First in Japan! D Clinic Initiates New 'Intracavernosal Injection (ICI Therapy)' Covering All ED Treatments Listed in Clinical Guidelines – Becomes the Only Medical Institution Offering All Options from PDE5 Inhibitors to Surgical Procedures

D Clinic Tokyo will commence treatment with "ICI therapy (intracavernosal injection)", one of the ED treatments, from April 8th.

D Clinic operates as a total men's healthcare clinic that comprehensively addresses all men's health issues. As part of this commitment, in ED treatment, we have offered a wide range of treatment options, including PDE5 inhibitors such as Viagra, Cialis, and Levitra, non-invasive vacuum erection devices (VED), the latest low-intensity extracorporeal shockwave therapy (Renova), and testosterone replacement therapy.

The newly introduced ICI therapy (intracavernosal injection) is a highly effective treatment that promotes erection by directly injecting medication into the penile corpus cavernosum, offering immediate results. It is applicable to individuals for whom PDE5 inhibitors are insufficient or who cannot use oral medications due to heart conditions, and has been implemented globally as a highly effective treatment.

With the commencement of this treatment, D Clinic has established a system to provide all ED treatment methods listed in the clinical guidelines of the Japan Society for Sexual Medicine/Japanese Urological Association.

HP: https://menshealth.d-clinicgroup.jp/

### ■Background for Providing Comprehensive ED Treatment

#### ① Comprehensive ED Treatment Compliant with Guidelines

In September 2025, the "Clinical Guidelines for Male Sexual Dysfunction" were published by the Japan Society for Sexual Medicine/Japanese Urological Association. These guidelines outline the flow from diagnosis to treatment of ED.

D Clinic complies with all treatments from the first to third choices based on these guidelines.

If penile prosthesis surgery, a third-choice treatment, is required, patients will be referred to Juntendo University Urayasu Hospital, where Professor Akira Tsujimura, the guideline drafting committee chairman, is affiliated.

[Flow of ED Treatment] - First choice: PDE5 inhibitors (Viagra, Cialis, Levitra, etc.) - Second choice: ICI therapy (intracavernosal injection), vacuum erection devices, low-intensity extracorporeal shockwave therapy, testosterone replacement therapy - Third choice: Penile prosthesis surgery

#### ② Appropriate Treatment System Approved by the Ethics Committee

The PGE1 formulation used in ICI therapy is not approved in Japan for ED treatment purposes. Our clinic has obtained approval after review by the ethics committee on the following items:

[Items] - Validity of treatment - Balance of benefits and risks for patients - Procedures for informed consent (explanation and agreement) - Response system in case of adverse events - Protection of patient privacy

#### ③ Treatment Supervised by the Guideline Drafting Committee Chairman

Our clinic's ED treatment receives cooperation from Professor Akira Tsujimura of the Department of Urology, Juntendo University Urayasu Hospital, who served as the chairman of the drafting committee for the Clinical Guidelines for Male Sexual Dysfunction. Even if penile prosthesis surgery, a third-choice treatment, becomes necessary, referrals to Juntendo University Urayasu Hospital, where Professor Tsujimura is affiliated, can be made smoothly.