{"id":9812,"date":"2026-08-03T21:54:10","date_gmt":"2026-08-03T12:54:10","guid":{"rendered":"https:\/\/kojihifu.com\/english\/?p=9812"},"modified":"2026-08-03T21:54:11","modified_gmt":"2026-08-03T12:54:11","slug":"ici-vs-viagra-cialis-tokyo","status":"publish","type":"post","link":"https:\/\/kojihifu.com\/english\/ici-vs-viagra-cialis-tokyo\/","title":{"rendered":"ICI vs Viagra Cialis Tokyo: ED Treatment Comparison"},"content":{"rendered":"<p><script type=\"application\/ld+json\">{\"@context\": \"https:\/\/schema.org\", \"@type\": \"FAQPage\", \"mainEntity\": [{\"@type\": \"Question\", \"name\": \"Can I get a prescription for sildenafil or tadalafil in Japan as a foreigner?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Yes. ED medication is legally available in Japan as a prescription drug from licensed clinics. Nationality is not a barrier to receiving a private (self-pay) prescription. BIOTOPE CLINIC provides English-speaking consultations for this purpose, and prescriptions can typically be issued at or shortly after the initial consultation, subject to the physician's medical assessment.\"}}, {\"@type\": \"Question\", \"name\": \"Is ICI therapy legal and available in Japan?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Alprostadil (single-agent injection) is approved in Japan for the treatment of ED. Compounded formulations such as Trimix and Bimix are prepared by licensed pharmacies under physician prescription. Availability and formulation options should be confirmed directly with the prescribing physician, as compounding practices can vary. Dr. Karibe can discuss what is currently available and appropriate at your consultation.\"}}, {\"@type\": \"Question\", \"name\": \"How many injections per week is it safe to use ICI?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Most clinical guidelines recommend limiting ICI use to no more than three times per week, with at least 24 hours between doses, in order to minimise the risk of penile fibrosis (scarring of the injection site) with long-term use. Injection site rotation is also recommended. Your physician will advise on a safe regimen specific to your formulation and dose.\"}}, {\"@type\": \"Question\", \"name\": \"What should I do if I experience an erection lasting longer than four hours after an ICI injection?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"A prolonged erection lasting more than four hours (priapism) is a medical emergency requiring prompt treatment to prevent permanent tissue damage. Before being authorised for home use of ICI, patients are thoroughly briefed on the management protocol \u2014 which includes a reversal agent that can be administered at home in early cases, and the instructions for seeking emergency care if required. This safety training is a non-negotiable part of the ICI initiation process at BIOTOPE CLINIC.\"}}, {\"@type\": \"Question\", \"name\": \"Is psychological ED better treated with pills or injections?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"For primarily psychogenic (psychological) ED in men with no significant vascular impairment, oral PDE5 inhibitors are generally the preferred starting point. They can help restore confidence and break the anxiety cycle that often sustains psychogenic ED. ICI is more commonly reserved for organic (physical) causes, though the two can occasionally be used in combination under medical guidance.\"}}]}<\/script><\/p>\n<h2>ICI vs Oral ED Medication in Tokyo: Which Treatment Is Right for You?<\/h2>\n<figure style=\"margin: 1.5em 0;\"><img decoding=\"async\" style=\"width: 100%; max-width: 100%; height: auto; border-radius: 8px;\" title=\"ICI vs Viagra Cialis Tokyo: choosing the right ED  \u2014 ICI vs Oral ED Medication in Tokyo: Which Treatment Is Right\" src=\"https:\/\/kojihifu.com\/english\/wp-content\/uploads\/2026\/08\/pexels_5998512_1785510282.webp\" alt=\"ICI vs Viagra Cialis Tokyo: choosing the right ED  \u2014 ICI vs Oral ED Medication in Tokyo: Which Treatment Is Right\" \/><\/figure>\n<p><strong>Erectile dysfunction (ED)<\/strong> is far more common than most men acknowledge, and seeking information about treatment options \u2014 especially in a foreign country \u2014 takes real courage.<\/p>\n<p>This article is written for English-speaking men in Tokyo who want a clear, medically accurate explanation of the two main treatment pathways: oral PDE5 inhibitors (the class of drugs that includes sildenafil and tadalafil, commonly known by the brand names Viagra and Cialis) and intracavernosal injection (ICI) therapy, a physician-guided self-injection method used when oral medication is insufficient.<\/p>\n<p>By the end of this page, you should have a solid understanding of how each option works, what clinical evidence says about effectiveness, realistic costs in Tokyo, and how to access an English-speaking consultation.<\/p>\n<ul>\n<li>How oral PDE5 inhibitors (sildenafil\/tadalafil) work and when they are the right first step<\/li>\n<li>What ICI therapy is, which medications are used, and why it is effective for men who do not respond to pills<\/li>\n<li>A side-by-side comparison of both approaches: onset, duration, efficacy, side effects, and suitability<\/li>\n<li>Realistic costs for ED treatment in Tokyo<\/li>\n<li>How to access English-speaking ED consultations at BIOTOPE CLINIC in Shirokanedai<\/li>\n<\/ul>\n<div class=\"kjmc-en-booking-inline\" style=\"background: #f7fbf7; border: 1px solid #d5e6d8; border-radius: 10px; padding: 16px 20px; margin: 26px 0; text-align: center;\">\n<p style=\"margin: 0 0 12px; color: #1a3a1f; font-size: 0.95em; line-height: 1.65;\"><strong>Have a question about this treatment?<\/strong><br \/>\nMessage us on LINE or WhatsApp \u2014 our English-speaking team usually replies the same day.<\/p>\n<p style=\"margin: 0; line-height: 1;\"><a style=\"display: inline-flex; align-items: center; gap: 8px; background: #06C755; color: #fff; padding: 10px 20px; border-radius: 8px; text-decoration: none; font-weight: bold; font-size: 0.92em; margin: 4px 6px; white-space: nowrap; vertical-align: middle;\" href=\"https:\/\/line.me\/R\/ti\/p\/@710uitns?ts=05311801&amp;oat_content=url#~\" target=\"_blank\" rel=\"noopener noreferrer\">Book via LINE<\/a><br \/>\n<a style=\"display: inline-flex; align-items: center; gap: 8px; background: #25D366; color: #fff; padding: 10px 20px; border-radius: 8px; text-decoration: none; font-weight: bold; font-size: 0.92em; margin: 4px 6px; white-space: nowrap; vertical-align: middle;\" href=\"https:\/\/whatsapp.com\/channel\/0029VbCA1v85K3zY4MLX2a1h\" target=\"_blank\" rel=\"noopener noreferrer\">Message on WhatsApp<\/a><\/p>\n<\/div>\n<h2>Understanding Oral PDE5 Inhibitors: Sildenafil and Tadalafil<\/h2>\n<figure style=\"margin: 1.5em 0;\"><img decoding=\"async\" style=\"width: 100%; max-width: 100%; height: auto; border-radius: 8px;\" title=\"ICI vs Viagra Cialis Tokyo: choosing the right ED  \u2014 Understanding Oral PDE5 Inhibitors: Sildenafil and Tadalafil\" src=\"https:\/\/kojihifu.com\/english\/wp-content\/uploads\/2026\/08\/pexels_5994630_1785510283.webp\" alt=\"ICI vs Viagra Cialis Tokyo: choosing the right ED  \u2014 Understanding Oral PDE5 Inhibitors: Sildenafil and Tadalafil\" \/><\/figure>\n<p><strong>PDE5 inhibitors<\/strong> are the globally recognised first-line pharmacological treatment for erectile dysfunction. They work by blocking an enzyme called phosphodiesterase type 5, which normally breaks down a chemical messenger (cyclic GMP) that relaxes smooth muscle in the penile arteries. By inhibiting this enzyme, the drugs allow blood to flow more freely into the erectile tissue in response to sexual stimulation.<\/p>\n<p>It is important to understand that these medications do not produce an erection independently \u2014 sexual arousal is still required. They lower the physiological threshold for an erection by optimising the vascular response.<\/p>\n<h3>Sildenafil (the active ingredient in Viagra)<\/h3>\n<p>Sildenafil typically takes effect within 30 to 60 minutes and remains active for approximately four to six hours. It is taken on an as-needed basis, and absorption can be slowed significantly by high-fat meals. Doses range from 25 mg to 100 mg depending on individual response and tolerability.<\/p>\n<h3>Tadalafil (the active ingredient in Cialis)<\/h3>\n<p>Tadalafil has a notably longer duration of action \u2014 up to 36 hours \u2014 which many patients find more conducive to natural sexual activity without time pressure. It is available in on-demand doses (10\u201320 mg) or as a low daily dose (2.5\u20135 mg), the latter offering continuous background support. Tadalafil is less sensitive to food intake than sildenafil.<\/p>\n<h3>Clinical Effectiveness of Oral PDE5 Inhibitors<\/h3>\n<p>Large-scale clinical data support the efficacy of this drug class. Studies suggest that PDE5 inhibitors produce satisfactory erectile responses in approximately <strong>60\u201370% of men<\/strong> with mild to moderate ED. However, response rates are lower in men with severe vascular disease, post-radical prostatectomy ED, or poorly controlled diabetes \u2014 in these groups, clinical reports indicate that oral efficacy may drop to 30\u201350%.<\/p>\n<p>Common side effects include headache, facial flushing, nasal congestion, and, less commonly, transient visual disturbance (sildenafil) or back and muscle ache (tadalafil). These medications are contraindicated in men taking nitrate-based medications for heart conditions, due to the risk of severe hypotension.<\/p>\n<h2>Understanding ICI Therapy: Intracavernosal Injection<\/h2>\n<figure style=\"margin: 1.5em 0;\"><img decoding=\"async\" style=\"width: 100%; max-width: 100%; height: auto; border-radius: 8px;\" title=\"ICI vs Viagra Cialis Tokyo: choosing the right ED  \u2014 Understanding ICI Therapy: Intracavernosal Injection\" src=\"https:\/\/kojihifu.com\/english\/wp-content\/uploads\/2026\/08\/pexels_4541337_1785510284.webp\" alt=\"ICI vs Viagra Cialis Tokyo: choosing the right ED  \u2014 Understanding ICI Therapy: Intracavernosal Injection\" \/><\/figure>\n<p><strong>Intracavernosal injection (ICI) therapy<\/strong> involves injecting a small amount of vasoactive medication directly into the corpora cavernosa \u2014 the two cylinders of erectile tissue running along the penis \u2014 using a very fine needle. This sounds daunting to most men at first, but under proper physician guidance, the technique is manageable and highly effective.<\/p>\n<p>Unlike oral medications, ICI acts locally and independently of systemic circulation. This means it can produce reliable erections even in men whose vascular response to oral PDE5 inhibitors is insufficient.<\/p>\n<h3>What Medications Are Used?<\/h3>\n<p>The most commonly used ICI formulations are:<\/p>\n<ul>\n<li><strong>Alprostadil (Prostaglandin E1):<\/strong> A single-agent injection that is internationally approved and well-studied. It is often the starting point for ICI therapy.<\/li>\n<li><strong>Bimix:<\/strong> A compounded two-drug combination, typically papaverine and phentolamine, which relaxes penile smooth muscle through complementary mechanisms.<\/li>\n<li><strong>Trimix:<\/strong> A three-drug compounded formulation combining alprostadil, papaverine, and phentolamine. Clinical reports indicate Trimix produces higher efficacy rates and can allow for lower individual drug doses, potentially reducing side effects. Studies suggest response rates with Trimix exceed 85\u201390% even in men with severe vascular or neurological ED.<\/li>\n<\/ul>\n<h3>How ICI Is Introduced to a Patient<\/h3>\n<p>ICI is not a take-home prescription handed out at a first appointment. The patient is trained by the physician in the correct injection technique, dosing, and \u2014 critically \u2014 in recognising and responding to the primary risk: priapism (a prolonged erection exceeding four hours, which requires prompt medical attention). A test dose is typically administered in the clinic setting before the patient is authorised to self-administer at home.<\/p>\n<blockquote style=\"border-left: 4px solid #5a8a5a; padding: .75em 1.1em; margin: 1.8em 0; background: #f7fbf7; border-radius: 0 6px 6px 0; font-size: .93em;\">\n<p style=\"margin: 0 0 .45em; font-weight: bold; color: #3a6e3a;\">Dr. Karibe&#8217;s Note<\/p>\n<p style=\"margin: 0; color: #333; line-height: 1.7;\">Many of our international patients at <strong>BIOTOPE CLINIC<\/strong> are surprised to find that ICI therapy is far less intimidating in practice than it sounds on paper.<\/p>\n<p style=\"margin: 0; color: #333; line-height: 1.7;\">The needle gauge is very fine \u2014 comparable to an insulin syringe \u2014 and once the technique is correctly learned, most patients report that discomfort is minimal. The psychological barrier is usually greater than the physical one.<\/p>\n<p style=\"margin: 0; color: #333; line-height: 1.7;\">A common question I receive is whether a patient must commit to injections permanently. The honest answer is no: ICI can be used on a situational basis, just as oral medication is, and some patients use it only occasionally as a reliable backup when oral therapy is insufficient.<\/p>\n<\/blockquote>\n<h2>ICI vs Oral PDE5 Inhibitors: Side-by-Side Comparison<\/h2>\n<figure style=\"margin: 1.5em 0;\"><img decoding=\"async\" style=\"width: 100%; max-width: 100%; height: auto; border-radius: 8px;\" title=\"ICI vs Viagra Cialis Tokyo: choosing the right ED  \u2014 ICI vs Oral PDE5 Inhibitors: Side-by-Side Comparison\" src=\"https:\/\/kojihifu.com\/english\/wp-content\/uploads\/2026\/08\/pexels_4210553_1785510285.webp\" alt=\"ICI vs Viagra Cialis Tokyo: choosing the right ED  \u2014 ICI vs Oral PDE5 Inhibitors: Side-by-Side Comparison\" \/><\/figure>\n<p>The following table summarises the key clinical differences between oral PDE5 inhibitors and ICI therapy to help guide decision-making in consultation with a physician.<\/p>\n<table style=\"border-collapse: collapse; width: 100%; margin: 20px 0; font-size: 0.95em; border: 1px solid #ccc;\">\n<thead>\n<tr>\n<th style=\"border: 1px solid #ccc; padding: 10px 12px; background: #f1faf3; text-align: left; font-weight: bold;\">Factor<\/th>\n<th style=\"border: 1px solid #ccc; padding: 10px 12px; background: #f1faf3; text-align: left; font-weight: bold;\">Oral PDE5 Inhibitors (Sildenafil \/ Tadalafil)<\/th>\n<th style=\"border: 1px solid #ccc; padding: 10px 12px; background: #f1faf3; text-align: left; font-weight: bold;\">ICI Therapy (Trimix \/ Bimix \/ Alprostadil)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Route of administration<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Oral tablet<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Self-injection into penile tissue<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Requires sexual stimulation<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Yes<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Generally not required<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Onset of action<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">30\u201360 minutes (sildenafil); 30 minutes (tadalafil)<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">5\u201315 minutes<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Duration of action<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">4\u20136 hours (sildenafil); up to 36 hours (tadalafil)<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">30\u201360 minutes (dose-dependent)<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Typical efficacy (all-cause ED)<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">60\u201370%<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">85\u201390%+ (especially Trimix)<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Efficacy in severe\/neurological\/post-surgical ED<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">30\u201350%<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">High \u2014 acts independently of systemic circulation<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Primary risks<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Hypotension with nitrates; headache; flushing<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Priapism (prolonged erection); penile fibrosis with long-term use; injection-site discomfort<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Contraindications<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Nitrate medications; severe cardiac disease<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Bleeding disorders; anticoagulation therapy; sickle cell disease<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Physician training required<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Prescription required; no injection training<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">In-clinic training session required before home use<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Typical use case<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Mild to moderate psychogenic or vascular ED<\/td>\n<td style=\"border: 1px solid #ccc; padding: 10px 12px; vertical-align: top;\">Moderate to severe ED; non-responders to oral therapy; post-prostatectomy ED<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>Cost of ED Treatment in Tokyo<\/h2>\n<figure style=\"margin: 1.5em 0;\"><img decoding=\"async\" style=\"width: 100%; max-width: 100%; height: auto; border-radius: 8px;\" title=\"ICI vs Viagra Cialis Tokyo: choosing the right ED  \u2014 Cost of ED Treatment in Tokyo\" src=\"https:\/\/kojihifu.com\/english\/wp-content\/uploads\/2026\/08\/pexels_4541398_1785510286.webp\" alt=\"ICI vs Viagra Cialis Tokyo: choosing the right ED  \u2014 Cost of ED Treatment in Tokyo\" \/><\/figure>\n<p>In Japan, erectile dysfunction medication is not covered by national health insurance (Koken Hoken) because it is classified as a lifestyle drug rather than a condition requiring mandatory coverage. All costs are therefore self-pay (jishu shinryo).<\/p>\n<p>At <strong>BIOTOPE CLINIC<\/strong> in Shirokanedai, an initial consultation is priced at <strong>\u00a53,300<\/strong>. A consultation specifically with Dr. Karibe for surgical or specialist assessment is <strong>\u00a52,200<\/strong>. Ongoing oral PDE5 inhibitor prescriptions (sildenafil or tadalafil) are priced according to dose and quantity at the time of consultation.<\/p>\n<p><strong>ICI therapy<\/strong> involves an initial supervised in-clinic dosing session and training appointment, followed by a compounded prescription for home use. Pricing for ICI therapy \u2014 including the initial training session and the compounded medication (Trimix or Bimix) \u2014 will be discussed and confirmed at consultation, as formulation and dosing are tailored to the individual patient.<\/p>\n<p>As a general reference for comparable private men&#8217;s health clinics in Tokyo, oral PDE5 inhibitor prescriptions typically range from \u00a51,500 to \u00a53,000 per tablet depending on dose and brand. ICI compounded preparations vary considerably with volume and formulation. For an accurate quote, we recommend booking a consultation.<\/p>\n<div class=\"kjmc-en-booking-inline\" style=\"background: #f7fbf7; border: 1px solid #d5e6d8; border-radius: 10px; padding: 16px 20px; margin: 26px 0; text-align: center;\">\n<p style=\"margin: 0 0 12px; color: #1a3a1f; font-size: 0.95em; line-height: 1.65;\"><strong>Have a question about this treatment?<\/strong><br \/>\nMessage us on LINE or WhatsApp \u2014 our English-speaking team usually replies the same day.<\/p>\n<p style=\"margin: 0; line-height: 1;\"><a style=\"display: inline-flex; align-items: center; gap: 8px; background: #06C755; color: #fff; padding: 10px 20px; border-radius: 8px; text-decoration: none; font-weight: bold; font-size: 0.92em; margin: 4px 6px; white-space: nowrap; vertical-align: middle;\" href=\"https:\/\/line.me\/R\/ti\/p\/@710uitns?ts=05311801&amp;oat_content=url#~\" target=\"_blank\" rel=\"noopener noreferrer\">Book via LINE<\/a><br \/>\n<a style=\"display: inline-flex; align-items: center; gap: 8px; background: #25D366; color: #fff; padding: 10px 20px; border-radius: 8px; text-decoration: none; font-weight: bold; font-size: 0.92em; margin: 4px 6px; white-space: nowrap; vertical-align: middle;\" href=\"https:\/\/whatsapp.com\/channel\/0029VbCA1v85K3zY4MLX2a1h\" target=\"_blank\" rel=\"noopener noreferrer\">Message on WhatsApp<\/a><\/p>\n<\/div>\n<h2>Who Is a Good Candidate for Each Treatment?<\/h2>\n<figure style=\"margin: 1.5em 0;\"><img decoding=\"async\" style=\"width: 100%; max-width: 100%; height: auto; border-radius: 8px;\" title=\"ICI vs Viagra Cialis Tokyo: choosing the right ED  \u2014 Who Is a Good Candidate for Each Treatment\" src=\"https:\/\/kojihifu.com\/english\/wp-content\/uploads\/2026\/08\/pexels_4226906_1785510287.webp\" alt=\"ICI vs Viagra Cialis Tokyo: choosing the right ED  \u2014 Who Is a Good Candidate for Each Treatment\" \/><\/figure>\n<h3>Oral PDE5 Inhibitors Are Often Appropriate For:<\/h3>\n<ul>\n<li>Men with mild to moderate ED, particularly where there is a psychological or situational component<\/li>\n<li>Those seeking a discreet, non-invasive, on-demand option<\/li>\n<li>Men whose ED is associated with lifestyle factors such as stress, alcohol use, or fatigue \u2014 and who are otherwise in good cardiovascular health<\/li>\n<li>Those who have not yet tried any pharmacological ED treatment<\/li>\n<\/ul>\n<h3>ICI Therapy Is Often Appropriate For:<\/h3>\n<ul>\n<li>Men who have tried oral PDE5 inhibitors at adequate doses without satisfactory results<\/li>\n<li>Those with moderate to severe vascular ED, including men with poorly controlled diabetes or peripheral artery disease<\/li>\n<li>Post-radical prostatectomy patients (where nerve-sparing was incomplete or not performed)<\/li>\n<li>Men with spinal cord injuries or other neurological conditions affecting erectile function<\/li>\n<li>Those in whom oral medications are contraindicated (e.g. nitrate use for angina)<\/li>\n<\/ul>\n<h3>Who Should Avoid ICI Therapy:<\/h3>\n<p>ICI is not appropriate for men with bleeding disorders, those taking therapeutic anticoagulants (blood thinners), men with sickle cell disease or other conditions predisposing to priapism, or those with a history of Peyronie&#8217;s disease (penile fibrosis) unless evaluated carefully by a physician.<\/p>\n<h2>What People Often Get Wrong About ICI and Oral ED Therapy<\/h2>\n<h3>Misconception 1: &#8220;If pills don&#8217;t work, nothing will.&#8221;<\/h3>\n<p>This is one of the most common \u2014 and most discouraging \u2014 beliefs among men who have tried sildenafil or tadalafil without success. In reality, non-response to oral PDE5 inhibitors does not mean that effective treatment is unavailable. ICI therapy operates through a fundamentally different mechanism and can produce reliable erections in men whose vascular or neurological pathways do not respond adequately to systemic oral medication. A failed oral trial should prompt a conversation with a physician about ICI \u2014 not a resignation to the situation.<\/p>\n<h3>Misconception 2: &#8220;ICI is a last resort reserved for the most extreme cases.&#8221;<\/h3>\n<p>In some contexts, particularly outside Japan and the US, ICI has historically been positioned as a third-line treatment behind oral medication and vacuum erection devices. However, contemporary urology guidelines recognise ICI as a highly effective second-line option with a strong evidence base, and many patients find it preferable to a vacuum device in terms of spontaneity and quality of the erection. It is a legitimate and well-established medical treatment \u2014 not an experimental or extreme measure.<\/p>\n<h2>Where to Get ED Treatment in Tokyo (English-Speaking Consultation)<\/h2>\n<p>Within our clinic group, English-speaking consultations are handled at <strong>BIOTOPE CLINIC<\/strong> in Shirokanedai (Minato-ku, Tokyo) by Dr. Jun Karibe. Our sister clinic, Kojimachi Dermatology &amp; Plastic Surgery Clinic in Ichigaya (Chiyoda-ku), handles Japanese-language insurance dermatology as the group&#8217;s main office but does not currently have English-speaking doctors. All English enquiries and bookings are handled via LINE or WhatsApp through our BIOTOPE-based English-speaking team.<\/p>\n<p>In Dr. Karibe&#8217;s clinical experience at <strong>BIOTOPE CLINIC<\/strong>, a significant proportion of international patients presenting with ED have already tried oral PDE5 inhibitors \u2014 often purchased online or through overseas prescriptions \u2014 without adequate medical supervision or dose titration. A proper in-person consultation allows for a full medical history review, discussion of cardiovascular safety, and the selection of the most appropriate treatment pathway, whether oral, injectable, or a combination approach. Both oral ED prescriptions (sildenafil\/tadalafil) and physician-supervised ICI therapy are available at BIOTOPE CLINIC in Shirokanedai.<\/p>\n<h2>Frequently Asked Questions<\/h2>\n<dl class=\"kj-faq\">\n<dt>Q. Can I get a prescription for sildenafil or tadalafil in Japan as a foreigner?<\/dt>\n<dd>Yes. ED medication is legally available in Japan as a prescription drug from licensed clinics. Nationality is not a barrier to receiving a private (self-pay) prescription. BIOTOPE CLINIC provides English-speaking consultations for this purpose, and prescriptions can typically be issued at or shortly after the initial consultation, subject to the physician&#8217;s medical assessment.<\/dd>\n<dd><\/dd>\n<dt>Q. Is ICI therapy legal and available in Japan?<\/dt>\n<dd>Alprostadil (single-agent injection) is approved in Japan for the treatment of ED. Compounded formulations such as Trimix and Bimix are prepared by licensed pharmacies under physician prescription. Availability and formulation options should be confirmed directly with the prescribing physician, as compounding practices can vary. Dr. Karibe can discuss what is currently available and appropriate at your consultation.<\/dd>\n<dd><\/dd>\n<dt>Q. How many injections per week is it safe to use ICI?<\/dt>\n<dd>Most clinical guidelines recommend limiting ICI use to no more than three times per week, with at least 24 hours between doses, in order to minimise the risk of penile fibrosis (scarring of the injection site) with long-term use. Injection site rotation is also recommended. Your physician will advise on a safe regimen specific to your formulation and dose.<\/dd>\n<dd><\/dd>\n<dt>Q. What should I do if I experience an erection lasting longer than four hours after an ICI injection?<\/dt>\n<dd>A prolonged erection lasting more than four hours (priapism) is a medical emergency requiring prompt treatment to prevent permanent tissue damage. Before being authorised for home use of ICI, patients are thoroughly briefed on the management protocol \u2014 which includes a reversal agent that can be administered at home in early cases, and the instructions for seeking emergency care if required. This safety training is a non-negotiable part of the ICI initiation process at BIOTOPE CLINIC.<\/dd>\n<dd><\/dd>\n<dt>Q. Is psychological ED better treated with pills or injections?<\/dt>\n<dd>For primarily psychogenic (psychological) ED in men with no significant vascular impairment, oral PDE5 inhibitors are generally the preferred starting point. They can help restore confidence and break the anxiety cycle that often sustains psychogenic ED. ICI is more commonly reserved for organic (physical) causes, though the two can occasionally be used in combination under medical guidance.<\/dd>\n<\/dl>\n<div class=\"kjmc-en-booking-inline\" style=\"background: #f7fbf7; border: 1px solid #d5e6d8; border-radius: 10px; padding: 16px 20px; margin: 26px 0; text-align: center;\">\n<p style=\"margin: 0 0 12px; color: #1a3a1f; font-size: 0.95em; line-height: 1.65;\"><strong>Have a question about this treatment?<\/strong><br \/>\nMessage us on LINE or WhatsApp \u2014 our English-speaking team usually replies the same day.<\/p>\n<p style=\"margin: 0; line-height: 1;\"><a style=\"display: inline-flex; align-items: center; gap: 8px; background: #06C755; color: #fff; padding: 10px 20px; border-radius: 8px; text-decoration: none; font-weight: bold; font-size: 0.92em; margin: 4px 6px; white-space: nowrap; vertical-align: middle;\" href=\"https:\/\/line.me\/R\/ti\/p\/@710uitns?ts=05311801&amp;oat_content=url#~\" target=\"_blank\" rel=\"noopener noreferrer\">Book via LINE<\/a><br \/>\n<a style=\"display: inline-flex; align-items: center; gap: 8px; background: #25D366; color: #fff; padding: 10px 20px; border-radius: 8px; text-decoration: none; font-weight: bold; font-size: 0.92em; margin: 4px 6px; white-space: nowrap; vertical-align: middle;\" href=\"https:\/\/whatsapp.com\/channel\/0029VbCA1v85K3zY4MLX2a1h\" target=\"_blank\" rel=\"noopener noreferrer\">Message on WhatsApp<\/a><\/p>\n<\/div>\n<h2>Summary<\/h2>\n<p><strong>Both oral PDE5 inhibitors and ICI therapy a<\/strong>re well-evidenced, effective treatments for erectile dysfunction \u2014 but they serve different patient profiles. Oral sildenafil and tadalafil are appropriate first-line options for most men with mild to moderate ED, offering convenience and a low intervention threshold.<strong> ICI therapy,<\/strong> particularly Trimix, provides a powerful and reliable alternative for men who do not respond adequately to oral medication or for whom oral drugs are contraindicated \u2014 with clinical studies suggesting response rates above 85% in appropriately selected patients.<\/p>\n<p>The most important step is an informed, private consultation with a qualified physician who can review your medical history, assess cardiovascular safety, and recommend the right treatment pathway for your specific situation. Self-medicating with unregulated online ED drugs \u2014 a risk that is particularly prevalent among international visitors who may not have access to a regular GP in Japan \u2014 carries genuine health risks that a short clinic visit can easily circumvent.<\/p>\n<p>If you have questions about ED treatment, English-speaking consultations are handled at <strong>BIOTOPE CLINIC<\/strong> in Shirokanedai (Minato-ku, Tokyo) by Dr. Karibe. Our sister clinic <strong>Kojimachi Dermatology &amp; Plastic Surgery Clinic<\/strong> in Ichigaya (Chiyoda-ku) handles Japanese-language insurance dermatology. English enquiries: LINE or WhatsApp.<\/p>\n<div class=\"kjmc-en-booking-box\" style=\"background: linear-gradient(135deg,#f1faf3 0%,#e6f3ea 100%); border-radius: 14px; padding: 32px 24px; margin: 36px 0 24px; border: 1px solid #c5dccd; text-align: center;\">\n<h3 style=\"margin: 0 0 8px; color: #3a6e3a; border: none; padding: 0; font-size: 1.3em;\">24\/7 Consultation &amp; Booking<\/h3>\n<div style=\"width: 48px; height: 2px; background: #3a6e3a; margin: 0 auto 22px;\"><\/div>\n<p style=\"margin: 0 0 12px; color: #1a3a1f; font-size: 1.1em; font-weight: bold;\">Book a Consultation or Treatment<\/p>\n<p style=\"margin: 0 0 24px; color: #2c4a35; line-height: 1.75;\">Our English-speaking team responds via LINE or WhatsApp \u2014 usually the same day.<\/p>\n<p style=\"margin: 0 0 10px; line-height: 1;\"><a style=\"display: inline-flex; align-items: center; justify-content: center; gap: 10px; background: #06C755; color: #fff; padding: 14px 32px; border-radius: 10px; text-decoration: none; font-weight: bold; font-size: 1.02em; box-shadow: 0 2px 8px rgba(6,199,85,0.25); min-width: 240px; white-space: nowrap;\" href=\"https:\/\/line.me\/R\/ti\/p\/@710uitns?ts=05311801&amp;oat_content=url#~\" target=\"_blank\" rel=\"noopener noreferrer\">Book via LINE<\/a><\/p>\n<p style=\"margin: 0; line-height: 1;\"><a style=\"display: inline-flex; align-items: center; justify-content: center; gap: 10px; background: #25D366; color: #fff; padding: 14px 32px; border-radius: 10px; text-decoration: none; font-weight: bold; font-size: 1.02em; box-shadow: 0 2px 8px rgba(37,211,102,0.25); min-width: 240px; white-space: nowrap;\" href=\"https:\/\/whatsapp.com\/channel\/0029VbCA1v85K3zY4MLX2a1h\" target=\"_blank\" rel=\"noopener noreferrer\">Message on WhatsApp<\/a><\/p>\n<\/div>\n<h2>References<\/h2>\n<ol>\n<li>Hatzimouratidis K, Amar E, Eardley I, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. European Urology. 2010;57(5):804\u2013814.<\/li>\n<li>Shabsigh R, Padma-Nathan H, Gittleman M, et al. Intracavernous alprostadil alfadex is more efficacious, better tolerated, and preferred over intraurethral alprostadil plus optional actis: a comparative, randomized, crossover, multicenter study. Urology. 2000;55(1):109\u2013113.<\/li>\n<li>Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. Journal of Urology. 2018;200(3):633\u2013641.<\/li>\n<li>Montorsi F, Basson R, Adaikan G, et al. Sexual medicine: sexual dysfunctions in men and women. 3rd International Consultation on Sexual Medicine. 2010. Paris: Health Publications.<\/li>\n<li>Yuan J, Hoang AN, Romero CA, et al. Vacuum therapy in erectile dysfunction \u2014 science and clinical evidence. International Journal of Impotence Research. 2010;22(4):211\u2013219.<\/li>\n<\/ol>\n<h2>Related Articles<\/h2>\n<p>You may also find these articles useful.<\/p>\n<ul>\n<li><a href=\"https:\/\/kojihifu.com\/english\/medical-weight-loss-tokyo-guide\/\" target=\"_blank\" rel=\"noopener\">Medical Weight Loss Tokyo: Options, Cost &amp; Clinic Guide<\/a><\/li>\n<li><a href=\"https:\/\/kojihifu.com\/english\/medical-weight-loss-tokyo-english\/\" target=\"_blank\" rel=\"noopener\">Medical Weight Loss Tokyo: English-Speaking Clinic Guide<\/a><\/li>\n<li><a href=\"https:\/\/kojihifu.com\/english\/medical-weight-loss-tokyo-expats\/\" target=\"_blank\" rel=\"noopener\">Medical Weight Loss Tokyo for Expats: Consultation<\/a><\/li>\n<li><a href=\"https:\/\/kojihifu.com\/english\/english-speaking-dermatologist-tokyo-melasma\/\" target=\"_blank\" rel=\"noopener\">English-Speaking Dermatologist Tokyo: Melasma &amp; Pigmentation<\/a><\/li>\n<\/ul>\n<div style=\"margin: 2.5em 0 1em; padding: 1.5em; border: 1px solid #d5d5d5; border-radius: 10px; background: #fafafa; font-size: .9em;\">\n<p style=\"font-size: .72em; font-weight: bold; color: #888; margin: 0 0 1.2em; letter-spacing: .08em;\">SUPERVISED BY<\/p>\n<div style=\"display: flex; align-items: flex-start; gap: 1.2em; flex-wrap: wrap;\">\n<div style=\"flex-shrink: 0; text-align: center; min-width: 110px;\"><img decoding=\"async\" style=\"width: 100px; height: 100px; border-radius: 50%; object-fit: cover; object-position: top center; display: block; margin: 0 auto; border: 3px solid #e0e0e0;\" src=\"https:\/\/kojihifu.com\/hon\/wp-content\/uploads\/2022\/01\/photo-karibejun-400-3_re-300x300.jpg\" alt=\"Dr. Jun Karibe MD \u2014 Board-certified Plastic Surgeon, Director of Kojimachi Dermatology &amp; Plastic Surgery Clinic\" \/><\/p>\n<p style=\"margin: .6em 0 .1em; font-weight: bold; font-size: .95em; color: #222;\">Dr. Jun Karibe<\/p>\n<p style=\"margin: 0 0 .1em; font-size: .75em; color: #999;\">MD<\/p>\n<p style=\"margin: 0; font-size: .75em; color: #555; font-weight: bold;\">Director<\/p>\n<\/div>\n<div style=\"flex: 1; min-width: 200px;\">\n<div style=\"margin-bottom: .75em; background: #fff; border: 1px solid #ebebeb; border-radius: 6px; padding: .7em 1em;\">\n<p style=\"margin: 0 0 .35em; font-size: .78em; font-weight: bold; color: #666; border-bottom: 1px solid #f2f2f2; padding-bottom: .3em;\">Education &amp; Career<\/p>\n<div style=\"font-size: .82em; color: #444; line-height: 1.75;\">\n<div>Juntendo University School of Medicine<\/div>\n<div>Department of Plastic Surgery, University of Tokyo Hospital<\/div>\n<div>Assistant Professor, Plastic &amp; Cosmetic Surgery, Saitama Medical University<\/div>\n<div>Assistant Professor &amp; Chief Resident, Yamanashi University Hospital<\/div>\n<div>2019: Founded Kojimachi Dermatology &amp; Plastic Surgery Clinic (Ichigaya, Tokyo)<\/div>\n<div>2021: Founded BIOTOPE CLINIC Shirokanedai (Minato-ku, Tokyo)<\/div>\n<\/div>\n<\/div>\n<div style=\"margin-bottom: .75em; background: #fff; border: 1px solid #ebebeb; border-radius: 6px; padding: .7em 1em;\">\n<p style=\"margin: 0 0 .35em; font-size: .78em; font-weight: bold; color: #666; border-bottom: 1px solid #f2f2f2; padding-bottom: .3em;\">Certifications<\/p>\n<div style=\"font-size: .82em; color: #444; line-height: 1.75;\">\n<div>Board-certified Plastic Surgeon \u2014 Japan Society of Plastic and Reconstructive Surgery<\/div>\n<div>Specialist \u2014 Japan Society of Anti-Aging Medicine<\/div>\n<div>Certified Industrial Physician \u2014 Japan Medical Association<\/div>\n<div>Allergan VST-certified Injector (Botox &amp; Hyaluronic Acid)<\/div>\n<\/div>\n<\/div>\n<div style=\"background: #fff; border: 1px solid #ebebeb; border-radius: 6px; padding: .7em 1em;\">\n<p style=\"margin: 0 0 .35em; font-size: .78em; font-weight: bold; color: #666; border-bottom: 1px solid #f2f2f2; padding-bottom: .3em;\">Awards<\/p>\n<div style=\"font-size: .82em; color: #444; line-height: 1.75;\">\n<div>Best Presentation Award \u2014 Dept. of Plastic Surgery, University of Tokyo (2016)<\/div>\n<div>Excellence Award \u2014 Japan Society of Plastic and Reconstructive Surgery (2018)<\/div>\n<div>Featured Presentation \u2014 ASPS Annual Scientific Meeting, USA (2018)<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div style=\"margin-top: 1em; padding-top: .75em; border-top: 1px solid #e8e8e8; display: flex; flex-wrap: wrap; align-items: center; gap: .5em;\"><a style=\"display: inline-block; background: #e1306c; color: #fff; padding: .4em .9em; border-radius: 4px; text-decoration: none; font-size: .8em; font-weight: bold;\" href=\"https:\/\/www.instagram.com\/dr.jun_\/\" target=\"_blank\" rel=\"noopener noreferrer\">Instagram<\/a><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"Compare ICI injection therapy with Viagra and Cialis for ED treatment in Tokyo. Learn effectiveness, costs, and how to access English-speaking consultations today.","protected":false},"author":4,"featured_media":9811,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[21],"tags":[589,593,594,579,581,583,584],"class_list":["post-9812","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-skin-dermatology","tag-penile-injection","tag-ed-treatment-tokyo","tag-viagra-cialis","tag-erectile-dysfunction","tag-mens-health-tokyo","tag-pde5-inhibitors","tag-ici-therapy"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/kojihifu.com\/english\/wp-json\/wp\/v2\/posts\/9812","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kojihifu.com\/english\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kojihifu.com\/english\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kojihifu.com\/english\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/kojihifu.com\/english\/wp-json\/wp\/v2\/comments?post=9812"}],"version-history":[{"count":1,"href":"https:\/\/kojihifu.com\/english\/wp-json\/wp\/v2\/posts\/9812\/revisions"}],"predecessor-version":[{"id":9981,"href":"https:\/\/kojihifu.com\/english\/wp-json\/wp\/v2\/posts\/9812\/revisions\/9981"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/kojihifu.com\/english\/wp-json\/wp\/v2\/media\/9811"}],"wp:attachment":[{"href":"https:\/\/kojihifu.com\/english\/wp-json\/wp\/v2\/media?parent=9812"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kojihifu.com\/english\/wp-json\/wp\/v2\/categories?post=9812"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kojihifu.com\/english\/wp-json\/wp\/v2\/tags?post=9812"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}