You have probably seen the ads: a quick, painless session, no pills, no needles and a treatment that claims to fix the underlying cause of ED rather than just helping with erections while you take a tablet. Extracorporeal shockwave therapy for erectile dysfunction is marketed as exactly that. The question is whether the evidence actually backs it up.
Short answer: it may help some men, but the evidence is uncertain and it is nowhere near the guaranteed fix some clinics advertise. The research is still catching up to the marketing.
In this guide, DirectMeds will break down what shockwave therapy actually does, what the clinical evidence shows (including the less flattering parts), who it is realistically likely to help and what the major medical bodies are telling doctors right now.
What Is Extracorporeal Shockwave Therapy?
Extracorporeal shockwave therapy (ESWT) is also called low intensity shockwave therapy (LI-ESWT) in the treatment of erectile dysfunction (ED) is a non invasive treatment involving sound wave vibrations applied locally through a portable device positioned on the penis. It aims to improve erectile function, but how it works, how long any benefit lasts and the best treatment protocol are still uncertain.
Unlike PDE5 inhibitors, which can be taken as needed or, in the case of tadalafil, daily if prescribed, shockwave therapy is given as a course of sessions. It has mainly been studied in vasculogenic ED, the form linked to reduced blood flow rather than nerve damage or psychological causes. Whether it offers lasting benefit is still uncertain.
What Does the Evidence Actually Show?
At this stage, the image is significantly complicated as compared to what most clinics’ marketing would indicate.
- A Cochrane review of 21 studies involving 1,357 men found that shockwave therapy may lead to a small improvement in erectile function. The certainty of this evidence was low, and it is uncertain whether the improvement would be noticeable to patients.
- In an Australian open-label study, which was published in the academic journal BJU International and involved 30 male participants receiving the treatment twice a week for 6 weeks, it was revealed that 60% of the subjects managed to show significant improvements in their erectile function scores and 50% of the men were able to achieve spontaneous erections.
- According to the Canadian rapid review, there is no statistical significance between shockwave therapy and traditional medical treatment, such as PDE5 inhibitor therapy.
What Do Major Medical Bodies Actually Say?
Organisation | Official Position |
Classifies shockwave therapy as investigational | |
Advises it be used exclusively for research purposes and only costs basic research fees | |
Gives a weak recommendation for selected men including those with mild vasculogenic ED or vasculogenic ED with poor response to tablets | |
Emphasises the need for more research to confirm its effectiveness |
Guidance differs between organisations, so it’s worth asking a doctor which recommendation applies to your situation.
Who Might Actually Benefit From Shockwave Therapy?
Research has mostly looked at men with vasculogenic ED and guidelines that support the treatment limit it to selected men.
- The EAU gives a weak recommendation for men with mild vasculogenic ED
- The EAU also gives a weak recommendation for men with vasculogenic ED who respond poorly to tablets.
- Evidence is less clear for other groups such as men with ED after nerve injury (for example, after radical prostatectomy) or severe diabetes-related ED. Whether shockwave therapy helps these men is uncertain
Shockwave Therapy vs. Other ED Treatments
Treatment | Evidence Strength | Approach |
PDE5 inhibitors (sildenafil, tadalafil, etc.) | Strong, extensive RCT evidence | Helps achieve an erection while the medicine is active. Can be taken as needed, or daily for tadalafil if prescribed. Does not treat the underlying cause of ED |
Shockwave therapy (LI-ESWT) | Low certainty, with uncertain noticeable benefit | Given as a course of sessions, aiming to improve erectile function |
Established & non invasive | Mechanically draws blood into the penis at the time of use | |
Penile injections (alprostadil) | Strong evidence & more invasive | Directly induces an erection via injection |
Practical Considerations Before Trying It
- Cost and insurance coverage: Shockwave therapy is not covered by Medicare in Australia and it can be expensive if done at private clinics. The Urology Care Foundation especially recommends that men consider this cost relative to the uncertain clinical evidence of effectiveness.
- Treatment protocol is not standardized: there is no agreement yet on the optimal number of sessions, strengths of shockwaves used or frequency of its use, making comparison of results between clinics difficult.
- Be careful about exaggerated marketing: the Urology Care Foundation points out the fact that there is plenty of misinformation surrounding shockwave therapy.
- Short-term side effects were uncommon in the studies reviewed but those studies were small and varied substantially, so long term safety is less well established.
Frequently Asked Questions
Does shockwave therapy for ED actually work?
Possibly, but the evidence is uncertain. A Cochrane review of 21 studies found a possible small improvement in erectile function, with low certainty and uncertain noticeable benefit. Lasting benefit and the best protocol remain unclear.
Is shockwave therapy for ED a scam?
Not in the sense of being fake. It has been studied in clinical trials, but the evidence is low certainty and the Urology Care Foundation warns that marketing can overstate what it can do. Ask a doctor about the evidence before paying for treatment.
How many sessions of shockwave therapy are needed?
There is no standard protocol. The number and frequency of sessions varies between studies and clinics so ask any provider what protocol they use and what evidence supports it.
Is shockwave therapy covered by Medicare in Australia?
No. The therapy is usually performed on a private basis and paid by the patients in cash which should be considered in comparison with the recent studies.
Who is the best candidate for shockwave therapy?
Guidelines that support shockwave therapy limit it to selected men, such as those with mild vasculogenic ED or vasculogenic ED that responds poorly to tablets, and the EAU’s recommendation is weak. Whether it helps men with ED after nerve injury or severe diabetes is less certain. A doctor can advise whether it is worth considering.
