Adding 5 Months of Maintenance Shockwave Therapy May Prolong Its Effects

Erectile dysfunction (ED) is common, occurring in roughly 24.2% of the global population, and around 52.2% in men older than 75 years. First-line treatment for ED often includes oral medications: phosphodiesterase type 5 inhibitors (PDE5is) such as Viagra and Cialis.

Also accepted as treatments by the American Urological Association (AUA) and the Sexual Medicine Society of North America (SMSNA) include non-medication options such as:

• Vacuum erection devices,
• Intracavernosal injections,
• Penile prosthesis implantation,
• Low-intensity extracorporeal shock wave therapy (Li-ESWT), as an investigational treatment.

Li-ESWT involves sending low-intensity sound waves through the penis to promote tissue repair, reduce inflammation, and help with blood flow and blood vessel formation. Usually, this treatment type happens over 3-6 weeks, with 6 sessions. However, some research notes that the positive effects of this treatment do tend to go away over time.

A recent study investigated how effective an additional course of Li-ESWT might be in keeping up with the positive effects of treatment. One group of 81 men received only 6 weeks of treatment and follow-up at 12 and 24 weeks. This was the control group. The other “maintenance” group included 70 men and received an additional 5 months of treatment, with one Li-ESWT session per month.

Benefits Are Minimal but Not Ignorable

Researchers measured the patients’ results with:

• The International Index of Erectile Function-Erectile Function (IIEF-EF) scale, where lower scores indicate worse ED. Here, there was no difference between the maintenance and control groups.
• The Erection Hardness Scale (EHS), where lower scores mean less hardness during erection;
• Minimal clinically important difference (MCID), which is the smallest change in outcome that patients find beneficial;
• Self-esteem, which improved in both groups but showed no drastic difference in improvement between the maintenance and control groups.
• And complications from Li-ESWT, of which there were none.

Despite having no difference in IIEF-EF scores, researchers did find that the maintenance group had a higher rate of MCID (perceived patient benefit) than the control group. This was consistent regardless of how severe the patient’s ED was.

The researchers believe this may be due to more tissue exposure to Li-ESWT, promoting healthier blood flow in the penis. With the ordinary 6-week protocol, this would decrease after a month. But, because the maintenance group was repeatedly exposed every month, this helped maintain the effects.

The EHS increased by at least one point in more of the maintenance group members by the end of the 24-week follow-up period. Researchers believe that this, combined with the information about MCID, shows that the extra five months of treatment can further improve ED in some patients.

Researchers note that those in the maintenance group with diabetes did not have as positive a change as their counterparts. This may mean that Li-ESWT is not as effective in ED patients with diabetes.

Key Takeaways

• Li-ESWT is being studied as a treatment for organic ED, but is still considered investigational in the U.S.
• Li-ESWT can be effective in treating ED on its own, but adding 5 more rounds after the initial 6-week treatment regimen may be more effective in treating ED.
• Even if the change was minimal, patients felt more improvement after the maintenance treatment than those who did not receive it.
• Despite lower patient adherence than expected, researchers believe this 5-month schedule is beneficial to maintaining the blood flow and tissue growth in the penis.
• More research is needed to see if these results are accurate and translate globally.
• It may be helpful to speak with a sexual health provider if ED is distressing and not psychological, to see what options are available.

Resources

Burnett, A. L., Nehra, A., Breau, R. H., Culkin, D. J., Faraday, M. M., Hakim, L. S., Heidelbaugh, J., Khera, M., McVary, K. T., Miner, M. M., Nelson, C. J., Sadeghi-Nejad, H., Seftel, A. D., & Shindel, A. W. (2018). Erectile dysfunction: AUA Guideline. Journal of Urology, 200(3), 633–641. https://doi.org/10.1016/j.juro.2018.05.004

Sandoval-Salinas, C., Martinez, J. M., Corredor, H. A., Barba, J., & Patrón, F. (2026). Effectiveness of monthly maintenance low-intensity shockwave therapy added to a weekly protocol for erectile dysfunction: Multicenter open-label Randomized Study. The Journal of Sexual Medicine, 23(4). https://doi.org/10.1093/jsxmed/qdag076