Exploring shockwave therapy for ED

Low-intensity extracorporeal shock wave therapy (ESWT or LI-ESWT), sometimes also called acoustic wave therapy, is a promising alternative treatment for both erectile dysfunction (ED) and Peyronie’s Disease. On the strong recommendation of Dr Jo Milios, I started trying it this week. Here’s more about my first experience and the background theory.

No shame in going to the ED clinic

I have to admit that until recently I felt nothing but pity and some derision for men going to ED clinics. I imagined it as something sleazy and furtive. If I had put words to it I would have said something like “Losers!”

But the clinic I went to, shown above, was bright and breezy, the other patients in the facility were healthy and cheerful just like me, and the staff were efficient, friendly and down to earth.

My Toronto urologist pooh-poohed the whole idea. He muttered “well if you have five thousand dollars….” in a way that implied it was a crazy vanity project.

It turns out he is poorly informed about the cost. The entire treatment for me, including Doppler penile bloodflow testing before and after treatment, and six ESWT treatments, is setting me back just under 600 Canadian dollars (430 US dollars). I am grateful that the Canadian public healthcare system (including my taxes!) paid for the initial doctor’s appointment.

Regarding the outcomes, time will tell and I will report back in a follow up post.

Why I tried ESWT to support my unreliable erections

I am trying shockwave therapy for ED because I think my core nerve recovery is strong but my physical erections are still rather weak. I hope this treatment will increase blood flow to the penis supporting more durable erections.

I’m also trying it because I respect the very positive reports from Dr Jo Milios. She is one of the world’s leading physiotherapists specialising in men’s recovery from prostate cancer. She included aspects of this treatment in her PhD thesis which I read some years ago. I immediately wanted to try it but couldn’t access the technology in South Africa at the time.

Recently I heard her speak in more depth on shockwave therapy for ED in Victoria Cullen’s excellent Touchy Subject Hub and I was amazed to hear Dr Milios report a 70% success rate in men between one and three years after prostate surgery. She also told success stories with men starting treatment up to 13 years after their cancer treatment. However, her stories intertwine treatment for Peyronie’s Disease and for general ED so I have searched for harder data.

How shockwave therapy works

The core technology involves using mechanical waves with a variety of frequencies and intensities. They penetrate below the skin just like ultrasound, but are designed to “jiggle” the tissues more vigorously than diagnostic ultrasound. This induces what’s described as cellular microtrauma, which in turn stimulates regenerative growth in the affected tissues.

The search for fully reliable scientific data continues, but for example a 2013 study concluded that

The results of our studies, which also included a double-blind randomized control trial, confirm that LI-ESWT generates a significant clinical improvement of erectile function and a significant improvement in penile hemodynamics without any adverse effects.

More recently, a 2022 randomized, double-blinded, clinical trial concluded that

LI-ESWT improves erectile function in the short-term especially in men with mild to moderate ED, and those without a cardiometabolic disease.

Not everybody agrees. A 2019 review of current and emerging therapeutic options for erectile dysfunction is much more cautious: “More stringent randomized controlled trials with longer-term follow-ups are warranted before LI-ESWT technology is accepted as the standard of care in ED.”

I found no indications of side effect risks that applied to me, so I am acting on the following: “Five years is not too long. You might benefit if you give it a go.”

What the ESWT treatment is like

After an initial consultation with a doctor, the actual treatment usually comprises six 20-minute sessions spread over three to six weeks. In the clinic I went to, the technician doing the treatment was very matter of fact. He instructed me to strip off my trousers and underwear and get on a standard treatment table. Then he slathered a gel over my genitals (seemed like the same kind of gel used for ultrasound).

Then the technician held the ESWT device firmly against the base of my penis, first on one side, then on the other side. It makes a clicking sound and I felt a slight prickling, tingling sensation in my penis. It wasn’t painful but slightly uncomfortable and each side lasted about four minutes.

The device the technician uses against the body is similar to the ones used for ultrasound – a cylindrical body with a smooth curved dome at the end that is pressed against the skin.

After treating the base and shaft of the penis, he then went on to the perineum. Knowing how much of the penile shaft extends back there, I was glad of this. He directed the shockwaves along each side of the perineum from the scrotum almost as far as the anus. I am not sure if he adjusted the machine setting between treating penis and perineum, but the perineum treatment felt less of a surface prickle and more of a deep penetrative healing.

After twenty minutes we were done. I didn’t hurt, I was not shamed, and no big changes happened immediately. But I am well motivated to go back tomorrow for my second round of treatment and continue in the following weeks.

Outlook and evaluation of shockwave therapy

Generally, results are evaluated after about three months. However Dr Milios reports one man whose erections woke up from zero after just a single treatment. I wasn’t that lucky but I do detect some signs that are cause for hope.

I’ll report back here about how it goes: five week report here