Erectile dysfunction (ED) is the consistent inability to attain and/or maintain an erection sufficient for satisfactory sexual performance. It is a common condition, with a worldwide prevalence of 18.4% in men aged 40-79 years. The introduction of oral phosphodiesterase type 5 inhibitors (PDE5i), such as sildenafil, has revolutionized the treatment of ED. However, PDE5i is ineffective in approximately 30% of patients. Therefore, there is still a significant unmet need for new therapies for the treatment of ED.1 

Radial Shockwave Therapy also known as Shockwave therapy (SWT) is a promising new non-invasive modality for the treatment of ED. SWT uses high-energy acoustic (sound) waves to stimulate angiogenesis and increase nitric oxide (NO) production. This results in increased blood flow to the penis and the growth and repair of penile muscle tissue. In this blog post, let us look at how shockwave therapy works and how it effectively improves men’s health.2

How Does Radial Shockwave Therapy Work? 

The exact mechanism by which SWT works is not fully understood. However, it is thought to work by stimulating the release of growth factors and natural chemicals that work to increase the blood flow to the penile tissue (muscles).

The primary stimulant for erection in our body is nitric oxide, which is synthesized by eNOS. SWT is a mechanical way of increasing the eNOS in your penile tissue leading to better erections. You can think of it as working like Viagra (sildenafil), which also enhances the activity of eNOS and increases nitric oxide. In addition, SWT increases vascular endothelial growth factor (VEGF) expression, which leads to new blood vessel formation (angiogenesis).2 

Role of eNOS

eNOS, or endothelial nitric oxide synthase, is responsible for the relaxation of smooth muscle cells which line the walls of blood vessels in penile tissue. This protein synthesizes the enzyme nitric oxide that initiates a reaction leading to the relaxation and widening of the blood vessels resulting in increased blood flow to the penis. The nitrite generated by eNOS also triggers a cascade of events resulting in prolonged erections and activated ejaculatory reflex in males.3

Low levels of eNOS can contribute to erectile dysfunction, which is why shockwave therapy – a non-invasive, highly accessible form of shockwave treatment directed at the penis – may help increase eNOS production over time by prompting the release of nitric oxide in response to shockwaves.

Is Shockwave Therapy Effective? 

Several studies have shown that SWT is an effective treatment for ED. In a recent trial, 68% of patients treated with SWT reported an improvement in their erections.4 A review of various studies also concluded that Shockwave therapy can be a great side-effect-free tool for ED.5 

Are There Any Side Effects? 

SWT is generally well tolerated with few side effects. The most common side effect is mild pain during treatment, which can be alleviated with topical anesthesia. Some studies have reported increased penile length after treatment, although this finding needs to be confirmed in larger trials.

Shockwave therapy is a promising new treatment for erectile dysfunction that has been shown to be effective in multiple studies. It works by increasing blood flow and stimulating the growth of new blood vessels. Shockwave therapy is generally well tolerated with few side effects.


1. Sooriyamoorthy T, Leslie SW. Erectile Dysfunction. Published online November 28, 2022. Accessed January 28, 2023.

2. Gruenwald I, Appel B, Kitrey ND, Vardi Y. Shockwave treatment of erectile dysfunction. Ther Adv Urol. 2013;5(2):95. doi:10.1177/1756287212470696

3. Cartledge J, Minhas S, Eardley I. The role of nitric oxide in penile erection. Expert Opin Pharmacother. 2001;2(1):95-107. doi:10.1517/14656566.2.1.95

4. Lurz K, Dreher P, Levy J, et al. Low-Intensity Shockwave Therapy in the Treatment of Erectile Dysfunction. Cureus. 2020;12(11). doi:10.7759/CUREUS.11286

5. Yuan F, Wang Y, Ma Z, et al. Low-intensity extracorporeal shockwave therapy for erectile dysfunction: an overview of systematic reviews. Transl Androl Urol. 2021;10(9):3684. doi:10.21037/TAU-21-730