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Shockwave Therapy for Erectile Dysfunction - MyConciergeMD

Erectile dysfunction (ED) is a common sexual health condition facing countless men around the world. Its prevalence can reach up to 75%. It is estimated that by 2025, more than 320 million men will be affected by erectile dysfunction. As a key research area in men’s health, ED has been studied for years to identify the best possible management and treatment options for this condition. Shockwave therapy is an effective drug-free ED treatment that more healthcare providers are now including in their ED treatment options.

What is Erectile Dysfunction?

Erectile dysfunction (ED) refers to the inability to achieve or maintain penile erections. When it was first diagnosed, doctors believed it was only caused by psychological problems like stress or performance anxiety. Later, further research has clarified that key physiological causes are linked to ED, especially those related to abnormal blood flow to the penis.

Types of Erectile Dysfunction

There are multiple types of ED based on the underlying cause. Vasculogenic ED is caused by impaired blood flow to the penis whereas neurogenic ED is associated with abnormal nerve supply to the penis which blocks the nerve signaling from the brain that trigger erections. Drug-induced, or iatrogenic, ED is caused by the use of specific medications like antidepressants which have side effects that reduce sex drive and arousal.

Causes of Erectile Dysfunction

Erections require a healthy blood flow to the penis. Some health conditions negatively affect vascular supply to penile tissue which results in ED. These conditions include:

  • Prostate problems, e.g. benign prostatic hyperplasia (BPH) or prostate cancer
  • Type 2 diabetes
  • Cardiovascular disease (high blood pressure, high blood cholesterol)

Other disorders like Peyronie’s disease (abnormally curved penis) and priapism (inflamed penis) affect the penis directly and can be linked to impaired erections and ED. Alcohol use and smoking are also risk factors for ED. Some medications can lead to ED. For example, side effects of blood pressure medications, antidepressants like SSRIs, and chemotherapy are associated with ED.

Patients who struggle to achieve or maintain erections can visit a urologist (a doctor who specializes in the male genitourinary system) to confirm the diagnosis and seek treatment of ED.

Shockwave Therapy for ED

Treatment options for ED include pharmaceutical drugs such as phosphodiesterase-5 (PDE5) inhibitors like Viagra or testosterone hormone replacement therapy (HRT). But randomized clinical trials have demonstrated a significant improvement of ED symptoms following a novel treatment option called low-intensity shockwave therapy.

What Is Shockwave Therapy?

Shockwave therapy, also known as low-intensity extracorporeal shockwave therapy (LI-ESWT), involves passing painless sound waves through the skin to stimulate tissue regeneration. It is used to treat different conditions from tendon injuries and inflammatory conditions to ED. The sound waves that pass through the penile skin are highly focused, targeting a small specific treatment area to improve erectile function.

There two different types of low-intensity shockwave therapy: radial ESWT and focused ESWT. Radial shockwave therapy entails the use of intense sound waves that gradually weaken as they pass through tissue; they are best suited to treat large but relatively superficial areas that are 3-4 cm below the skin. Radial shockwave therapy is not used to treat ED.

Focused shockwave therapy relies on the use of sound waves that are more targeted so they can precisely focus on a small but deep area, up to 12 cm below the skin. Another advantage of focused ESWT is that it triggers the release of a natural vasodilator called nitric oxide which plays a key role in achieving erections. This type is ideal for ED treatment because it can remove any fatty deposits in penile blood vessels and restore blood flow.

How Does Shockwave Therapy Work?

Shockwave treatment works by increasing the blood flow to the penis. By stimulating tissue repair, the waves activate the smooth muscle cells in the penis to regenerate and heal more quickly. During this repair process, new blood vessels are formed in a process called angiogenesis. This boosts vascular supply and improves the symptoms of ED. Although the Food and Drug Administration (FDA) has not approved the shockwave treatment protocol for ED yet, the success rates of this therapy make it a promising treatment of erectile dysfunction for many men who want to avoid the side effects of pills or the pain of injections or penile implant surgery.

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Benefits of Shockwave Therapy

Shockwave therapy has several benefits that make it easier and more effective as a treatment of ED.

  • Targets vascular cause of ED: because impaired blood flow is often the root cause of most erection problems, shock wave treatment addresses this aspect directly to yield better and long-lasting erections
  • Quick results: ED patients who receive shockwave therapy can notice improved erections within 3 weeks, this can be very important for patients who want to quickly restore a healthy sex life with their partners
  • High success rate: clinical studies show success rates with over 75% of patients still reporting (3) good sexual performance without using PDE5 inhibitors during follow-up 30 months after treatment ends
  • Drug-free and non-invasive treatment: men with ED can improve their erections without relying on pills with side effects or painful injections
Benefits of Shockwave Therapy - MyConciergeMD

How Many Sessions of Shockwave Therapy Are Needed?

Typically, to effectively treat ED, patients need around 12 sessions scheduled twice weekly for 6 weeks. The effectiveness of shockwave treatment depends on the underlying cause of ED. For instance, if a patient has pre-existing diabetes or heart disease, they can modify their lifestyle in parallel with shockwave therapy to optimize its effect. Once the symptoms of the pre-existing conditions are treated, the effect of shockwave therapy can last a lifetime. A peer-reviewed systematic review and meta-analysis found that, on average, the improvement of ED symptoms after shockwave therapy lasts at least 3 months.

Side Effects of Low-Intensity Shockwave Therapy

Unlike drug-based treatments and surgical interventions, low-intensity shockwave therapy (LIESWT) is completely painless with no down-time or side effects. Although not FDA-approved yet, this natural treatment is also non-invasive, the application of focused sound waves is applied from outside the penis so there’s no discomfort or pain. Patients can complete the session and go home without worrying about any discomfort for the rest of the day.

Reference:

(1) Kessler A, Sollie S, Challacombe B, Briggs K, Van Hemelrijck M. The global prevalence of erectile dysfunction: a review. BJU international. 2019 Oct;124(4):587-99. https://doi.org/10.1111/bju.14813

(2) Gruenwald I, Appel B, Kitrey ND, Vardi Y. Shockwave treatment of erectile dysfunction. Therapeutic advances in urology. 2013 Apr;5(2):95-9. https://doi.org/10.1177/1756287212470696

(3) Adeldaeim HM, Abouyoussif T, El Gebaly O, Assem A, Wahab MM, Rashad H, Sakr M, Zahran AR. Prognostic indicators for successful low-intensity extracorporeal shock wave therapy treatment of erectile dysfunction. Urology. 2021 Mar 1;149:133-9. https://doi.org/10.1016/j.urology.2020.12.019

(4) Rizk PJ, Krieger JR, Kohn TP, Pastuszak AW. Low-intensity shockwave therapy for erectile dysfunction. Sexual medicine reviews. 2018 Oct;6(4):624-30. https://doi.org/10.1016/j.sxmr.2018.01.002

(5) Man L, Li G. Low-intensity extracorporeal shock wave therapy for erectile dysfunction: a systematic review and meta-analysis. Urology. 2018 Sep 1;119:97-103. https://doi.org/10.1016/j.urology.2017.09.011

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MyConciergeMD | Shockwave Therapy for Erectile Dysfunction

Author: David Nazarian, M.D.

Board Certified in Internal Medicine and Specialist in Concierge Medicine & Executive Health. Dr. Nazarian practices Integrative Medicine with focus on preventative medicine, anti-aging, hormone replacement therapy and IV Vitamin optimizations. Dr. David Nazarian, received his bachelor of sciences from the University of Los Angeles, California in Psychology and Biology. He obtained his Medical Doctorate degree from Sackler School of Medicine. He completed his medical residency at Huntington Memorial Hospital, a University of Southern California affiliate hospital. Once completed, he established a practice in the heart of Beverly Hills. Dr. Nazarian is a Diplomat of the American Board of Internal Medicine. He has received numerous awards and recognition as a top doctor in his field.