To Your Good Health: Shockwave therapy for ED not meeting hype

DEAR DR. ROACH: I recently heard about a new treatment for erectile dysfunction using shockwave therapy. Has there been enough research to know if it works? Can you comment on this and any other treatments besides pills? – D.P.

ANSWER: Male erectile function relies on multiple systems. First, the man must have interest and be stimulated. Second, there must be appropriate hormonal support (testosterone is the main issue). Third, the nerve impulse from the brain to the penis must be sent and received. Fourth, the blood flow into and out of the penis needs to be adjusted so that it fills with blood. Finally, the heart and circulatory system need to be strong enough to increase the blood flow to the penis. Serious disturbances at any of these levels can cause erectile dysfunction. Pills like Viagra work only on the fourth possibility, at the level of blood vessel control. The letters I receive suggest that the other possibilities often are ignored by doctors.

Shockwave therapy, which is most commonly used for kidney stones, is an experimental treatment for ED. It is thought to work by improving blood flow inside the penis. Unfortunately, a trial published in March 2018 failed to show benefit of this procedure. Shockwave therapy is not recommended for treatment of ED at this time, outside of further clinical trials.