Low-intensity shockwave therapy (Li-ESWT) is a non-invasive treatment for erectile dysfunction (ED). Unlike tablets, which work only when you take them, it aims to improve the blood supply to the penis itself, so that natural erections become easier. It does not help everyone. It works best for some men, and it should always follow a proper assessment of why ED is happening. This guide explains how it works, who it is most likely to help, what the evidence shows and what a course involves.
What is shockwave therapy for ED?
Li-ESWT uses a handheld applicator to deliver low-energy acoustic (sound) waves to the shaft and base of the penis. These are much weaker than the shockwaves used to break up kidney stones.
In laboratory and animal studies, these waves appear to encourage the growth of new small blood vessels and to improve the function of the vessel lining. The aim is to improve blood flow into the erectile tissue, which is the main problem in vasculogenic ED, the most common physical cause of ED.
Who is most likely to benefit?
The evidence is strongest for men with mild to moderate ED caused by reduced blood flow. Shockwave therapy may be worth discussing if you:
- have mild or moderate ED and would prefer not to rely on tablets;
- respond to tablets such as sildenafil or tadalafil but want to reduce how much you depend on them;
- cannot take ED tablets, or find the side effects difficult;
- have early ED linked to blood vessel risk factors, alongside work on lifestyle and general health.
It tends to be less effective in severe ED, and in ED caused mainly by nerve damage, for example after radical prostate surgery, or by long-standing diabetes. In these situations, your specialist may recommend other treatments instead of, or as well as, shockwave therapy.
What does the evidence show?
Several randomised, sham-controlled trials and meta-analyses have shown that Li-ESWT can improve erectile function scores compared with a sham (placebo) treatment, particularly in men with milder vasculogenic ED. A 2017 meta-analysis in European Urology found a statistically significant improvement in erectile function scores after treatment.
The European Association of Urology (EAU) guidelines state that Li-ESWT can be offered to men with mild vasculogenic ED, or as an alternative first-line option for men who are not suitable for, or do not wish to take, oral medication. The guidelines also note that studies use different machines and treatment protocols, results vary between men, and the long-term durability of the benefit is still being studied. The American Urological Association currently regards shockwave therapy for ED as investigational, which reflects the same uncertainty about protocols and long-term results.
In plain terms: shockwave therapy can help some men meaningfully, but it is not a guaranteed cure, and it is not a replacement for a proper medical assessment.
Why an assessment comes first
ED is often the first sign of a problem elsewhere in the body, including heart disease, diabetes, high blood pressure, high cholesterol or low testosterone. Before any treatment, a specialist should take a full history and check for these conditions. If you have ED together with chest pain, breathlessness or new symptoms, please speak to your GP promptly.
At International Andrology, your consultation will consider the likely cause of your ED, its severity, your medications and your goals, so that the treatment plan suits you rather than a single fixed package. Read more about our erectile dysfunction service.
What a course of treatment involves
Protocols vary, but a typical course looks like this:
- Sessions: usually around 6 sessions, often once or twice a week. Your clinician may recommend more depending on your response.
- Duration: about 15 to 20 minutes per session. No anaesthetic, needles or downtime are needed.
- How it feels: most men describe a tapping or mild tingling sensation. It should not be painful.
- Afterwards: you can return to work and normal activities straight away, including sex.
- When results appear: improvement, if it comes, builds gradually and is usually assessed around one to three months after the course.
Shockwave therapy can be combined with other treatments, such as tablets, lifestyle changes and pelvic floor exercises, where appropriate. Find out more about shockwave therapy at International Andrology.
Side effects and safety
Li-ESWT is generally very well tolerated. Side effects are uncommon and usually minor, such as temporary redness, mild discomfort or small spots of bruising on the skin.
It may not be suitable, or may need extra caution, if you:
- take blood-thinning medication or have a bleeding disorder;
- have an infection, wound or untreated skin condition in the treatment area;
- have a penile implant;
- have cancer in the treatment area, or are having treatment for it.
Your clinician will check these at your consultation.
Realistic expectations
Shockwave therapy is not a quick fix, and results are not the same for everyone. Some men notice firmer, more reliable erections and need tablets less often. Others notice a smaller change, and some do not benefit. Any improvement may fade with time, and some men choose a repeat course later.
If shockwave therapy and medication do not give you the result you need, there are other effective options, including injection therapy and, for some men, a penile implant.
Frequently asked questions
Does shockwave therapy for ED really work?
In clinical trials, it has improved erectile function more than sham treatment, especially in men with mild to moderate ED caused by reduced blood flow. Results vary between individuals.
How many sessions will I need?
A typical course is around 6 sessions over a few weeks. Your specialist will recommend a plan based on your assessment and response.
Is shockwave therapy painful?
Most men feel only tapping or mild tingling. No anaesthetic is needed.
How long do the results last?
This varies. Some men maintain an improvement for a year or more, while others find the benefit fades sooner. Research on long-term results is ongoing.
Can shockwave therapy increase penis size?
No. Shockwave therapy is a treatment for erectile function, not for penis size.
How do I get started?
Book a free phone call with our team, or message us on WhatsApp at +44 7457 404374.
References
- Salonia A, et al. EAU Guidelines on Sexual and Reproductive Health. European Association of Urology; current edition.
- Lu Z, Lin G, Reed-Maldonado A, et al. Low-intensity extracorporeal shock wave treatment improves erectile function: a systematic review and meta-analysis. Eur Urol. 2017;71(2):223–233.
- Clavijo RI, Kohn TP, Kohn JR, Ramasamy R. Effects of low-intensity extracorporeal shockwave therapy on erectile dysfunction: a systematic review and meta-analysis. J Sex Med. 2017;14(1):27–35.
- Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633–641.
This article is for educational purposes only and does not constitute personal medical advice. All treatment decisions should follow consultation with a qualified professional.
