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The Science and History Behind Shockwave Therapy for Erectile Dysfunction

Updated: May 10

the science and history behind shockwave therapy for erectile dysfunction

What’s up, everyone? It’s Rich, and I’m back in full force! I hope you’re ready for an eyeful because I have a lot to say in this post! We’re talking about low-intensity extracorporeal shockwave therapy for erectile dysfunction (Li-ESWT for short) and its current position as a pending treatment for ED.

It’s come to my attention that there’s a lot of misinformation and contradictions across the web about:

  • What shockwave therapy is

  • The different types of shockwaves (not all shockwaves are created equal)

  • What Li-ESWT does for men with erectile dysfunction (ED), Peyronie’s disease, CPPS, etc.

  • What the current literature on shockwave therapy for ED states

  • What Urologists and people from the medical community say about this type of therapy

  • What other websites and clinics you find on the web that offers Li-ESWT say

  • Realistic and unrealistic expectations of Li-ESWT treatment from the health clinics and at-home devices

I’ve much more to say than the list above, but it’s important to expose the truth behind Li-ESWT so that you guys can understand exactly what you’re paying for and what it’s supposed to do for your penis.

I’m also pretty sure I’m going to royally piss off some men’s health clinics, as well as marketing teams. But the truth is, they’re a big part of the reason for much of the confusion on the topic.

So, let’s dive in…

But first, READ my disclaimer., (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.

Why Do We Need to Review Li-ESWT Literature?

Another important message: I’m reviewing the literature on shockwave therapy for ED because most of you emailed me about vague, inaccurate, or inaccessible information. So, I'm doing this comprehensive research for you, guys.
what is lieswt treatment for ED infographic by bdestyle

Some research on this topic requires fees to access databases and view current clinical trials and data on shockwave therapy. There are, however, ways to access most of this data for free.

I always suggest looking into Pubmed, NCBI, ResearchGate, Onlinelibrary, The Journal Of Sexual Medicine, and other publications to perform simple search queries to find and read the FULL studies on this topic.

This post will not include every study on shockwave therapy for ED, Peyronies, and CPPS. However, I’ll put emphasis on two meta-analysis studies that used focused shockwaves (not radial).

The analyses review and compare over a dozen studies in the past 15 years and hold the most data on the efficacy of treating vasculogenic ED for patients with mild to moderate ED.

The two meta analyses’ I will constantly be referring to are:

  1. (Free version here)

  2. (Free version here)

I’ll also include certain studies on rats. The value of these studies versus the studies on human males is that there’s no psychological component in animal studies.

Whether you want to believe it or not, if you have any of the types of ED (vasculogenic, neurogenic, pharmacological, hormonal, etc.), you most likely will develop psychological ED due to the frustration, stress, shame, and frequency of these erection issues.

These animal studies also hold interesting data on nerve regeneration.

Lastly, I’ll also include research and discussion on radial shockwave therapy as there is currently “limited information” on radial waves being enough to treat vasculogenic ED (because it’s still new, coupled with contradictions and additional questions).

doctor argue over shockwaves versus radial shockwaves for ED

If you're unsure what I'm referring to, I've also done a full review of the difference between radial and focus shockwave therapy for ED, so make sure to check that out.

But, since I’m a believer in science and continuous research, I think in the next ten years, we’ll have more data and research on shockwave therapy as a whole to reflect on this so we can have standardized approaches when considering each wave type and device as a potential regenerative ED treatment option.

Is Shockwave Therapy For ED Approved in the U.S.?

I must say this here… Li-ESWT is currently not approved as a treatment option for erectile dysfunction and other sexual health-related issues in the U.S. Because we need more reliable research, it’s still considered investigational.

guy climbing a mountain representing that shockwave therapy for erectile dysfunction is soon to be approved in the United States

It was, however, approved in Europe in 2021. Still, it must be coupled with counseling and proper screening, and the patient must be informed that success isn’t guaranteed. This is because the patient could have other types of ED or a severe case of ED.

It appears that the FDA in the U.S. is more uptight, and they have every right to consider the limitations and questions that still need to be answered from the Li-ESWT research to date.

But, with the current data, there is potential in this treatment, and it can help men with vasculogenic ED (only), early onset Peyronie’s disease, CPPS, and other sexual health issues.

Glossary of Terms

Let’s look at the scientific terminology to help you understand the discussion we’ll have on this type of therapy.

  • Li-ESWT - Low-Intensity Extracorporeal Shockwave Therapy

  • fESWT - Focus Extracorporeal Shockwave Therapy

  • rESWT - Radial Extracorporeal Shockwave Therapy

  • IIEF-EF Score - International Index Erectile Function (Used during studies to determine success)

  • IIEF-5 - An abridged version of the IIEF Score that only includes five questions

  • EHS - Erection Hardness Score (used during the studies)

  • AWT- Acoustic Wave Therapy (a layman’s term for shockwave therapy)

  • Linear Shockwave - A different type of shockwave (people confuse this and focus shockwaves — but they’re different)

  • Sham - A “control group” where a doctor/researcher doesn’t administer the actual real treatment (not to be confused with placebos used in pharmacological studies...the term sham is often used for non-pharmacological studies —as we are reviewing studies on testing devices and not pills)

  • RCT - Randomized Control Trials (Researchers prefer these and double-blind studies for clinical trials to compare an intervention group and a placebo control group)

  • PED5i - Phosphodiesterase type 5 inhibitor — ED pills such as Viagra

  • EFD - Energy Flux Density — EFD is related to the energy of the shockwave

This list is not exhaustive of all the variations and keyphrases used in the studies or the mainstream, so do your research and make your own conclusions!

Now that we got this out of the way, let’s take a look at the history behind shockwave therapy. Most people think this is a new treatment option, but it’s been around longer than you think!

You guys can save the infographic below for quick reference if needed!

glossary of terms to know about shockwave therapy for ed

The History of Shockwave Therapy

Low-intensity extracorporeal shockwave treatment ( Li-ST) for men’s sexual health has rapidly gained traction in the last decade. But shockwaves have been used in medicine since 1980.

However, this type of treatment traces its roots to the 1950s, when there was a surge of research into shockwave use in medicine. Ceramics were disintegrated by shockwaves when shot through water in laboratory tests. Frank Rieber of New York was the first to apply for an electrohydraulic shockwave generator patent.

shockwave pressure mpa history graph
adaptation of the graphic used

Between the 1960s and 1970s, the German Department of Defense researched the effects of shockwaves on animals. Following successful animal testing, shockwaves were used to disintegrate a kidney stone in the first human patient in 1980.

After this initial use in humans, shockwave treatment for kidney stones became the norm. For the next decade, shockwave machines were tested and used to cure orthopedic disorders such as non-union fractures, pseudo-arthroses, osteochondrosis, and various tendinopathies.

In 2010, Vardi et al. demonstrated in a pilot study that low-intensity shockwave lithotripsy (LiST) treatment (energy of about 10MPa) improved erectile function in men with vasculogenic ED. He followed up his findings from 2012 with a randomized, double-blind, sham-controlled study, showing again that LiST benefits people experiencing erectile dysfunction.

In the last ten years, there have been high-quality, randomized studies supporting the effectiveness of LiST in treating ED and, in some cases reversing it. As more studies are conducted, LiST has become an exciting way to help treat ED.

What Is a Shockwave?

A shockwave is a type of energy transmitted through water or air. It is created when a device emits an intense burst of energy. This energy travels until it encounters an object and is then reflected.

Extracorporeal shockwaves (ESW) are acoustic pressure waves. Shockwaves are different from ordinary acoustic waves since they have a lower frequency. A smaller, everyday version of a shockwave is created by clapping your hands.

what are the mechanisms of shockwaves

So, what does that look like with ESWT treatment?

ESWT treatment involves using low-energy waves that go through a person's skin with the help of a transducer. A gel is used as a medium, making treatment painless, so no anesthesia or medication is required.

By stimulating the body's natural healing mechanisms, shockwave therapy could help to repair tissue and reduce pain.

How Shockwave Therapy Works On Penile Tissue

Based on the current research on treating erectile dysfunction, Li-ESWT is supposed to aid the release of vascular endothelial growth factor (VEGF) and nitric oxide, key mediators in collateral blood vessel formation and angiogenesis.