Erectile Dysfunction (ED)
Causes, Diagnosis & Evidence-Based Treatment Options
Understanding Erecticle Dysfunction (ED)
Erectile dysfunction (ED) is a common medical condition defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Clinical guidelines from the European Association of Urology (EAU) define ED as symptoms lasting for at least six months.
ED affects men of all ages and may be associated with vascular disease, diabetes, hormonal imbalance, neurological conditions, psychological stress, medication side effects, or lifestyle factors.
Importantly, ED may be an early indicator of cardiovascular or metabolic disease. Evaluation by a licensed healthcare professional is strongly recommended.
Self-Assessment:
Could Erectile Dysfunction Be Affecting You?
The International Index of Erectile Function (IIEF-5) is a validated screening questionnaire
frequently used in clinical practice.
This short assessment does not replace medical diagnosis but may help determine
whether consultation with a qualified urologist is advisable.
Evidence-Based Treatment Options for ED
Management depends on underlying cause, severity, and patient preference. Treatment options include:
WHAT ARE SHOCKWAVES?
Shockwaves¹⁶ are high-energy acoustic pulses characterized by rapid pressure changes. In medical applications, controlled shockwaves are used to stimulate tissue repair and vascular regeneration.
They have been applied in urology, orthopedics, wound care, and rehabilitation medicine.¹⁷
How Does Shockwave Therapy Work for ED?
Low-intensity shockwave therapy¹⁷ is believed to:
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Promote angiogenesis (formation of new blood vessels)
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Increase vascular endothelial growth factor (VEGF) expression
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Enhance microcirculation
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Improve cavernosal hemodynamics
By targeting impaired penile blood flow, Li-ESWT may improve¹⁸ erectile function in men with mild to moderate vasculogenic ED.
Shockwave therapy is generally well tolerated¹⁹. Current clinical studies report low rates of adverse effects²⁰; however, long-term outcome data continue to evolve.
Finding a Qualified Provider
If you are considering shockwave therapy, consultation with a licensed urologist is essential.
For Physicians: Join the Provider Network
Licensed physicians offering evidence-based shockwave therapy may apply to be listed in our international provider directory.
Benefits include:
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Visibility to patients seeking non-invasive ED treatment
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Educational alignment with evidence-based guidelines
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Inclusion in location-based provider searches
FREQUENTLY ASKED QUESTIONS
ABOUT SHOCKWAVE TREATMENT
Click on any question below to learn more.
References
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European Association of Urology. (2022). Management of Erectile Dysfunction. In Sexual and Reproductive Health Guidelines (Chapter 5). Uroweb. Retrieved August 5, 2025, from https://uroweb.org/guidelines/sexual-and-reproductive-health-2022/chapter/management-of-erectile-dysfunction
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Kouidrat, Y., Pizzol, D., Cosco, T., Thompson, T., Carnaghi, M., Bertoldo, A., Solmi, M., Stubbs, B., & Veronese, N. (2017). High prevalence of erectile dysfunction in diabetes: A systematic review and meta‑analysis of 145 studies. Diabetic Medicine, 34(9), 1185–1192. https://doi.org/10.1111/dme.13403
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Leslie, S. W., & Sooriyamoorthy, T. (2024, January 9). Erectile dysfunction. In StatPearls [Internet]. StatPearls Publishing. Treasure Island, FL. Retrieved August 5, 2025, from https://www.ncbi.nlm.nih.gov/books/NBK562253/
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Kessler, A. (2019). The global prevalence of erectile dysfunction: A review. BJU International, 124(4), 587–599. https://doi.org/10.1111/bju.14813
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Lui, J. L., Shaw, N. M., Abbasi, B., Hakam, N., & Breyer, B. N. (2023). Adverse reactions of PDE5 inhibitors: An analysis of the World Health Organization pharmacovigilance database. Andrology, 11(7), 1408–1417. https://doi.org/10.1111/andr.13430
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Zenoozian, S., Bayat, F., Soltani, A., Mirloo, M. M., & Kharaghani, R. (2024). The prevalence of sexual problems in the divorced population and the prevalence of separation in populations with sexual problems: A meta‑analysis. International Journal of Impotence Research, 37, 347–355. https://doi.org/10.1038/s41443-024-00918-2
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Brock, G. (2002). Oral agents: first‑line therapy for erectile dysfunction. European Urology Supplements, 1(4), 30–35.
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Pyrgidis, N., Kalyvianakis, D., Mykoniatis, I., & Hatzichristou, D. (2024, August 6). The recommended treatment protocol for low‑intensity shockwave therapy based on the severity of erectile dysfunction. International Journal of Impotence Research, 37, 566–568. https://doi.org/10.1038/s41443‑024‑00959‑7
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National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Treatment for erectile dysfunction. In Health Information | Urologic Diseases | Erectile Dysfunction. National Institutes of Health. Retrieved August 5, 2025, from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment
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Cleveland Clinic. (2025). Apomorphine (Apokyn) injection: uses & side effects. In Health Library – Drugs, Devices & Supplements. Retrieved August 5, 2025, from https://my.clevelandclinic.org/health/drugs/19850-apomorphine-injection
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National Institute of Diabetes and Digestive and Kidney Diseases. (2024, October). Treatment for erectile dysfunction. In Health Information: Urologic Diseases → Erectile Dysfunction. National Institutes of Health. Retrieved August 5, 2025, from https://www.niddk.nih.gov/health‑information/urologic‑diseases/erectile‑dysfunction/treatment
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Cavayero, C. T., Leslie, S. W., & McIntosh, G. V. (2025, January). Penile prosthesis implantation. In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved August 5, 2025, from https://www.ncbi.nlm.nih.gov/books/NBK563292/
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Kouidrat, Y., Pizzol, D., Cosco, T., Thompson, T., Carnaghi, M., Bertoldo, A., Solmi, M., Stubbs, B., & Veronese, N. (2017). High prevalence of erectile dysfunction in diabetes: A systematic review and meta‑analysis of 145 studies. Diabetic Medicine, 34(9), 1185–1192. https://doi.org/10.1111/dme.13403
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Vardi, Y., Appel, B., Kilchevsky, A., & Gruenwald, I. (2012). Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? Short‑term results of a randomized, double‑blind, sham‑controlled study. The Journal of Urology, 187(5), 1769–1775. https://doi.org/10.1016/j.juro.2011.12.117
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Kitrey, N. D., Vardi, Y., Appel, B., Shechter, A., Massarwa, O., Abu‑Ghanem, Y., … Gruenwald, I. (2018). Low‑intensity shock wave treatment for erectile dysfunction: How long does the effect last? Two‑year follow‑up of a randomized sham‑controlled study. The Journal of Urology, 200(1), 167–170. https://doi.org/10.1016/j.juro.2018.02.070
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De la Corte‑Rodríguez, H., Román‑Belmonte, J. M., Rodríguez‑Damiani, B. A., Vázquez‑Sasot, A., & Rodríguez‑Merchán, E. C. (2023). Extracorporeal shock wave therapy for the treatment of musculoskeletal pain: A narrative review. Healthcare, 11(21), 2830. https://doi.org/10.3390/healthcare11212830
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Crevenna, R., Mickel, M., Schuhfried, O., Gesslbauer, C., Zdravkovic, A., & Keilani, M. (2021). Focused extracorporeal shockwave therapy in physical medicine and rehabilitation. Current Physical Medicine and Rehabilitation Reports, 9(1), 1–10. https://doi.org/10.1007/s40141-020-00306-z
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Gruenwald, I., Appel, B., Kitrey, N. D., & Vardi, Y. (2013). Shockwave treatment of erectile dysfunction. Therapeutic Advances in Urology, 5(2), 95–99. https://doi.org/10.1177/1756287212470696
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Lu, Z., Reed‑Maldonado, A., Wang, C., Lee, Y., & Lue, T. F. (2017). Low‑intensity extracorporeal shock wave treatment improves erectile function: A systematic review and meta‑analysis. European Urology, 71(2), 223–233. https://doi.org/10.1016/j.eururo.2016.05.050
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Clavijo, R. I., Kohn, T. P., Kohn, J. R., Ramasamy, R., & Chung, E. (2017). Effects of low‑intensity extracorporeal shock wave therapy on erectile dysfunction: a randomized sham‑controlled trial. The Journal of Sexual Medicine, 14(1), 27–35. https://doi.org/10.1016/j.jsxm.2016.11.001