Key messages

• Low-intensity shockwave therapy may improve erections in the long term.

• Low-intensity shockwave therapy may improve the firmness and stiffness of the penis (penile rigidity) in the short term.

• Treatment-related side effects and early discontinuation of treatment due to side effects are uncommon in the short term.

What is erectile dysfunction ?

Erectile dysfunction is a common issue where a man has difficulty having or keeping an erection during sexual intercourse. It can be caused by many things, such as other health conditions, medical treatments (such as medicines or surgery on the prostate), unhealthy lifestyles (such as smoking, poor diet, and lack of exercise), and depression and anxiety.

How is erectile dysfunction treated?

There are different ways to treat erectile dysfunction. First, doctors might suggest lifestyle changes, such as exercising more, eating a balanced diet, or stopping smoking. If these do not work, doctors might suggest some medicines. Sometimes, if the problem is more about feelings or relationships with sexual partners, doctors might suggest talking to a therapist. There are other treatments, such as devices, injections, or surgeries. In this Cochrane review, we are looking at a new treatment method using shockwaves.

What is shockwave therapy?

Low-intensity shockwave therapy uses sound waves to help blood flow better to the penis, which can help with erections. It is a simple treatment. A doctor uses a small device on different parts of the penis. The treatment does not hurt, and no medicine is needed to numb the area. Treatment takes about 15 to 20 minutes and happens several times over a span of weeks.

The term low-intensity shockwave therapy highlights the safe nature of the therapy. High-intensity shockwaves are strong and used for breaking things like kidney stones, but low-intensity waves are soft and effective enough to work without causing harm.

What did we want to find out?

We wanted to know if low-intensity shockwave therapy works better than a sham treatment (a device that pretends to use shockwaves). We looked at:

• how well shockwave therapy helps with erections;

• whether people stop shockwave therapy earlier than sham therapy earlier;

• if there are any unwanted effects;

• if patients and their partners are happy with the treatment results;

• if shockwave therapy makes the penis more rigid; and

• if shockwave therapy makes sexual life better.

What did we do?

We searched for all the medical studies that compared low-intensity shockwave therapy to a sham treatment in men with erectile dysfunction. We checked the results of these studies and summarized the results and rated our confidence in them based on factors such as how well they performed.

What did we find?

We found 21 studies with 1357 men who received either low-intensity shockwave therapy or the sham treatment. These men were between the ages of 39 and 65 and had erectile dysfunction for between 3 and 68 months.

Main results

We found that in the short term (3 months or less), low-intensity shockwave therapy may have a small improving effect on erections, but that effect may not be big enough for men to notice. In the long term (more than 3 months), it may improve erections. In the short term, it may improve how rigid the penis gets. In the long term, it may also have a small effect on how rigid the penis gets, but once again this effect may not be big enough for men to notice. All treatments were only used in the short term, but some results were reported in the long term. Both in the short term and long term, low-intensity shockwave therapy may have little to no effect on side effects from treatment or discontinuing treatment. We did not find any information on patients' and their partners' happiness with the treatment results or about their sexual lives.

What are the limitations of the evidence?

We have little confidence in these results, mainly because:

• the studies were not done very well;

• the evidence does not cover all the people, treatments, or endpoints we were interested in;

• the studies were done on men with erectile dysfunction and used different ways of delivering shockwaves; and

• the results were very different in each study.

Nine of the 21 studies received money from companies that make the devices that deliver shockwave treatment. Five studies said they did not receive any money from industry, and the rest of the studies did not state if they received any money or not.

How up to date is this evidence?

This review is current to 7 July 2024.