Shockwave Therapy for Erectile Dysfunction: What It Offers, and Where the Evidence Stops

Last updated: August 27, 2026

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Every other treatment for erectile dysfunction works on the moment. Tablets and injections produce an erection when needed and change nothing about why it stopped happening. Low-intensity shockwave therapy is the one treatment that aims at the underlying blood supply instead — which is what makes it interesting, and why it is worth being careful about how much is claimed for it.

Related reading: the major causes of ED — the link on this page previously pointed to an address that no longer exists — and how oral tablet therapy works.

• Urology center Bangkok hospital Thailand Booking online 02-310-3009 bhquro@bdms.co.th
• Samitivej Sriracha hospital Chonburi 088-022-1445

Before anything else: ED is a vascular warning

The penile arteries are narrower than the coronary arteries and are affected earlier by the same disease, so erectile dysfunction frequently appears years before a heart attack or stroke. Any man presenting with ED — particularly under about 60, or with diabetes, high blood pressure, raised cholesterol or a smoking history — should have those checked.

That comes first because it is the part with the most to gain, and because quietly buying a course of treatment without it means the warning goes unheard. See also what exercise does for erectile function.

What it is, and what it is proposed to do

Low-energy acoustic waves are delivered through the skin to the erectile tissue in a series of short outpatient sessions. There is no needle, no anaesthetic and no recovery period.

The proposed mechanism is that the mechanical stimulus prompts new small blood vessels to form, improves the behaviour of the vessel lining, and reduces fibrosis in the erectile tissue. An earlier version of this article presented those as established effects. They come largely from laboratory and animal work, and while they are a coherent explanation for what is observed clinically, describing them as demonstrated in men overstates what has been shown. The honest version is that the mechanism is plausible and the clinical effect is what has actually been measured.

Where the evidence actually stands

The earlier version of this article described the treatment as having scientifically significant effectiveness, a scientifically confirmed synergistic effect with tablets, and no serious side effects. That is more confident than the field is, and it has been rewritten.

• Randomised trials do show improvement over sham treatment in men with mild to moderate ED of vascular origin. That is real, and it is why the treatment is offered at all.
• The effect is modest on average, and larger in men with milder disease. A man with severe long-standing ED and poor arterial inflow should not expect what a man with early mild ED gets.
• Guidance is divided. Some urological guidelines position it as an option in selected men with vasculogenic ED; others still classify it as investigational and ask that men be told so before paying for it. This page takes the second position on disclosure regardless of the first: it is offered here with the limits of the evidence explained beforehand rather than afterwards.
• Side effects are genuinely uncommon and minor — transient discomfort or redness. That is a fair claim; no serious side effects as an absolute is not, and no procedure carries a zero rate.

The limitation that matters most when comparing clinics

This was absent from the earlier version and is the most practically useful thing on the page.

There is no single agreed protocol. Devices differ, the energy delivered differs, the number of sessions differs, where on the penis the probe is applied differs, and so does the spacing of treatments. A result obtained in one trial with one machine does not automatically transfer to a different device at a different setting.

The practical consequence for a man being quoted a price: ask what device is used, how many sessions, over how long, and what happens if it does not work. Two clinics offering shockwave therapy may be offering quite different treatments.

How long it lasts

The earlier version was straightforward about this and deserves credit for it, because many clinics are not: the effect fades. Roughly one man in ten has returned to his previous state by three months, and by two years more than four in ten have. Those figures are approximate, and the direction is not in doubt.

So this is a treatment with a maintenance schedule rather than a cure, and the cost of the maintenance belongs in the decision from the start. It should be discussed before the first session, not when the improvement starts slipping.

Who it suits, and who it does not

• Best suited: men with mild to moderate ED of vascular origin, including those who respond to tablets but would rather not depend on them.
• Reasonable to try: men who have not responded well to tablets, with the expectation set that response is less likely the more severe the disease.
• Address first: low testosterone, which is treated in its own right before judging any other ED treatment. So is uncontrolled diabetes, and so is a medication that is causing the problem.
• Where ED is not vascular — after spinal cord injury, after pelvic surgery with nerve damage, or where the problem is psychological — the treatment is aimed at something that is not the cause. The earlier version said men with spinal cord injury cannot benefit because the nerve connection is permanently disrupted; that is too absolute, since the picture after spinal injury varies considerably with level and completeness and many men respond to other treatments. What is fair is that shockwave is not the treatment aimed at that problem.

Where tablets and shockwave both fail, injection therapy and the full range of ED treatment including penile implant surgery remain — and an implant is a definitive solution with high satisfaction rather than a defeat.

A note on tablets

Where PDE5 inhibitors such as sildenafil or tadalafil are used alongside this treatment, one warning applies absolutely: they must never be combined with nitrates — including nitrate sprays, patches and tablets under the tongue used for angina — because the combination can cause a catastrophic drop in blood pressure. Tell whoever prescribes them about every heart medicine you take. Caution also applies alongside alpha blockers, which many men take for the prostate.

Symptoms that need attention the same day

In an emergency in Thailand, call 1669.

• An erection lasting more than four hours — this needs treating the same day, whatever caused it.
• Chest pain or breathlessness during sexual activity, which is assessed as a cardiac symptom and not a sexual one.
• Sudden loss of erectile function after perineal or pelvic injury, or alongside new groin numbness, leg weakness or change in bladder or bowel control.
• Erectile dysfunction with pain and a developing bend — a different condition, covered under Peyronie’s disease.

Frequently Asked Questions About Shockwave Therapy for ED

Does it work?

Randomised trials show improvement over sham treatment in men with mild to moderate vascular ED, with a modest average effect that is larger in milder disease. Guidance is divided — some bodies list it as an option in selected men, others still classify it as investigational. It is offered here with those limits explained beforehand. An earlier version of this article described it as scientifically validated, which was too strong.

How long do the results last?

They fade. Approximately one man in ten has relapsed by three months and more than four in ten by two years. It is a treatment with a maintenance schedule rather than a cure, and the cost of maintenance belongs in the decision from the outset.

Why do different clinics offer different protocols?

Because there is no single agreed one. Devices, energy levels, session numbers, application sites and spacing all vary, and results from one protocol do not automatically transfer to another. Ask what device is used, how many sessions, over how long, and what happens if it does not work.

Is it painful, and are there side effects?

Most men describe mild discomfort at most. There is no needle, no anaesthetic and no recovery time, and side effects are uncommon and minor — transient discomfort or redness. That is a fair description; describing any procedure as having no serious side effects at all is not.

Should I have my testosterone checked first?

Yes. Low testosterone is treated in its own right, and judging any ED treatment while it is uncorrected wastes both the treatment and the assessment. The same applies to uncontrolled diabetes and to a medication that may be causing the problem.

Arranging a consultation

Dr. Soarawee Weerasopone completed an andrology fellowship at Chang Gung Memorial Hospital Kaohsiung, Taiwan, and sees men’s health patients at Bangkok Hospital Headquarters and at Samitivej Sriracha Hospital in Chonburi on 088-022-1445. Bring a list of your medicines and any recent blood pressure, blood sugar, cholesterol or testosterone results.

Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. Samitivej Sriracha is in-person only. Enquiries about cost are answered by the hospital, not by this website.

Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters, and is intended for education only. It is not medical advice, diagnosis or a prescription for any individual, and no advice, diagnosis or prescription is given through personal messaging channels or social media. Dr. Soarawee operates no public social media account; any account offering private consultation in his name is fraudulent. In an emergency in Thailand, call 1669.