What Is Shock Wave Therapy for Erectile Dysfunction?

physical therapy of the knee and the foot with shock wave
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Low-intensity shock wave therapy, also known as shock wave therapy, uses sound waves to stimulate tissues inside the body. Originally developed as a treatment for wounds and injuries, shock wave therapy is thought to stimulate increased blood flow in order to promote healing. As erectile dysfunction (ED) is often a product of issues with blood flow into and out of the penis, shock wave therapy has been proposed as a possible therapy for ED. It has also been proposed as a potential therapy for Peyronie's disease and other sexual health problems. Unfortunately, there is only limited and inconsistent evidence that it works.


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Erectile Function Measurement

In general, trials studying shock wave therapy use self-reports by men to determine the effectiveness of treatment. Those reports generally consist of one or both of the two most common ways of measuring erectile function—the International Index of Erectile Function (IIEF) and the Erection Hardness Scale (EHS). Both of those scales are used by doctors to assess erectile dysfunction, as well as by researchers.

The EHS asks men to rate the hardness of their erection on a scale from 1 (no enlargement) to 5 (completely hard and fully rigid). In contrast, questions on the IIEF are more about the quality of an individual's erections and their effect on sexual satisfaction and function. Patients rate each question on a scale of 1 to 5, and topics include:

  • How do you rate your confidence that you could get and keep an erection?
  • When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
  • During sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner?
  • When you attempted sexual intercourse, how often was it satisfactory for you?

Together, these two scales can give a reasonable assessment of men's erectile function without requiring men to get an erection during a medical or research visit. They can also be used to determine how much of an improvement men report, if they see one.

Research on Shock Wave Therapy for Erectile Dysfunction

To date, there have been a number of randomized controlled trials looking at the effects of shock wave therapy on men with erectile dysfunction. Most of those trials have been small, looking at between 30 to 60 men per group, and of low quality. The results have varied substantially across studies, with similar numbers of studies (on similar numbers of patients) suggesting that the procedure both does and does not help. None of the studies have reported any adverse events from undergoing shock wave therapy. It's just unclear whether or not it's useful. Furthermore, even those meta-analyses that have found a significant improvement in men's IIEF scores have only found them to go up by 2 to 3 points.

Basic science research, and animal research, on shock wave therapy has been more promising. In animal studies, shock wave therapy has been shown to both improve the growth of blood vessels and to stimulate growth and differentiation of penile tissue. In the lab, studies show shock wave therapy has also been shown to help with tissue growth. This gives plausible mechanisms by which shock wave therapy could be useful in humans. However, that does not mean that shock wave therapy will be found to be an effective treatment for erectile dysfunction.

Should Men Consider Shock Wave Therapy for ED?

In 2019, scientists from the European Society of Sexual Medicine reviewed the evidence for the use of shock wave therapy in sexual health. What did they find? There is some evidence that shock wave therapy may help with erectile dysfunction. However, the evidence is inconsistent and even where there were reported improvements, those improvements reflected only a small improvement in erectile function. Shock wave therapy appears to be safe, and most men do not have side effects. However, it may make sense to wait for further evidence before investing in this type of treatment, particularly for men who have not yet tried more proven options.

As for men with Peyronie's disease, there is some evidence that shock wave therapy may help with the pain of Peyronie's disease. However, there is no evidence that it improves penile curvature or gets rid of the plaques that cause those curves. Therefore, men who are considering this form of treatment should not go in expecting changes in their penile function, although it could be a way to deal with discomfort.

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