Most men are handed a PDE5 inhibitor (Viagra/Cialis) without proper diagnosis. If your ED is vascular, hormonal, or structural — a pill won't fix the root cause. Dr. Hwang identifies your specific cause before recommending treatment at our Seomyeon clinic.
The IIEF-5 (International Index of Erectile Function) is the global standard for ED severity scoring. Answer the 5 questions below honestly. Each scores 1–5. Total determines severity tier.
Q1. How often were you able to get an erection during sexual activity?
1=No sexual activity, 2=Almost never, 3=Sometimes, 4=Most times, 5=Almost always
Q2. When you had erections, how often were they hard enough for penetration?
1=No erections, 2=Almost never, 3=Sometimes, 4=Most times, 5=Almost always
Q3. During intercourse, how often were you able to maintain your erection?
1=Did not attempt, 2=Almost never, 3=Sometimes, 4=Most times, 5=Almost always
Q4. During intercourse, how difficult was it to maintain your erection to completion?
1=Did not attempt, 2=Extremely difficult, 3=Very difficult, 4=Difficult, 5=Not difficult
Q5. When you attempted sex, how often was it satisfactory for you?
1=No attempts, 2=Almost never, 3=Sometimes, 4=Most times, 5=Almost always
| Score range | Severity | Typical treatment tier |
|---|---|---|
| 22–25 | No ED | Assessment only |
| 17–21 | Mild ED | Lifestyle + PDE5 inhibitors |
| 12–16 | Mild–moderate | PDE5 + cause investigation |
| 8–11 | Moderate | ICI or LiSWT therapy |
| 5–7 | Severe | Penile prosthesis considered |
ED has 7 main causes: vascular (most common, 60%), hormonal (low testosterone), neurological (diabetes/injury), medication-induced, psychological, structural (Peyronie's), and mixed. Treating the wrong cause is ineffective. Dr. Hwang identifies the primary cause before recommending treatment.
IIEF-5 questionnaire, testosterone blood panel, penile Doppler ultrasound (if vascular suspected), nocturnal tumescence test, and full medical history review. Most diagnostic work completed in one visit at our Seomyeon clinic.
Oral PDE5 inhibitors (Viagra/Cialis) as first line, vacuum erection devices, intracavernosal injections (ICI), low-intensity shockwave therapy (LiSWT), and penile prosthesis implant for refractory ED. Dr. Hwang recommends starting at the least invasive effective tier.
Message Dr. Hwang your IIEF-5 score and symptoms via WhatsApp. He'll tell you which cause type to investigate and what your first consultation in Busan should include.
TL;DR: ED has 7 clinically distinct causes — vascular (most common), neurological, hormonal, psychogenic, medication-induced, anatomical, and mixed. Identifying your cause determines your treatment. IIEF-5 score below 21 = ED confirmed. Penile Doppler ultrasound identifies the vascular component. Dr. Hwang's 4-tier ladder starts at the least invasive option appropriate for your cause and severity.
The IIEF-5 (International Index of Erectile Function – 5 item) is the validated clinical tool used at Busan Men's Health Clinic to confirm and grade ED severity. Each of the 5 questions is scored 1–5. Total 25 = no ED. Complete the assessment before your consultation.
| IIEF-5 Score | ED Severity | First-Line Treatment at BMH | Estimated Cost (USD) |
|---|---|---|---|
| 22–25 | No ED | Lifestyle review; no treatment indicated | — |
| 17–21 | Mild ED | PDE5 inhibitors (sildenafil/tadalafil) + shockwave | $200–$400 |
| 12–16 | Mild–Moderate ED | LiSWT shockwave series (6 sessions) + PDE5i | $1,100–$1,400 |
| 8–11 | Moderate ED | LiSWT + ICI injection training + penile Doppler | $1,400–$2,200 |
| 1–7 | Severe ED | Penile implant evaluation (AMS 700 CX or Coloplast) | $9,200–$11,500 |
IIEF-5 score alone does not determine treatment — cause does. A score of 12 due to medication side effects has different first-line treatment than a score of 12 due to vascular disease. Dr. Hwang's assessment establishes both.
ED is a symptom, not a diagnosis. Effective treatment requires identifying the underlying cause. Dr. Hwang screens all 7 recognised aetiologies at first consultation.
Reduced blood flow to the corpora cavernosa. Identified by penile Doppler ultrasound. PSV (peak systolic velocity) <25 cm/s confirms arterial insufficiency. First-line: LiSWT shockwave therapy stimulates angiogenesis.
Post-prostatectomy, spinal cord injury, diabetes mellitus (peripheral neuropathy), multiple sclerosis. Shockwave is less effective. Implant is often definitive treatment.
Total T <300 ng/dL confirmed by blood test. TRT alone resolves ED in 30–40% of hypogonadal men. Hyperprolactinaemia (elevated prolactin) requires MRI to exclude pituitary adenoma.
Situational ED (works with some partners, not others; morning erections intact). Psychogenic ED responds well to PDE5i + cognitive approaches. Penile Doppler is normal.
Over 200 drugs impair erectile function. Dose adjustment or substitution may resolve ED without other treatment. Dr. Hwang reviews all current medications at consultation.
Fibrous plaque in the tunica albuginea causing penile curvature and pain. Plaque location determined by ultrasound. Treatment: collagenase injection, traction therapy, or surgical correction.
Identified by penile Doppler (EDV >5 cm/s during full erection). Difficult to treat non-surgically. Venous ligation or implant may be required.
Dr. Hwang's protocol always starts at the least invasive tier appropriate for your cause and IIEF-5 score. Most foreign patients are placed on Tier 1 or 2. Tier 4 (implant) is reserved for Tier 1–3 failures or neurogenic ED.
Penile Doppler ultrasound is Dr. Hwang's primary diagnostic imaging tool for ED. It is performed in-clinic with pharmacological stimulation (ICI of alprostadil to produce an erection), and takes 30 minutes.
It measures peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the cavernosal arteries — the only objective way to confirm or exclude vascular ED.
| Measurement | Normal | Arterial Insufficiency | Venous Leak |
|---|---|---|---|
| PSV | > 35 cm/s | < 25 cm/s | Variable |
| EDV | < 5 cm/s | Variable | > 5 cm/s |
| RI (Resistive Index) | > 0.9 | < 0.75 | < 0.75 |
ED in men under 50 is a cardiovascular early-warning sign. PSV <25 cm/s in a man aged 40–50 correlates with elevated 10-year major cardiovascular event risk. Dr. Hwang's assessment includes cardiovascular risk screening and may recommend cardiology referral.
| Treatment | Sessions | Time in Busan | Fly Home | Follow-Up |
|---|---|---|---|---|
| IIEF-5 assessment + Doppler | 1 visit | 1 day | Same day | WhatsApp 8-week IIEF-5 retest |
| PDE5i prescription | 1 visit | 1 day | Same day | Video at 8 weeks |
| LiSWT Shockwave (6 sessions) | 6 × 15 min | 5–6 days | Day 6 | Video at 3 months |
| ICI Training | 1–2 sessions | 2 days | Day 3 | WhatsApp support ongoing |
| Penile Implant (AMS 700 CX) | 1 surgery | 12–14 days | Day 12–14 | Video at 6 weeks |
The most efficient foreign patient visit for ED: Doppler ultrasound + IIEF-5 assessment + LiSWT shockwave (first 3 sessions) in one 3-day visit to Busan. Remaining 3 shockwave sessions can sometimes be completed at a home-country clinic if a STORZ or BTL device is available — Dr. Hwang provides a written protocol.