What Is Shockwave Therapy for ED?

Dr. Joseph Pazona, Board Certified Urologist

For those of you too young to remember, this is Peter Gabriel from one of his music videos. What does he have to do with ED? Stay tuned.

Peter Gabriel Image

First things first: What is a music video? Music videos were epic productions of rock stars typically played on MTV. In the 1980s, we watched them because we were awesome.

What’s not awesome are the standard treatment options for erectile dysfunction. Pills, vacuum devices and penis injections?! No thanks. I’ll pass on a painful 4-hour erection and watch some SEC football instead.

What if there were some natural way to improve erections? What if we could turn back the clock to the good old days of strong, spontaneous erections anytime the wind blew in the right direction? That sounds fantastic.

(As long as we can skip the awkward erections we had to hide when walking to the chalkboard in 4th period Geometry.)

There is finally a solution. ESWT, or penile Shockwave Therapy for ED. If the old dog is asleep, this is going to wake him up.

What is ESWT or Shockwave Therapy?

Extracorporeal shockwave therapy (ESWT) is a non-invasive therapy involving sound waves. Extracorporeal is fancy doctor-speak for outside of the body. Nothing is inserted in the body. Rather, a device is placed near or on the treatment area of interest.


The device sends sound waves through the soft tissue of your body. How deep the sound waves travel depends on the particular device. Different devices also deliver different intensities or power depending on the condition being treated. Finally, the sound waves can be focal or spread out (radial) in their pattern of delivery. 


In the case of shockwave therapy for ED, the energy is:

  • Low intensity (painless)
  • Superficial (doesn’t hurt any deeper tissues)
  • Radial (spreads out to treat all of the microscopic nerves and blood vessels)

What does ESWT treat?

Traditionally, ESWT is used in urology to break up kidney stones (extracorporeal shock wave lithotripsy or ESWL). However, ESWT has been used for years in the treatment of musculoskeletal injuries, including plantar fasciitis and tennis elbow.

Newer applications in the treatment of chronic, non-healing wounds have further shown the natural healing capabilities of ESWT.

Ummm . . . so what does this have to do with the penis and ED?

As you can imagine, if there’s an affliction of the penis, then there’s a man somewhere who is trying to make his penis: bigger, stronger, faster . . . on second thought . . . definitely not faster.

There’s actually some science which explains why ESWT would help ED.

How does ESWT for ED work?

If you recall from my previous blog on ED, the most common cause of erectile dysfunction is atherosclerosis or blocked blood vessels. The second most common cause is nerve damage from diabetes or surgery.

Shockwave therapy causes a micro-trauma to these damaged blood vessels and nerves. This trauma then starts a cascade of natural healing and regrowth. These natural growth factors promote new blood vessel growth, nerve regeneration, and help to break up scar tissue in the penis.

What is the ESWT treatment course for ED?

Shockwave therapy for ED is delivered in an office setting. 6 treatments are typically performed over the course of three weeks. The sessions last about 10 minutes and are painless for most men.

While sitting in a frog-leg position, naked of course, on an examination table, the first shockwaves are delivered to the perineum (that’s the “taint” for those men who were confused). These treatments are targeting the nerves and blood vessels heading to the bulb of the penis. This is where blood is first entering the erectile chambers.

The next set of treatments are along the shaft of the penis. Usually with your help, we deliver shockwaves every 1 cm along the shaft to help promote healing of the corpora cavernosa or erectile chambers. This is sensitive for some men. Topical anesthesia or a little laughing gas is used in 10-20% of our patients.

After the treatment session there is no pain and no restrictions. In fact, we encourage patients to be sexually active in between sessions to promote blood flow to the area. Some men with no natural erections use a vacuum erection device to “stretch out” and get some blood in the penis.

How long does shockwave therapy for ED take to work?


Some men will notice an improvement in erections immediately. A recently treated patient of mine, who is a skeptical physician himself, noted increased morning erections after just one session. Most patients will start to see benefits within 6-12 weeks.


What results can I expect from shockwave therapy for ED?


Every man is different and presents with varying degrees of erectile dysfunction. Men with atherosclerosis tend to have better results than men with nerve damage from radiation or surgery. In preliminary studies and anecdotally, 70-80% of men can expect some improvement in their erections.


For some men, improvement might be eliminating the need for “the little blue pill”. For others, it may mean “the little blue pill” works again after previously failing. Some men even report improved sensitivity and pleasure from sex.


I know your next question. I wouldn’t expect ESWT to increase the size of your Johnson. Don’t deny it, you were thinking about it.


Good candidate for ESWT

How do I know if I’m a candidate ESWT for ED?


If you are tired of the current therapy options for ED, then shockwave therapy may be right for you. The ideal patient for ESWT is:

  • Suffering from mild-to-moderate erectile dysfunction (difficulty maintaining or achieving a rigid erection satisfactory for intercourse) due to atherosclerosis
  • No longer responding to oral therapies such as Sildenafil (Viagra) or Tadalafil (Cialis)
  • Having side effects like headaches, backaches, changes in vision to the pills
  • Not interested in long-term use of vacuum erection devices or penile injections
  • Interested in spontaneous, stress-free sexual activity


Although ESWT can be safely used to treat almost any man with erectile dysfunction, I would temper any expectations of a man who has ED in the following scenarios:

  • >1 year past prostate cancer treatment with radiation or surgery (indicative of pelvic nerve damage that is more difficult to recover)
  • Severe ED with no penile fullness for several years prior to ESWT consideration
  • Multiple medical problems, specifically history of heart attack or stroke, such that sexual active may not be safe
  • Previous successful penile implant surgery


If you’re not certain if ESWT is right for you, seek a second opinion from a board-certified urologist who specializes in ED and offers shockwave therapy to his/her patients.

Is there any scientific proof to prove these results?


Absolutely. One collection of studies (meta-analysis) from the journal Nature looked at multiple studies over an eight-year period and showed improved erectile function in 873 men compared to placebo. A more recent study out of Europe showed the ESWT for ED was especially effective in treating men with more mild to moderate ED.


Currently in the U.S. there are ongoing trials to further study the effects of shockwave therapy for ED. Until then, the therapy is being offered outside of insurance as a non-FDA approved therapy. 

Why should I consider shockwave therapy for ED if it’s not FDA approved?


A core principle in medicine is “first do no harm.” The beauty of shockwave therapy for ED is that it has no risk of complications. Given that we have no other proven restorative therapies for ED, and ESWT works for many men, there is no harm to considering the therapy if you're tired of needles and pills.


All current therapies are “band-aids”. They don’t treat the underlying cause of ED, which in most cases is atherosclerosis. Shockwave therapy causes your body to naturally heal and repair narrowed blood vessels and damaged nerves. 


Don’t forget that just because something is FDA approved does not necessarily mean that it is safe. In the past 25 years, Vioxx, Seldane and Accutane are three drugs that were pulled off the market for dangerous side effects. These medications were previously “FDA approved” and deemed “safe”.  


Lastly, insurance companies are quick to deny any ED therapy. Any man who’s been on Viagra can tell you the hundreds if not thousands of dollars he’s spent over the years on the little blue pill. In our current healthcare environment, I don’t see any ED therapies being covered by insurance companies any time soon.


How do I decide where to have ESWT for ED? 


If you search for ESWT or shockwave therapy for ED, you’ll be bombarded with countless ads. There are even options to purchase your own device for treatment at home. Buyer beware.


One major problem with ESWT for ED is that there is huge variation in the quality of devices available for use.  Anyone can go on eBay, order a ESWT device from China for $2000 and set up an “ED clinic”. Unfortunately, this happens.


As you seek help for erectile dysfunction, make certain the doctor you choose:

  • Has expertise in erectile dysfunction
  • Offers a variety of the most up-to-date therapies rather than one treatment that they are incentivized to sell
  • Addresses the causes of ED and discusses overall health improvement
  • Has a positive online reputation


Typically, a board-certified urologist in your area is going to be the provider best suited to address ED. Just do your homework to ensure they provide patients with the latest treatment options and great customer service. Many urologists are good doctors but set in their ways. They’re treating patients today like they did in 1993. Remember life before cell phones?


What if I have further questions about shock wave therapy for ED?


Send me an email at hello@pazonamd.com. I’d be more than happy to answer any questions or direct you to other reputable resources.


I’m a big believer in improving the quality-of-life of my patients through safe, minimally invasive therapies. I’m very excited to offer shockwave therapy to treat ED in the right patients. 


There’s finally something that can provide men with spontaneous, pill-free, pain-free sex.


If it’s time to “shock the monkey” (thank you Peter Gabriel) then give Pazona MD a call:


(615) 527-4700


Talk soon!

Dr. P.


Dr. Joseph Pazona is a board-certified urologist with a private, solo practice in the heart of Nashville TN. He specializes in the treatment of ED and offers state-of-the-art restorative therapies.

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About the Author

Doctor Joseph Pazona is the founder of Pazona MD, a specialty urology practice located in Nashville, TN. He has been published in medical journals on the topic of urology & authored several consumer ebooks on a variety of urologic conditions in addition to the topics of telemedicine, and continuing medical education (CME). When he’s not treating patients or writing he enjoys traveling, hiking, running, cooking, and spending time with his three children and fiancé, Catherine.


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