Shockwave Therapy for Erectile Dysfunction: An Honest Guide

By Mr Sarp Keskin, Consultant Urological Surgeon

Low-intensity shockwave therapy (Li-ESWT) is one of the most talked-about treatments for erectile dysfunction. It is widely advertised – sometimes with bold claims of a "cure". This guide sets out what the treatment involves, who it may help, and – just as important – who it is unlikely to help, so you can make an informed decision.

What is shockwave therapy for ED?

Shockwave therapy uses gentle, low-energy sound (acoustic) waves, delivered through a probe placed against the penis. These are far weaker than the shockwaves used to break kidney stones.

The idea is that the waves cause a mild, controlled stress to the tissue, which may:

• Encourage the growth of new small blood vessels

• Improve blood flow into the penis

• Help repair the tissue that controls erections

Unlike tablets or injections, which work "on demand", shockwave therapy aims to improve the penis's own ability to produce an erection over time.

What does treatment involve?

• A course of usually around 6 sessions, typically once or twice a week (protocols vary)

• Each session takes about 15–20 minutes

• Gel is applied and a hand-held probe is moved along different areas of the penis

• No anaesthetic is needed – most men feel only a mild tapping or tingling

• You can drive, work and have sex as normal straight afterwards

• Any improvement usually develops gradually over 1–3 months after the course

Who is most likely to benefit?

The best results are seen in men with:

• Mild to moderate ED

• ED caused mainly by reduced blood flow (vasculogenic ED)

• A partial response to tablets – shockwave therapy may help tablets work better

Who is unlikely to benefit?

• Men with severe ED who get no response to tablets

• ED after radical prostate surgery or pelvic radiotherapy, where the main problem is nerve damage

• ED that is mainly psychological or hormonal

• Men with poorly controlled diabetes or heart disease, unless these are addressed first

What does the evidence say?

Being honest:

• Some well-designed studies show a modest improvement in erection scores in men with mild vasculogenic ED, compared with a "dummy" treatment

• Other studies show little or no benefit

• Research is made harder because machines, energy levels and treatment schedules differ widely between clinics

• We do not yet know how long any benefit lasts – some men may need repeat courses

• European urology guidelines consider it a reasonable option for men with mild vasculogenic ED, but it is not a proven "cure"

Is it safe?

Yes – side-effects are rare and usually limited to mild, temporary discomfort or slight redness of the skin. There is no anaesthetic, no needles and no downtime.

How does it compare with other treatments?

• Tablets and injections are more reliable and work every time they are used, but need to be taken before sex

• Shockwave therapy aims for longer-term improvement but works in fewer men and to a lesser degree

• For the right man, it can be a good addition – not usually a replacement – for other treatments

Our approach

Because shockwave therapy works best in carefully selected men, Mr Keskin will first assess you fully – including blood tests and, where helpful, a penile Doppler ultrasound – to work out the cause of your ED. He will then give you honest advice on whether shockwave therapy is likely to be worthwhile for you, or whether another treatment would serve you better.