Shock Wave Therapy for ED

Greetings, Bestie! I’m happy to have you and you know I love a good chat. Today, I thought we could talk about shock wave therapy for erectile dysfunction (ED). If you missed our last chat on ED, find that here. As a quick refresher, ED is the inability to develop and/or maintain a penile erection for satisfactory sexual intercourse.

What Causes ED?

To understand how shock wave therapy is used to treat ED, we first have to understand what causes penile erection and ED. Penile erection is the physiological process in which the penis becomes engorged with blood. This is often a response to sexual arousal. In order for a penis to become erect, there must be increased flow of blood to the penis and decreased blood flow out of the penile tissues. Arteries bring blood to the penis and veins drain blood out of the penis. In cases where arteries are blocked narrowed, ED can occur because not enough blood can flow to the penis. Aside from this hemodynamic process, penile erection is also made possible by certain nerves. These include the pudendal and cavernosus nerves. The pudendal nerve is responsible for penile sensation and innervation of the superficial pelvic floor muscles (PFMs). These superficial PFMs include the ischiocavernosus and bulbospongiosus muscles. They work to maintain erection by contracting and compressing the veins of the penis. This decreases the amount of blood that is drained out of the penis and helps it to remain engorged.

Since penile erection relies on the presence of blood to occur, a lack of good blood flow can result in ED. Therefore, poor cardiovascular function and cardiovascular disease are risk factors for ED (1). Another common cause for ED is radical prostatectomy surgery. After such surgery, rates of ED soar up to 85% (4). Radical prostatectomy is usually performed in folks with prostate cancer where the cancer is confined within the prostate gland. During this procedure, the cavernosus nerves, are disrupted and may take up to 24 months to heal after the procedure (4). This may result in ED during the recovery period, or even longer. There are lots of other causes of ED, but these are some of the most common.

What is Shock wave Therapy?

Shock waves are acoustic waves that carry energy (2). They are able to travel through different mediums and can be used noninvasively to target specific anatomical tissue (2). The type of shock wave therapy we’re talking about today is called low-intensity extracorporeal shock wave therapy (LI-ESWT). In a study by Wang et. al., researchers found that shock wave therapy resulted in neovascularization of the targeted area (3) in rabbits. In other words, it stimulated new blood vessel growth, which, in turn, resulted in improved blood supply to the specified region. This study was done over 20 years ago, but research since then has expanded on the findings and proven that shock wave therapy can have beneficial effects for humans (2, 4).  Shock wave therapy is performed in a clinic, only takes a few minutes, and is painless. Studies have looked at various protocols, but most land somewhere between 4 and 18 sessions for best results, with more sessions not always correlating with better results (5). Further research is needed in order to determine the most ideal protocol.

How does shock wave therapy impact ED?

As we discussed above, one of the most common causes of ED is a lack of sufficient blood flow to the penis to allow for full erection. This is where shock wave treatment enters the chat! In folks with vascular dysfunction (for example: arteries that are narrowed or blocked), shock wave therapy can help encourage new blood vessel growth in order to allow more blood to travel to the penis during arousal. It has not been widely shown to be beneficial in folks with nerve-related ED and even studies looking at shock wave therapy for vascular ED present varying results (2, 3, 4, 5).

How to get shock wave therapy:

If you or someone you know is suffering from ED, you might be wondering: “Where can I get shock wave therapy?” Shock wave therapy can be administered by a licensed medical professional with appropriate training. Your pelvic health physical therapist may be able to perform shock wave therapy, but this depends on their specific training and the devices they have access to. Shock wave devices (such as the PiezoWave) can be extremely expensive and not every clinic will have one. If you are interested in shock wave therapy, talk with your pelvic health provider to find out if you would be a good candidate for the treatment. Remember, not everyone with ED will benefit from shock wave therapy. If you are a good candidate, your pelvic health specialist can help you find someone with access to a shock wave device. Larger medical networks, such as those connected with hospitals, might also be more likely to offer shock wave treatments. Shock wave therapy may or may not be covered by insurance, depending on your insurance provider. If you are not sure whether it’s covered, call your insurance to check. Out-of-pocket expenses for shock wave therapy can run you up to $500 per session, so it may not be affordable for everyone.

What did I miss? Do you have more questions about shock wave therapy for ED? Send them my way!

XOXO,

Your Pelvic Bestie

References:

1.     Gerbild H, Larsen CM, Graugaard C, Areskoug Josefsson K. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Sex Med. 2018 Jun;6(2):75-89. doi: 10.1016/j.esxm.2018.02.001. Epub 2018 Apr 13. ‘

2.     Gruenwald I, Appel B, Kitrey ND, Vardi Y. Shockwave treatment of erectile dysfunction. Ther Adv Urol. 2013 Apr;5(2):95-9. doi: 10.1177/1756287212470696. PMID: 23554844; PMCID: PMC3607492.

3.     Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, Yang LC. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res. 2003 Nov;21(6):984-9. doi: 10.1016/S0736-0266(03)00104-9. PMID: 14554209.

4.     Bocchino AC, Pezzoli M, Martínez-Salamanca JI, Russo GI, Lo Giudice A, Cocci A. Low-intensity extracorporeal shock wave therapy for erectile dysfunction: Myths and realities. Investig Clin Urol. 2023 Mar;64(2):118-125. doi: 10.4111/icu.20220327. PMID: 36882170; PMCID: PMC9995960.

5.     Kalyvianakis D, Memmos E, Mykoniatis I, Kapoteli P, Memmos D, Hatzichristou D. Low-Intensity Shockwave Therapy for Erectile Dysfunction: A Randomized Clinical Trial Comparing 2 Treatment Protocols and the Impact of Repeating Treatment. J Sex Med. 2018 Mar;15(3):334-345. doi: 10.1016/j.jsxm.2018.01.003. Epub 2018 Feb 1. PMID: 29396020.

*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives