Erection shockwave therapy may help with erectile dysfunction, but it's shrouded in shame

A couple years ago, J.G. noticed a significant dip in his libido and a weak erection that, according to societal norms, was uncharacteristic of young, healthy men like himself. Last year he sought a doctor’s help and learned that his testosterone levels were much lower than they should be for a man in his 30s.

“There’s a psychological effect that can happen if you don’t address this physical issue. So I knew I had to nip it in the bud real quick,” said J.G., who asked to be identified only by his initials in order to protect his privacy; he is a patient of one of the doctors USA TODAY interviewed about this procedure.

J.G. went on to lose 35 pounds and began hormone therapy. Meanwhile, he visited a urologist, who suggested an extra, somewhat unconventional treatment: erection shockwave therapy.

It involves the use of an ultrasound-type probe that sends shock waves through penile tissue to stimulate the growth of new cells and vessels for better blood flow to the area, and thus a stronger erection. The therapy can benefit people with erectile dysfunction (ED) or those who simply want to boost their sex lives.

Treatment plans typically involve one session per week for six months, with about one to two follow-ups each year for tune ups. Results can last anywhere from months to years, depending on a person’s age and health status. 

J.G. has completed three sessions so far, all of which were painless thanks to a numbing cream, and each took about 20 minutes.

“I engage more now and I can have sex multiple times a day. Overall, it just changed everything” J.G. said. “I feel like how I should have felt for many years, like how I was when I was in college.” 

J.G. said he understands that sexual health is nothing to be ashamed of, yet research shows that embarrassment prevents many men from discussing ED with their doctors. 

“If you can take control of your ego and allow yourself to show weakness, vulnerability and imperfections, you tend to solve things a lot quicker,” J.G. said.

Men often struggle with penis insecurityBut no one wants to talk about it.

Although the treatment is safe, according to the doctors we spoke to, posing minimal risks aside from potential bruising and temporary discomfort, it’s still not a standard of care for people dealing with ED — a condition that's caused by physical issues like poor blood flow and psychological problems like stress. The technology also is not FDA-approved to treat ED.

Some urologists are trying to change that. 

“Only about 20% of urologists are doing it, others are still putting their head in the sand,” said Dr. David Shusterman, who’s J.G.’s urologist and the founder of NY Urology where he offers his own ErectionWave technology. “When you have a technology that offers improvement and has no side effects, it should at least be offered as an option.” 

“I’ve done it to over a thousand people and I haven’t had a single complication,” Shusterman said, adding that he performs the treatment on about 10 new patients each week.

Why some doctors are recommending this treatment for ED

Erection shockwave therapy is a popular treatment for ED in Europe, and it’s been gaining traction in the U.S. where more of the 30 million men with the condition are seeking additional ways to improve their sex lives and self-esteem.

Because the therapy can benefit even those without ED, insurance doesn't cover it. Each session is about $500.

But Shusterman said that erection shockwave therapy is worth the price for those who can afford it. Most of his patients have positive responses to the treatment.

Studies, however, show that erection shockwave therapy offers modest improvement among men with ED at best, with anywhere between 40-80% of patients reporting satisfaction with their results. 

The American Urological Association questions the treatment’s ability to restore normal erectile function because research conducted so far is generally of low-quality and produces “inconsistent” findings; it says that the treatment should only be used in clinical trials because of the time and costs associated with it.

A few oral medications, vacuum erection devices and penile injections are FDA-approved for the treatment of ED. A topical gel was just approved in June 2023. 

Unlike these more common treatments, however, erection shockwave therapy “is truly restorative, as it brings new blood vessels and restores tissue,” said Dr. Justin Dubin, a urologist and men’s health specialist in South Florida, who doesn't currently perform the treatment. He's seen a growing interest in it from his patients, he said. “Other options are like a band-aid; they’re not addressing the underlying causes of ED.” 

That said, urologists say that erection shockwave therapy works best as part of an overall treatment plan that may involve weight loss, medications or mental health therapy, particularly for people with more serious health conditions, such as cardiovascular disease, high blood pressure and diabetes — all of which can cause ED. 

Overall, Dubin supports the treatment, but he acknowledged that the studies are conflicting: “I do believe in this, and I think it can work for the right patient. It's safe. But it's not a miracle that works for everyone.”

Erectile dysfunction can affect physical and mental health 

One of the biggest misconceptions about ED, according to Dubin, is that it occurs separately from a person’s general health. So when men avoid seeking medical attention for their sexual problems, “they’re not addressing potential other health factors coming along with it.” 

Dubin calls it the “IKEA effect” — when guys buy furniture, they don’t want to read the instructions because they want to figure it out themselves. “It’s the same with their health,” Dubin said. 

In many cases, ED is one of the first warning signs of current or future heart disease, especially for younger men, according to Dr. Joshua Gonzalez, a urologist and sexual medicine specialist in Los Angeles, California, who offers erection shockwave therapy to his patients. “Sometimes we’re diagnosing patients with erectile and vascular dysfunction and it’s the first time they’re even understanding that they may have a heart problem,” Gonzalez said.

Sexual health is also intrinsic to mental health, particularly when men view their penis as a symbol of their masculinity.  

“Not only can feelings like stress and anxiety negatively impact sexual function,” Gonzalez said, “but sexual dysfunction can often cause negative mental health symptoms, affecting a person’s self-esteem and identity.” Not to mention, some medications for anxiety and depression can cause ED.

To dismantle the stigma that continues to surround men’s health today, it’s important to encourage men to speak openly and honestly about their health at large — a generational shift that experts say is already in the works. 

“Historically, it's just been something that many folks have avoided talking about,” Dr. Petar Bajic, a urologist specializing in sexual medicine and director of the Center for Men’s Health at Cleveland Clinic, previously told USA TODAY. “But what we see is that to some degree, the times are changing, and there's a little bit more openness in younger generations for discussing sexual function, sexuality, etc.”

Urologists agree that if you're having sexual health-related issues, it's best to see your doctor and be honest about what you're experiencing to protect your physical and mental wellbeing.