Shock wave therapy for erectile dysfunction gains popularity despite limited evidence

Some men in the United States seeking relief from erectile dysfunction are not getting Viagra prescriptions. Instead, they are going to health clinics to have low-energy sound waves applied to their genitals, promoted as a painless route to penile healing. The treatment, called shock wave therapy, is controversial. But if it fulfills its promise of improving erections by increasing blood flow in the penis, it could help the millions of people whose ED is caused by vascular problems.

Leading physician groups do not support shock wave therapy for ED because evidence of long-term benefits is inconsistent. Although it is not approved by the U.S. Food and Drug Administration, men’s health providers regularly offer the treatment along with testosterone supplementation and medication, says James Weinberger, a urological surgeon in Beverly Hills, Calif. At least 152 clinics across eight of the largest metro areas in the United States offer the therapy, Weinberger and colleagues reported in 2022. “That certainly undercounts what exists today,” he says.

While ED can occur at any age and be caused by certain medications, anxiety and other nonvascular factors, shock wave therapy aims to address damaged blood flow. “Think of erectile tissue like a sponge,” Weinberger says. “When healthy, it fills with blood easily and holds it under pressure.” In men with vascular risk factors like diabetes, high blood pressure or high cholesterol, the tissue can become scarred and less able to hold blood. Demand for a fix is high: An analysis of 2021 survey data found that 24.2 percent of U.S. men who responded experienced symptoms consistent with ED, with the rate rising to 52.2 percent among those ages 75 and up.

“Think of erectile tissue like a sponge,” Weinberger says. “When healthy, it fills with blood easily and holds it under pressure.” In men with vascular risk factors like diabetes, high blood pressure or high cholesterol, the tissue becomes scarred and less able to hold blood.

Shock wave therapy using high-energy sound waves has been used for decades to break up kidney stones. In 2010, doctors hoping to find other applications conducted a trial of low-intensity sound waves in 20 middle-aged men with ED. Six months after treatment, half of the men had improved enough to have penetrative sex without Viagra-type drugs.

Unlike kidney stone therapy, “the goal is not to destroy anything,” Weinberger says, but instead to promote healing.

In the procedure, a clinician uses a chunky wandlike device on several areas of the penis for 15 to 20 minutes. The device makes a snapping sound, but patients should not feel any pain. “The energy creates microscopic mechanical stresses at the cellular level,” triggering the body to heal itself, says urologist Taylor Kohn of Baylor College of Medicine in Houston. “Rather than compensating for the problem the way a pill does, the theoretical goal is to restore the tissue itself.”

In general, patients come in for six to 12 treatments that may cost several hundred dollars each.

The benefit may be hard to detect. Researchers at the Cochrane Library, a leading reviewer of medical evidence, analyzed 21 studies on the technique. They found that it might have a small effect on erectile function over the first few months and could have some benefit over the longer term. But variability in the studies shook the review authors’ confidence. A 2026 report in Sexual Medicine Reviews found that shock wave studies tended to be small and varied in session count, making them hard to compare. Still, none reported evidence of harm. Most side effects in trials are skin reactions to the gel used, Kohn says.

Kohn reserves the treatment for men who still respond to Viagra-type drugs. “If you’re no longer responding to oral medications, or having no erections at all, it’s kind of a waste of time,” he says.

Weinberger warns against choosing the wrong clinician. At the 152 clinics his team identified, only 25 percent of providers offering shock wave therapy for ED were urologists. In addition to primary care physicians or other reproductive health specialists, providers also included plastic surgeons, dermatologists, and even chiropractors. It matters who provides the therapy, Weinberger says, since treatment should include conversations about hormones and medications. Stand-alone ED clinics may not offer comprehensive care.

The American Urological Association and the Sexual Medicine Society of North America say evidence is not strong enough to warrant the treatment’s use outside clinical trials. Researchers, including Kohn, “are actively pursuing many avenues to regenerate the tissue within the penis,” he says. For many men, this kind of progress can’t come soon enough.