Shockwave · Men's health

Shockwave Therapy for Erectile Dysfunction

Shockwave therapy for erectile dysfunction (ED) gets a lot of attention. Here is what it involves, what the major urology guidelines say, and why a full medical check comes first.

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In short

Low-intensity shockwave therapy is being studied for erectile dysfunction, mainly ED caused by reduced blood flow. Some trials report better erections on average, particularly in milder cases, but no shockwave device is FDA-cleared for ED. The American Urological Association calls it investigational; the European Association of Urology says it may be considered for mild blood-flow-related ED. ED can be an early sign of heart disease or diabetes, so it starts with a medical evaluation. Results vary, and not everyone responds.

Updated November 2, 2026 · Educational information, not medical advice. Results vary, and not everyone is a candidate.

ED is common, and often a sign worth checking

Erectile dysfunction means trouble getting or keeping an erection firm enough for sex. It becomes more common with age, and it is very treatable.

The most common physical cause is reduced blood flow. The same things that narrow arteries elsewhere in the body, such as high blood pressure, high cholesterol, diabetes, smoking and excess weight, also affect the small arteries of the penis. Because those arteries are small, ED can show up years before chest pain or a heart attack. That is why the American Urological Association recommends that men with ED be checked for heart disease and its risk factors.

Other causes include low testosterone, some medicines (including certain blood pressure drugs and antidepressants), nerve damage after prostate surgery, alcohol, poor sleep, stress and relationship strain. Often there is more than one.

What is usually tried first

Guidelines start with a medical evaluation and simple, proven steps:

A history, physical exam and blood work, which may include blood sugar (A1c), cholesterol and testosterone
Treating what is found, such as diabetes, blood pressure or low testosterone
Reviewing medicines that can affect erections
Lifestyle change: more physical activity, weight loss if you are carrying extra weight, stopping smoking and cutting back on alcohol
Oral medicines (PDE5 inhibitors), which are prescription-only and not safe for everyone, particularly men who take nitrate heart medicines

Weight loss deserves a special mention. In a two-year randomized trial of 110 men with obesity and ED, published in JAMA, about 31% of men in the weight-loss and exercise group regained normal erectile function, compared with about 5% in the control group. If weight is part of the picture, our medical weight management program may be the most useful place to start.

What low-intensity shockwave is

Low-intensity shockwave therapy (sometimes written Li-ESWT or LI-SWT) uses a handheld device to deliver low-energy acoustic waves to the shaft of the penis. It is done in the office, without needles, numbing or downtime. In studies, a course was often several short sessions, once or twice a week, over a few weeks.

The idea being tested is that low-energy waves may encourage new small blood vessels and better blood flow in the erectile tissue. That mechanism comes mostly from laboratory and animal work. It is not settled in people, and it is why shockwave is studied mainly for ED caused by blood flow problems rather than nerve damage.

What the research and guidelines say

The evidence is growing, but the major guideline bodies do not agree on how far it goes.

American Urological Association (2018 ED guideline): low-intensity shockwave should be considered investigational for ED.
European Association of Urology (2025 guideline): it may be used in men with mild ED caused by reduced blood flow, as a weak recommendation. The guideline describes the improvement seen in trials as modest.
Sexual Medicine Society of North America (2021 position statement): there is not yet enough evidence for routine use, and it recommends offering it under research protocols.
FDA: no shockwave device is cleared or approved specifically for erectile dysfunction. Devices used for ED are cleared for other uses.

Put simply: some trials found that men with mild, blood-flow-related ED had better erections on average after shockwave, and others found smaller or no differences. The evidence is weakest for severe ED and for ED caused by nerve damage. It is not a replacement for a medical work-up or for proven treatments. Results vary, and not everyone responds.

Who may and may not be a candidate

Shockwave is most often discussed for men with mild to moderate ED linked to blood flow, who have had a full medical evaluation, and who understand it is investigational. It is usually not suitable if you:

Have not yet had ED evaluated, including a check for heart disease and diabetes
Have severe ED, or ED caused mainly by nerve damage
Have Peyronie's disease, a penile implant, an active infection or a skin problem in the treatment area, unless a urologist has advised otherwise
Take blood thinners or have a bleeding disorder, until your provider has reviewed it

Your provider may also suggest seeing a urologist, particularly if you have pain, curvature, blood in your urine or semen, or ED after prostate surgery.

What a visit at Innovare Tx looks like

You start with a private evaluation with Charles Ortega, PA-C. He takes a medical history, reviews your medicines and checks for the conditions linked to ED, with labs if needed. Many of those steps, including the office visit and lab work, may be billable to insurance. If something like blood sugar, blood pressure or weight is part of the picture, that is addressed first.

If shockwave seems reasonable, the provider explains the evidence, sets the plan and answers questions. Trained medical staff perform the sessions. Shockwave itself is self-pay; most insurance plans do not cover it. See cost and memberships and what to expect.

When to get help promptly

See a doctor soon, or call 911 where noted, if:

You have chest pain, shortness of breath or pain with exertion: call 911 for chest pain
An erection lasts more than 4 hours: this is an emergency, go to the ER
ED started suddenly after an injury to the pelvis or genitals
You notice a new curve, lump or pain in the penis

Frequently asked questions

It is still being studied. Some trials found that men with mild ED caused by reduced blood flow had better erections on average after low-intensity shockwave. The American Urological Association calls it investigational, and the European Association of Urology gives it a weak recommendation for mild cases. Results vary, and not everyone responds.

No. No shockwave device is FDA-cleared or approved specifically for erectile dysfunction. Devices used for ED are cleared for other uses, such as musculoskeletal pain.

Yes. ED can be an early warning sign of heart disease, diabetes or low testosterone, so it starts with a medical evaluation. Treating what is found, and lifestyle steps such as weight loss and exercise, may help on their own.

Most men describe low-intensity sessions as a tapping sensation with mild or no discomfort. No needles or numbing are used, and you can usually return to normal activity the same day.

Ask the provider who prescribed it. In some studies, shockwave was used alongside oral ED medicine. Do not start or stop a prescription medicine without your prescriber's advice.

Most insurance plans do not cover shockwave therapy, so the sessions are self-pay. Your office visit and lab work may be billable to insurance. Ask our team for details.

Sources

Keep reading

See everything in the shockwave guide

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