Not All Shockwaves Are Created Equal: Radial vs Focus Shockwave Therapy for Erectile Dysfunction
Updated: Apr 27
What’s up everyone? It’s Rich here again, and I’m here to talk about some things anyone trying to learn more about shockwave therapy will come up against — the idea that “not all shockwaves are created equal”.
I’m sure you all have probably read this title on some men’s health clinic’s website. This statement has grown popular in the past few years, and some clinics have had their marketing teams scrape other content from different websites and often reword it without doing their own research behind it.
Seriously…I dare you to Google it, and you’ll find a handful of these sites with similar content or content that doesn’t make sense.
But are they right, or are they wrong?
After some digging in the past two plus years, they are right — to some degree.
What you should know about shockwave therapy is that there are different types of shock waves or “soundwaves”:
Focus shockwaves/pressure waves
Radial shockwaves/pressure waves
Today, we will dig deeper into this topic and compare focus and radial shockwave and their use in erectile dysfunction treatment. My hope is that this ongoing debate between the efficacy and use of radial shockwaves versus focus shockwave therapy will have a different painted picture once you read what I found in my research.
But first, READ my disclaimer.
Bdestyle.com, (We, I, Us) is a professional review site that tests men’s health products thoroughly and provides educational information that shouldn't be misconstrued as medical advice. We are independently owned, and the opinions expressed here are our own. We are NOT doctors. We can’t diagnose you. If you need a diagnosis, prognosis or medical advice, go to your doctor. Read more about our policies and disclosures here.
Is Shockwave Therapy Approved for Treatment of ED in the U.S.?
It’s important to point out from the start that shockwave therapy for erectile dysfunction (Li-ESWT) isn’t approved in the United States yet. At the moment, research is still ongoing.
That said, in 2021, it was approved in Europe; however, counseling after a full screening is required before administering treatment. Additionally, because there are often other ED factors at play, patients need to know that there’s no cast-iron guarantee of success. But rather, a multiple-approach strategy is needed to tackle this condition from multiple angles.
So far, data suggest that shockwave therapy can help guys with vasculogenic ED, early onset Peyronie’s disease, CPPS, and several other sexual health problems.
What Is a Shockwave?
Shockwaves are energy transmitted across air or water. The wave is generated by a device that emits intense energy bursts. Once the energy reaches an object, it’s reflected.
Extracorporeal shockwaves (ESW) are non-invasive. These acoustic pressure waves target body parts to reduce pain or repair damaged tissue.
Let’s discuss how that relates to Extracorporeal Shockwave Therapy (ESWT). This type of treatment uses low-energy waves that move through your skin using transducers. There’s no need for anesthetic, and the treatment is usually tolerable or pain-free. However, some clinics use anesthetics anyway to avoid patient discomfort.
What’s the Difference Between Shockwave Therapy and Acoustic Wave Therapy?
There’s so much scientific jargon associated with shockwave therapy it’s easy to get confused. But maybe that’s how some professionals in the industry want you to feel…Some people play off this confusion on purpose.
Acoustic wave therapy is a non-scientific term. One reason that it’s often used is that it sounds less scary than the term “shockwave”. Of course, shockwaves don’t actually shock you, but it’s understandable from a marketing point of view that a softer term is used.
If you read anywhere that shockwave and acoustic wave therapy are different, it’s time to call BS. They’re clearly spreading misleading information.
When it comes to medical studies, you’ll always hear talk of shockwaves - radial or focus shockwaves. But to add extra confusion to the mix, physicists use the term “pressure waves.”
The glossary above is the terminology used in scientific studies on shockwave therapy to help clear up some confusion:
What’s The Difference Between Focus Shockwaves And Radial Shockwaves?
If you go to a men’s health clinic’s website, you’ll often see some marketing related to whatever device is being used by their providers.
For instance, on one side, you’ll see clinics that only use focus shockwave devices and bash other clinics for using radial shockwave devices. You’ll often see them writing misinformation about radial shockwave "patient experiences" or the wrong specifications on the actual radial device when they have NEVER used it themselves.
On the same token, you’ll see clinics that use radial shockwave devices and have a plethora of reviews and positive anecdotal experiences. Lastly, there are clinics that use BOTH radial and focus shockwave devices in their clinic because they BOTH work!
It’s a matter of knowing the differences and seeing it for yourself by actually doing your own research. Here’s what I’ve discovered.
How do Focused Shockwaves Work?
Focused shockwaves (FSW) are high-energy waves that target a specific area. The sound waves focus on a small spot, similar to how a magnifying glass focuses sunlight on one point.
There are three methods to how focus shockwaves are generated (FSWT).
Electrohydraulic
Electromagnetic (flat coil / cylindrical coil)
Piezoelectric
The only difference between the three is the moment at which the shockwave is formed and the device employed by a practitioner who offers shockwave treatment. At this time, 6 focus shockwave devices are still being questioned from the earlier studies on shockwave therapy from the 2005-2016 era.
These devices are registered as class 3 medical devices and are only operated by trained professionals. Why? Because these devices are very powerful and can potentially injure you at higher and unregulated intensities.
At the same time, different practitioners using focus shock wave devices may or may not use the same protocol. Treatment will vary by different energy flux densities (EFD) or different settings on their devices on a patient-by-patient basis.
These focused shockwaves have the ability to penetrate deep into tissue, delivering strength at the designated depth. If we look at available focus wave devices, some companies, like Storz Medical, state their focus shockwaves penetrate up to 12 cm deep with very little energy loss. Damage to skin and underlying tissue is minimal.
If we translate this to treating penile tissue, the "average" penis size isn’t that big, guys! The wave type easily penetrates penile tissues on one focal point or a singular treatment line.
From experience of getting this type of treatment, you’re laying on a table naked from the waist down and flaccid unless you accidentally get erect during treatment, which happens! This treatment will penetrate no matter the size or rigidity of your penis.
How Do Radial Shockwaves Work?
In the past, radial shockwaves were generated using a pneumatic system. Using compressed air, a projectile is accelerated to a high speed and then quickly slowed down by a transmitter.
The kinetic energy created is then sent to the tissue through waves. These waves are generated at the transmitter's surface, with the highest pressure and strongest energy density.
Currently, better-made radial shockwave devices use electromagnetic systems instead of pneumatic systems. In an electromagnetic system, there’s a bullet in a barrel accelerated using alternating magnetic fields. These fields cause the bullet to strike an end plate creating a shockwave.
Devices like these usually categorize their shockwaves in terms of actual energy instead of the pressure “bar”. They use milijoules to determine the difference in energy level.
However, most studies I’ve seen use both measurements and often have a conversion table or chart to determine a pressure bar of 1.0, all the way to a bar of 5.0 being 60 to 180 mj (milijoules).
Even at the highest “pressure bar” or “milijoule”, the “conversion” or calculation of energy flux density for a pressure bar of 3.0 or 120 mj is approximately around 0.12 mj/mm2, which is within the range we have seen focus devices use during the clinical trials when treating erectile dysfunction.
***The below is approximations based on the current data.
Compressed Air Bar | Magnetic mJ | Energy Per mm using 15mm head mJ/mm2 |
1 | 60 | |
2 | 90 | |
3 | 120 | 0.12 |
4 | 150 | |
5 | 180 | 0.38 |
Based on the setting of a radial device, this is an example of what each pressure bar/milijoule output looks like:
