Low-Intensity Extracorporeal Shockwave Therapy (LI-ESWT), commonly called shockwave therapy, is used to treat ED caused by vascular problems. Administering low-intensity sound waves has been found to encourage the development of new blood vessels (angiogenesis), and improve the function of smooth muscle and endothelial cells. Shockwaves may also break up and reduce blockages in arteries in the penis.
Shockwave therapy is a well-established procedure for promoting healing of injuries and bone fractures, and treating achilles tendinitis and plantar fasciitis. Its use as a treatment for erectile dysfunction is relatively recent, dating back just a few years.
When treating ED, a portable device is coated with a lubricating gel and applied directly to the penis. The procedure is painless. Sessions may last from 10 to 30 minutes. Treatment requires one or more sessions per week, over a period of 6-12 weeks. A follow-up treatment may be scheduled 6 months later.
There are many studies that show good results1 2 3 4 5 6 7 8 9, especially for men with mild to moderate ED caused by vascular problems10. A 2016 study found shockwave therapy to be effective for men who do not respond to PDE-5 inhibitors11, and that the benefits persisted for 12 months.
A review of previous work12, conducted in 2017, found contradictory results, with some studies showing promise, some providing inconclusive findings and some even discouraging. However, another review conducted in 201913 found overall positive results.
A study published in 2019 looked at the effectiveness of LI-ESWT for men who had undergone a radical prostatectomy14; the results were positive, but too small to be statistically significant.
A 2021 study15 found that shockwave therapy is as effective as on-demand sildenafil. However, sildenafil must be taken each time a man wants to have sex, while shockwave therapy offers long-lasting benefits.
A 2018 study showed that about half the men who have a successful outcome from LI-ESWT lose the beneficial effects after two years16, and require another treatment.
Because this treatment is administered externally, it does not require approval by the US Food & Drug Administration (FDA).
LI-ESWT therapy is marketed under various brand names, including GAINSWave®, REGENAWAVE®, and SONICWAVE™, each with their own treatment protocol. None of these companies has funded or published any peer-reviewed clinical studies. One consequence of this is that the treatment methodology is not standardized, and may vary from one clinic to another… so research results may not apply to all practitioners.
Shockwave therapy is also expensive. A complete course of treatment in a clinical setting typically costs several thousand dollars.
Note: As of June, 2020, we’ve moved this section from our article on “New and Experimental Treatments for Erectile Dysfunction” to create this standalone article. We believe that there is sufficient clinical evidence to consider LI-ESWT a mainstream treatment for erectile dysfunction.
Focused (linear) versus Unfocussed (radial) Therapy
There are two general types of shockwave therapy – linear and radial. Many studies do not specify the type of device used. A small study published in 201917 showed slightly better outcomes for radial therapy, but given the size of the study, the results should not be considered conclusive.
Shockwave Therapy and Peyronie’s Disease
Early studies18 19 20 of the use of LI-ESWT for the treatment of Peyronie’s Disease (PD) have been promising; the treatment shows the potential to significantly reduce plaque, penile curvature, and painful erections.
Shockwave Therapy and Incontinence
There is some clinical evidence21 that shockwave therapy may also be an effective treatment for incontinence.
Shockwave Therapy at Home
A southern California company is now selling a home LI-ESWT unit which they claim provides the same treatment protocol as clinical devices. This has the potential to make shockwave therapy much more affordable and available. (See our article on the Phoenix home LI-ESWT device.)
Frequently Asked Questions About Shockwave Therapy
Does shockwave therapy for ED Work?
According to numerous studies (cited in this article), shockwave therapy is a safe and effective treatment for men with vascular ED. Vascular ED is caused by poor blood flow in the penis; it’s the most common form of erectile dysfunction.
Is shockwave therapy painful?
Shockwave therapy is a non-invasive, non-surgical treatment. Some men experience discomfort during shockwave therapy sessions. This is easy to deal with by applying a topical numbing ointment a few minutes prior to the treatment.
What are the side effects of shockwave therapy?
Shockwave therapy is very safe and there are few side effects. Men may experience minor bruising, swelling, or numbness, which should heal in a few days.
How long does shockwave therapy take?
Shockwave therapy consists of a series of treatments, typically administered over 6-12 weeks. Each session lasts about half an hour.
How much does shockwave therapy cost?
In the United States, a series of treatments in a clinic typically costs $3-6,000.
Can I buy a shockwave machine for ED?
Yes, the Phoenix home shockwave therapy device is designed specifically for treating erectile dysfunction at home.
For More Information
Causes of Erectile Dysfunction
Treatments for Erectile Dysfunction
- Ong, William Lay Keat; Lechmiannandan, Sivaneswaran; Lim, Yen Li ; Manoharan, Devindran; Lee, Say Bob. “Early outcomes of short-course low intensity shockwave therapy (LiSWT) for erectile dysfunction: A prospective, randomized, double-blinded, sham-controlled study in Malaysia.” Andrologia. July 2022.
- Gruenwald, Ilan; Appel, Boaz; Kitrey, Noam D; Vardi, Yoram. “Shockwave treatment of erectile dysfunction.” Therapeutic Advances in Urology. Apr 2013; 5(2): 95–99.
- Musa, Zubairu S.; El-Assmy, Ahmed; Shokry, Ahmad M; Shokeir, Ahmed A; Zween, Tamer; Al-Kenawya, Mahmoud R. “Long-term effectiveness and predictors of success of low-intensity shockwave therapy in phosphodiesterase type 5 inhibitors non-responders.” Arab Journal of Urology. 2020; 18(1): 54–58.
- Sramkova, Tatjana ; Motil, Igor; Jarkovsky, Jiří; Sramkova, Katerina. “Erectile Dysfunction Treatment Using Focused Linear Low-Intensity Extracorporeal Shockwaves: Single-Blind, Sham-Controlled, Randomized Clinical Trial.” Urologia Internationalis. Dec 2020; 104(5-6):417-424.
- Abu-Ghanem, Yasmin; Kitrey, Noam D; Gruenwald, Ilan; Appel, Boaz; Vardi, Yoram. “Penile Low-Intensity Shock Wave Therapy: A Promising Novel Modality for Erectile Dysfunction.” Korean Journal of Urology, May 2014; 55(5): 295–299.
- Kalyvianakis, D; Memmos, E; Mykoniatis, I; Kapoteli, P; Memmos, D; Hatzichristou, D. “Low-Intensity Shockwave Therapy for Erectile Dysfunction: A Randomized Clinical Trial Comparing 2 Treatment Protocols and the Impact of Repeating Treatment.” Journal of Sexual Medicine. Mar 2018. 15(3):334-345.
- Srini, Vasan Satya; Reddy, Rahul Kumar; Shultz, Tamar; Denes, Bela. “Low intensity extracorporeal shockwave therapy for erectile dysfunction: a study in an Indian population.” The Canadian Journal of Urology. Feb 2015. 22(1).
- Fojecki, GL; Tiessen, S; Osther P.J. “Effect of Linear Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction-12-Month Follow-Up of a Randomized, Double-Blinded, Sham-Controlled Study.” Sexual Medicine. Mar 2018. 6(1):1-7.
- Lu, Z; Lin, G; Reed-Maldonado, A; Wang, C; Lee, Y.C.; Lue, T.F. “Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis.” European Urology. Feb 2017. 71(2):223-233.
- Xin, Zhongcheng; Guan, Ruili; Cui, Wanshou; Zhang, Xiaodong; Tian, Long; Xie, Yi; Lei, Hongen; Liu, Jihong; Wang, Tao. “PD69-04 Safety and Efficacy of Low Intensity Extracorporeal Shockwave in the Treatment of Vasculogenic Erectile Dysfunction: a Multi-Center, Double-Blind, Randomized Sham-Controlled Clinical Trial.” The Journal of Urology. Apr 2017.
- Bechara, Amado; Casabé, Adolfo; De Bonis, Walter; Ciciclia, Pablo Gomez. “Twelve-Month Efficacy and Safety of Low-Intensity Shockwave Therapy for Erectile Dysfunction in Patients Who Do Not Respond to Phosphodiesterase Type 5 Inhibitors.” Journal of Sexual Medicine. Dec 2016. 4(4):e225-e232. doi: 10.1016/j.esxm.2016.06.001.
- Fode, Mikkel; Lowenstein, Lior; Reisman, Yacov. “Low-Intensity Extracorporeal Shockwave Therapy in Sexual Medicine: A Questionnaire-Based Assessment of Knowledge, Clinical Practice Patterns, and Attitudes in Sexual Medicine Practitioners.” The Journal of Sexual Medicine. Jun 2017. 5(2): e94–e98.
- Sokolakis, Ioannis; Hatzichristodoulou, Georgios. “Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomized controlled trials.” International Journal of Impotence Research. Jan 2019.
- Baccaglini, Willy; Pazeto, Cristiano Linck; Barros, Eduardo Augusto Corrêa; Timóteo, Frederico; Monteiro, Leonardo; Rached, Raiff Yusser Saad; Navas, Arthur; Glina, Sidney. “The Role of the Low-Intensity Extracorporeal Shockwave Therapy on Penile Rehabilitation After Radical Prostatectomy: A Randomized Clinical Trial.” The Journal of Sexual Medicine. Dec 2019.
- Lei, Qi; Wang, Dong; Liu, Chunhui; Ji, Zhigang; Yan, Su. “Comparison of the efficacy and safety of low-intensity extracorporeal shock wave therapy versus on-demand sildenafil for erectile dysfunction.” Translational Andrology and Urology. Feb 2021; 10(2):860-868. doi: 10.21037/tau-20-1069.
- Kitrey, Noam D. ; Vardi. Yoram; Appel, Boaz; Shechter. Arik; Massarwi, Omar; Abu-Ghanem. Yasmin; Gruenwald, Ilan. “Low Intensity Shock Wave Treatment for Erectile Dysfunction—How Long Does the Effect Last?” Journal of Urology. Jul 2018.
- Eryilmaz, Recep ; Kaplan, Şeyhmus ; Aslan, Rahmi; Demir, Murat; Taken, Kerem. “Comparison of focused and unfocused ESWT in treatment of erectile dysfunction.” The Aging Male. May 2019.
- Chung, Eric. “Pro: does shockwave therapy have a place in the treatment of Peyronie’s disease?” Translational Andrology and Urology. June 2016.
- Shimpi, Rajendra Kashinath; Jain, Ravi Jineshkumar. “Role of extracorporeal shock wave therapy in management of Peyronie’s disease: A preliminary report.” Urology Annals. Oct-Dec 2016.
- Di Mauro, Marina; Russo, Giorgio Ivan; et al. “Extracorporeal Shock Wave Therapy in Peyronie’s Disease: Clinical Efficacy and Safety from a Single-Arm Observational Study.” World Journal of Men’s Health. Mar 2019.
- Long, Cheng-Yu; Lin, Kun-Ling; Lee, Yung-Chin; Chuang, Shu-Mien; Lu, Jian-He; Wu, Bin-Nan; Chueh, Kuang-Shun; Ker, Chin-Ru; Shen, Mei-Chen; Juan, Yung-Shun. “Therapeutic effects of Low intensity extracorporeal low energy shock wave therapy (LiESWT) on stress urinary incontinence.” Nature Scientific Reports. April 2020. 10, Article number: 5818 (2020).