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UP TO 50 million men in the U.S. have erectile dysfunction, and it’s a condition that gets more common with age. Some pop a pill before sex, and then there are those who prefer to zap their penises to get an erection. Yes, really.
Shock wave therapy is on the rise for guys looking for alternative ways to treat erectile dysfunction. These treatments involve using low-intensity shock waves to spark chain reactions that could help harden the penis.
Right now, the method isn’t as popular as taking Viagra or other erectile dysfunction pills, but there’s been a push in recent years for men’s health clinics to offer the service. One study noted at least 152 clinics offering the service in eight of the largest metropolitan areas across the country.
Here’s what you need to know about this unconventional but popular ED treatment.
How Does Shock Wave Therapy Work?
THE THERAPY USES low-energy sound waves delivered to different areas of the penis with a handheld wand. Sound waves begin with a short pulse, then a rapid increase to maximum positive pressure, followed by a prolonged period of negative pressure.
“Unlike the high-intensity shockwaves used to break up kidney stones, these are much lower-energy waves and the treatment is generally non-invasive and does not require anesthesia,” says Onuralp Ergun, MD, researcher and urology resident at University of Minnesota. Treatments are usually done over several sessions in the office setting.
The idea behind this treatment is that it may cause “micro-trauma” inside the penile tissue, helping with the formation of blood vessels and tissue repair, says Rajiv Jayadevan, MD, urologist with UCLA Health. “This would, in theory, improve blood flow to the penis,” he says. Since adequate blood flow is an important part of achieving an erection, Dr. Ergun says shock wave therapy could theoretically improve erectile function.
There’s also another theory of shock wave therapy increasing nitric oxide production, which helps with widening blood vessels. Think of it as the “ignition” for erections. For people with nitric oxide deficiency, there is some mixed evidence of nitric oxide supplements potentially helping with ED.
David Kaufman, MD, director of Central Park Urology, says that in a perfect world, shock wave therapy could get rid of the need for ED medications altogether. But the reality is much more complicated.
Does Shock Wave Therapy Actually Work?
MAYBE, BUT THE data that’s out there is not all that great.
“The trials are really small and don’t have enough patients in them to truly say if this makes a difference,” says John P. Mulhall, MD, director of the Sexual & Reproductive Medicine Program at Memorial Sloan-Kettering Cancer Center and professor at Weill Cornell Medical Center. A big issue with these trials is that they aren’t differentiating whether a man’s impotence is because something is wrong anatomically or if it’s purely psychological.
Power of the placebo
The latter is one of the reasons why urologists think guys are finding success with shock wave therapy. Dr. Kaufman says there’s a “strong placebo effect” in how men gauge success with treatments. “It’s human nature to believe that a treatment they’ve invested thousands of dollars in made a difference and was not a waste.”
A review of multiple clinical trials for ED pills found men in the placebo group still showed significant improvement in erectile function, a finding the authors attribute to “the power of belief.” Dr. Mulhall estimates ED treatments in general have a 30 percent to 35 percent placebo effect.
Conflict of interests all around
Dr. Ergun was a lead author of a scientific review analyzing the data and results of shock wave therapy clinical trials. He acknowledges that low-intensity shock wave therapy may provide some improvement in erectile function in the form of penile rigidity. However, what’s blocking shock wave therapy from being a mainstream ED treatment are the shoddy experimental designs.
“The improvement appeared relatively small and may not be large enough for many men to consider it clinically meaningful,” Dr. Ergun says. “While the results suggest possible benefits, we have limited confidence that the currently available studies have identified the true size of the effect.”
Plus, a number of the studies were funded by companies involved in manufacturing shock wave devices. A huge conflict of interest.
“It’s almost like we have a new drug where we don’t know the dose, side effects, and benefits,” says Dr. Mulhall. Shock wave therapy is not covered by health insurance, so you pay a provider directly to have the treatments done. When health insurance coverage is involved, doctors end up making less money from a procedure.
“You cannot give a balanced discussion as a physician if you’re getting paid in cash,” adds Dr. Mulhall. “There is a conflict of interest. It’s a cash cow for these practices.”
Some Men Still Prefer an Unproven Treatment Over an ED Pill
THE COMMON REASON doctors keep seeing in patients interested in shock wave therapy is that it’s not a medication. PDE5 inhibitors like sildenafil citrate and tadalafil have side effects ranging from headaches to dizziness and upset stomachs.
“Shock wave therapy is often marketed as a more ‘natural,’ ‘restorative,’ or potentially long-lasting treatment that addresses the underlying cause of ED rather than temporarily treating the symptoms,” Dr. Ergun says. “That message can be very appealing to patients.”
The noninvasive treatment is also considered safe. One study followed up with guys five years after they received 3,000 shocks twice weekly for 6 weeks. The researchers found that the benefits of shock wave therapy declined over time and plateaued at 40 percent clinical efficacy. There was also no penile pain or deformity in any of the guys.
“Men are looking for something that can potentially lead to long-term improvement in their sexual health,” Dr. Jayadevan says. “That’s the role that this has positioned itself.”
If you’re interested in erectile dysfunction treatments, the best resource is your doctor. They can start a conversation about all your options, which may or may not include shock wave therapy.
Korin Miller is a seasoned freelance writer specializing in general wellness, sexual health and relationships, and lifestyle trends, with work appearing in Men’s Health, Women’s Health, Everyday Health, Food & Wine, and more. She has a master’s degree from American University and lives by the beach.
