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What is acoustic wave therapy?

Acoustic wave therapy (AWT), clinically referred to as ‘low-intensity shockwave therapy’ (LiSWT), is a revolutionary and interesting therapy that utilizes sound waves that can pass through the skin and other tissue to target specific areas of the body. 

These waves cause stimulation in body tissue, which triggers chemical and physiological processes.

AWT is generally considered a healing agent, which has long been used in treating wounds and broken bones. It’s also useful for repairing other tissues and reducing inflammation in tendons and ligaments. 

An additional benefit of AWT is its ability to improve blood flow to certain areas. 

In cases of erectile dysfunction (ED), AWT works to stimulate the corpora cavernosa. The corpora cavernosa in men exists in the shaft of the penis and is composed of erectile tissue with nerves, muscle fibers, and blood vessels. 

This portion of the penis fills with blood during an erection, which causes increased pressure and hardening of the penis. Theoretically, if AWT can increase blood flow to this area, it could help relieve ED symptoms. 

How does it work for erectile dysfunction?

Many experts have theorized about how AWT works for ED. Some of the hypotheses are listed below.

Neovascularization

Neovascularization refers to the formation of new blood vessels. AWT can simulate neovascularization by increasing growth factors that facilitate new blood vessel formation.

This effect is therapeutic in the case of ED as AWT can increase cell turnover in the corpus cavernosum, allowing new blood vessels to form. This neovascularization¹ process often occurs 1–3 months after treatment. AWT can increase blood flow to the penis and facilitate longer and stronger erections. 

Vasodilation

In human and animal models, AWT has also demonstrated the ability to dilate blood vessels (vasodilation). If such dilation occurs in the genital area, it can increase blood flow to the penis, facilitating erections. 

Other treatments that promote vasodilation, such as calcium channel blockers, may be effective in treating ED in men with high blood pressure. 

Regeneration of nerve tissue

A small number of animal studies² have investigated AWT's effect on nerve tissue. They have revealed its efficacy in promoting the regeneration of nerves damaged by certain disorders. However, more research involving human participants is required before AWT is seen as a potential treatment for the regeneration of nerve tissue. 

AWT facilitates this by creating an internal environment in the area that’s conducive to nerve growth. When used on the penis in rat studies,³ increased nerve regeneration occurred. This regeneration allows for a better connection to the rest of the body and sensitivity, which can stimulate erection in rats. 

Recruitment of stem cells/progenitor cells

AWT may also relieve ED symptoms by recruiting stem cells to the penis. Such stem cells are proposed to divide and change into blood vessel cells. This process has additional neovascularization effects, which can reduce ED symptoms. 

Is acoustic wave therapy effective for erectile dysfunction?

While AWT is yet to be approved by the FDA for use with ED, many researchers have noted its efficacy. 

Several meta-analyses⁴ have demonstrated AWT's ability to reduce ED symptoms across trials. One particular analysis demonstrated that over 14 studies, the vast majority of men with ED significantly improved the International Index of Erectile Function (IIEF) and Erection Hardness Score (EHS). 

This effect was seen despite variations in treatment regimes and protocols. 

Other studies⁵ have heralded AWT as a revolutionary ED treatment that may be able to regenerate erectile tissue. The neovascular properties of AWT result in researchers hypothesizing its potential benefits for improving or restoring erectile function. 

Those with mild to moderate ED tend to improve largely with this treatment. It’s important to note that AWT may not be as effective in cases of severe ED or those with underlying disorders such as diabetes.

However, the sample size was small and more studies are required before any conclusive claims can be made. 

A strong and growing body of literature⁶ suggests that AWT is a safe and effective treatment for ED.

Is acoustic wave therapy safe to treat erectile dysfunction?

AWT is generally considered to be well-tolerated and safe as an ED treatment. In a 2020 meta-analysis⁷ of AWTs, the researchers found no evidence of pain or requirement for analgesia. 

They also reported a drop-out rate of zero in many clinical trials, indicating AWT's safety and effectiveness. 

AWT has also been proven safe for other procedures, including the reduction of localized fat tissue. 

Experts found that even after one month (eight sessions) of AWT treatment, no severe side effects were noted, and the only adverse effects were slight tenderness and bruising in the treated area. This treatment was deemed safe for fat reduction.

Who needs acoustic wave therapy for erectile dysfunction?

AWT is most effective in men with mild to moderate ED. Men with underlying issues, such as pelvic surgery or nerve damage, may not find this therapy effective.

Acoustic wave therapy procedure for erectile dysfunction

AWT is undertaken in a clinician's office. While some individuals state that the penis should be numbed before the procedure, most experts say the procedure does not require anesthesia. An individual is placed in a comfortable position where the healthcare professional, often a urologist, has access to the genital area.

Special acoustic therapy equipment is then used to treat the area. This equipment often appears as a wand-like instrument positioned close to the genitals. It emits sound waves that can stimulate the corpora cavernosa. 

A popular brand is a Duolith⁸ device. This device is moved around the genitals to ensure good coverage and acoustic wave transmission.

This treatment tends to last around 15 minutes, with 2,000 separate pulses. While procedures have not been standardized yet, many experts say that for the treatment to be the most effective, it should occur in a two- or three-week period with six separate sessions.

People often experience improvements after three to four treatments, lasting at least three months. Some men report experiencing therapeutic benefits for up to a year after treatment. 

Side effects of acoustic wave therapy for erectile dysfunction

As previously mentioned, AWT is well tolerated and deemed safe for treating ED. Very rarely, people who undergo AWT experience some side effects, which include:

  • blood in the urine

  • bruising around the genital area

  • painful erections causing difficulty having sexual intercourse

  • skin infections

However, the vast majority of individuals undertaking AWT do not experience any adverse effects.

Benefits of acoustic wave therapy for erectile dysfunction

Aside from AWT's proposed effectiveness, some men greatly prefer it to other ED treatments for its long list of benefits. A commonly cited benefit is that AWT is a drug-free solution. 

Drug solutions for ED, such as Viagra, can be tiresome to take every day. AWT can be better in this case as the treatment period is relatively short, and the effects can last up to a year. In contrast, the effects of Viagra only last around four to eight hours after treatment.

Additionally, some men may not be able to take such drugs due to co-existing health issues.

AWT is also noninvasive, which means anesthesia and other drugs usually aren’t required. This can make it preferable to other ED treatments, such as penile injections. Such treatments are highly invasive and therefore have high dropout rates. 

Some men also prefer AWT as it treats the cause of ED rather than the symptoms. While Viagra and other treatments target the failure to achieve an erection as a symptom, AWT facilitates blood vessel growth, which can target the underlying cause of ED. 

Risks of acoustic wave therapy for erectile dysfunction

As has been repeated in this article, AWT has generally considered a safe treatment for ED. Side effects are very rare and often minor. However, one risk of AWT is false hope.

Despite the large field of positive research in this area, it’s still possible that AWT won’t work. 

This could cause disappointment and feelings of hopelessness, so hinging all hopes on AWT is not advisable. A doctor can recommend other possible treatments as alternatives. 

Alternative treatment options for erectile dysfunction

Even though AWT may be a beneficial treatment, it’s not yet FDA-approved. However, many other treatments are approved and recommended by the FDA, which include 

  • pills (oral erectogenic), e.g., Viagra

  • hormonal replacement

  • penile self-injection

  • corrective surgery

  • vacuum penile pumps

Other options have also been proven effective, such as psychotherapy (either individual or with the man’s sexual partner(s)) and lifestyle changes. Anyone suffering from ED should talk to a healthcare professional about the best option.

The lowdown

Although the FDA hasn’t approved AWT for use in ED yet, most research shows that it’s well-tolerated and effective for many men. 

Anyone interested in AWT should contact their doctor or local urologist; these professionals will be able to determine whether AWT is the right choice.

  1. Low-intensity shockwave therapy for erectile dysfunction: Is the evidence strong enough? (2017)

  2. Improved rate of peripheral nerve regeneration induced by extracorporeal shock wave treatment in the rat (2012)

  3. Molecular mechanism of action of low-intensity extracorporeal shockwave therapy for regenerating penile and peripheral nerves (2020)

  4. Low-intensity extracorporeal shock wave treatment improves erectile function: A systematic review and meta-analysis (2016)

  5. Shockwave treatment of erectile dysfunction (2013)

  6. A review of current and emerging therapeutic options for erectile dysfunction (2019)

  7. Clinical practice guideline recommendation on the use of low intensity extracorporeal shock wave therapy and low intensity pulsed ultrasound shock wave therapy to treat erectile dysfunction: The Asia-Pacific society for sexual medicine position statement (2021)

  8. A prospective, randomized, double-blinded, clinical trial using a second-generation duolith SD1 low-intensity shockwave machine in males with vascular erectile dysfunction (2020)

Other sources:

Have you considered clinical trials for Erectile dysfunction?

We make it easy for you to participate in a clinical trial for Erectile dysfunction, and get access to the latest treatments not yet widely available - and be a part of finding a cure.

Joining community groups and exercise programs for my condition made me feel empowered – but I want to be part of finding a cure.
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