higher response rates in men whose ED is primarily psychogenic or mild-to-moderate in severity. Sildenafil is typically taken on demand, while tadalafil is available in both on-demand and daily low-dose formats, which some patients find more convenient.
Both sildenafil and tadalafil are available at BIOTOPE CLINIC as part of the men’s health programme. Feel free to ask about dosing options and which format might suit your lifestyle during a consultation with Dr. Karibe.
Intracavernosal Injection (ICI) Therapy
For patients who do not respond adequately to oral therapy — including those with significant vascular disease, post-prostatectomy ED, or diabetes-related ED — Intracavernosal Injection (ICI) therapy is an established second-line option. This involves self-injection of a vasodilating medication directly into the erectile tissue of the penis.
The most common formulations are Trimix (a combination of alprostadil, phentolamine, and papaverine) and Bimix (two of those components). Studies suggest response rates for ICI therapy exceed 80–90% even in patients who have failed oral treatments. BIOTOPE CLINIC offers ICI therapy under physician guidance, with a supervised in-clinic demonstration before patients begin self-administration at home.
Comparison: Oral Medication vs. ICI Therapy
| Feature | Oral PDE5 Inhibitors (Sildenafil / Tadalafil) | ICI Therapy (Trimix / Bimix) |
|---|---|---|
| Route | Oral tablet | Self-injection into penis |
| Onset | 30–60 minutes (sildenafil); 30 min–2 hrs (tadalafil) | 5–15 minutes |
| Requires sexual stimulation | Yes | Not always |
| Reported efficacy | Approx. 60–70% | Approx. 80–90% |
| Suitable for severe/vascular ED | Less effective | Often effective |
| Key contraindication | Nitrate medications (absolute) | Anticoagulant use (relative); bleeding disorders |
| Availability at BIOTOPE | Yes | Yes — with supervised training |
Cost of ED Consultation and Treatment in Tokyo
Understanding costs in advance helps patients plan appropriately, particularly for those without Japanese national health insurance coverage (most non-permanent residents will be paying out of pocket for cosmetic and men’s health services).
At BIOTOPE CLINIC, the initial consultation fee is ¥3,300. Where a surgical consultation with Dr. Karibe is booked specifically, the consultation fee is ¥2,200. Blood work, if recommended, is charged additionally at ¥11,000 for pre-consultative panels.
Oral PDE5 inhibitors (sildenafil and tadalafil) are self-pay medications in the context of cosmetic/private men’s health clinics in Japan; pricing varies by dosage and quantity prescribed and will be confirmed during the consultation. ICI therapy involves an initial physician-supervised training session plus the cost of the medication formulation.
For an accurate quote based on your specific situation, we recommend booking a consultation.
Have a question about this treatment?
Message us on LINE or WhatsApp — our English-speaking team usually replies the same day.
What People Often Get Wrong About ED Consultations
Misconception 1: “ED Medication Is Available Over the Counter in Japan”
A common and potentially dangerous assumption among visitors to Japan is that sildenafil or tadalafil can be purchased freely at pharmacies without a prescription. In Japan, these medications are prescription-only (要処方箋), and purchasing them through unofficial channels — including certain online marketplaces — carries the risk of counterfeit products with no quality guarantee. A formal consultation and legal prescription from a licensed physician is the safe and appropriate pathway.
Misconception 2: “If Oral Tablets Don’t Work, There Are No Other Options”
Many men who have tried a PDE5 inhibitor once, or who stopped taking it after a single unsuccessful attempt, assume they have exhausted their options. In practice, non-response to a single trial of sildenafil does not predict response to tadalafil, nor does it rule out ICI therapy, which has a substantially higher efficacy rate in treatment-resistant cases. A proper medical review of previous use — including dosing, timing, and context — often reveals reasons why a first attempt failed that are easily addressed.
Who Is a Good Candidate for ED Treatment?
Most men with ED are suitable candidates for at least one form of evidence-based treatment. Oral PDE5 inhibitors are appropriate for men without contraindications — most critically, men who are not taking nitrate medications for heart conditions, as this combination can cause a dangerous drop in blood pressure.
ICI therapy is particularly suited to men with diabetes-related ED, post-surgical ED (e.g., following prostate surgery), or those with significant vascular disease. Patients who require anticoagulant therapy will need physician evaluation before ICI is considered.
Men experiencing significant psychological contributors to ED — such as performance anxiety or relationship stress — may benefit from a combined approach that includes medical treatment alongside psychological support. This is something that can be discussed openly during a consultation.
Frequently Asked Questions
- Q. Do I need a referral letter to book an ED consultation at a private clinic in Tokyo?
- No. Private clinics in Japan, including BIOTOPE CLINIC, accept direct bookings without a referral letter (紹介状). You can enquire directly via LINE or WhatsApp in English, and the team will guide you through the booking process.
- Q. Will my ED consultation be conducted entirely in English?
- At BIOTOPE CLINIC in Shirokanedai, English-speaking consultations are conducted by Dr. Jun Karibe, a board-certified plastic and reconstructive surgeon with men’s health expertise. The clinic’s English-speaking support team also handles all enquiries and administrative steps in English.
- Q. Is ED treatment covered by Japanese national health insurance?
- In most cases, ED treatment is not covered by Japanese national health insurance (健康保険) and is paid for as a self-pay (自由診療) service. Pre-operative blood work and some diagnostic tests may have insurance implications depending on the context, which can be clarified at consultation.
- Q. How soon can I start treatment after my first consultation?
- For oral medications, a prescription can often be issued at the first consultation if no further diagnostic work-up is required. ICI therapy involves an additional supervised training session before home use begins. The timeline will be discussed with Dr. Karibe based on individual clinical findings.
- Q. Is it safe to have blood tests on the day of the consultation?
- Yes. Basic blood panels can be arranged at the clinic on the day of consultation. Some results may be available within a short turnaround; others are sent to an external laboratory and reviewed at a follow-up appointment. The physician will advise which tests are relevant and explain the results clearly.
Have a question about this treatment?
Message us on LINE or WhatsApp — our English-speaking team usually replies the same day.
Where to Get an English-Language ED Consultation in Tokyo
Within our clinic group, English-speaking consultations are handled at BIOTOPE CLINIC in Shirokanedai (Minato-ku, Tokyo) by Dr. Jun Karibe. Our sister clinic, Kojimachi Dermatology & Plastic Surgery Clinic in Ichigaya (Chiyoda-ku), serves as the group’s main office and handles Japanese-language insurance-covered dermatology. Bookings and enquiries in English: LINE or WhatsApp.
In Dr. Karibe’s clinical experience at BIOTOPE CLINIC, international patients often arrive having already tried to navigate Japanese-language options without success, or having delayed seeking help due to language concerns alone. The clinic’s dedicated English-speaking team exists precisely to remove that barrier — from the first enquiry through to follow-up appointments.
BIOTOPE CLINIC is located in Shirokanedai, Minato-ku, Tokyo — a straightforward access from central Tokyo and easily reachable from major expatriate residential neighbourhoods. Consultations can be booked in advance via LINE or WhatsApp, with no Japanese-language requirement at any stage of the process.
Summary
A first ED consultation in Tokyo at an English-speaking private clinic is a structured, medically thorough, and confidential appointment.
It typically involves a detailed medical and sexual history, validated questionnaire assessment, and targeted blood work to identify contributing causes. Treatment options — primarily oral PDE5 inhibitors (sildenafil or tadalafil) and, for more resistant cases, ICI therapy with Trimix or Bimix — are discussed and tailored to the individual patient’s health profile and preferences.
Costs are manageable and transparent: ¥3,300 for an initial consultation, with medication and any diagnostic tests priced separately. Most men are good candidates for at least one evidence-based treatment option, and the consultation itself is the most important step towards identifying which approach is appropriate.
If you have questions about your first ED consultation in Tokyo, English-speaking consultations are handled at BIOTOPE CLINIC in Shirokanedai (Minato-ku, Tokyo) by Dr. Karibe. Our sister clinic Kojimachi Dermatology & Plastic Surgery Clinic in Ichigaya (Chiyoda-ku) handles Japanese-language insurance dermatology. English enquiries: LINE or WhatsApp.
24/7 Consultation & Booking
Book a Consultation or Treatment
Our English-speaking team responds via LINE or WhatsApp — usually the same day.
References
- Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. Journal of Urology. 1994.
- Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. Journal of Urology. 2018.
- Hatzimouratidis K, Amar E, Eardley I, et al. Guidelines on Male Sexual Dysfunction: Erectile Dysfunction and Premature Ejaculation. European Urology. 2010.
- Shabsigh R, Padma-Nathan H, Gittleman M, McMurray J, Kaufman J, Goldstein I. Intracavernous alprostadil alfadex is more efficacious, better tolerated, and preferred over intraurethral alprostadil plus optional actis: a comparative, randomized, crossover, multicenter study. Urology. 2000.
- 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.
Related Articles
You may also find these articles useful.
- English Speaking Dermatologist Tokyo: First Visit Guide
- English Speaking Dermatologist Tokyo: Complete Guide
- Medical Weight Loss Tokyo for Expats: Consultation
- English Speaking Plastic Surgeon Tokyo: Complete Guide
SUPERVISED BY
Dr. Jun Karibe
MD
Director
Education & Career
Certifications
Awards
