Erectile dysfunction is remarkably common—affecting approximately 50% of men over 40 to some degree. For many men, particularly those with vasculogenic ED (caused by poor blood flow to the penis), Li-ESWT represents a genuinely promising treatment avenue.
What does the evidence show?
A lot of research has looked at whether Li-ESWT helps with erection problems. The biggest review so far came out in 2025 — a Cochrane review, which is considered the gold standard for summing up medical evidence. It looked at 21 studies involving 1,357 men. The findings? Shockwave therapy does seem to improve erection scores in the short term, but the average improvement was small — about 3.9 points on a standard questionnaire. That's just under the 4-point mark that doctors consider the smallest change a patient would actually notice. So statistically it works, but for the average man the difference might not feel meaningful in the bedroom.
When researchers looked at longer-term results, the improvement was bigger — around 5.3 points — but that came from only five studies, and the results were all over the place. The Cochrane reviewers rated the overall quality of the evidence as low. That doesn't mean the treatment is useless. It means we still can't say with confidence exactly how well it works, who benefits most, or how long the effect lasts. In my clinic, some men do get a noticeable benefit — especially those with mild to moderate erection problems caused by poor blood flow. But I won't dress it up as stronger evidence than it is.
Where the professional guidelines stand
This is the part many clinics leave out, so I want to be straightforward about it. The major urology bodies do not agree on shockwave therapy, and neither treats it as a standard, first-line treatment.
The American Urological Association classes low-intensity shockwave therapy for erectile dysfunction as investigational — a conditional recommendation resting on low-certainty (Grade C) evidence. The European Association of Urology is more permissive, saying it may be offered to men with mild blood-flow-related erection problems, or to those who would rather not take tablets — but only with a weak strength of recommendation.
A large part of why the evidence stays uncertain is that trials have used very different protocols — different energy settings, numbers of sessions and devices — which makes their results hard to compare and pool. You should also know that some of the most favourable analyses in this field are published or promoted with involvement from the companies that make the devices. I mention that not to dismiss their findings, but because you deserve to know where the enthusiasm comes from.
Who tends to benefit most?
- Mild to moderate vasculogenic ED: Men with blood flow issues rather than severe anatomical damage tend to see better outcomes.
- Younger patients: Generally respond better than older men with multiple comorbidities.
- Recent-onset ED: Those with shorter duration of symptoms often achieve better results.
- PDE5 inhibitor non-responders: Interestingly, research suggests Li-ESWT can help some men who haven't responded adequately to oral medications—in some cases, restoring their responsiveness to these drugs.
Our treatment protocol
At our partner centres, protocols typically involve 6-12 sessions over 3-6 weeks, usually twice weekly. Each session involves delivering 1,500-3,000 shockwave pulses to the penile shaft and crura (the base of the penis where it attaches internally).
Before proceeding, I'll assess your suitability through comprehensive evaluation, which may include a Penile Doppler ultrasound to confirm vascular ED. Not everyone is a suitable candidate, and honest discussion about realistic expectations is fundamental to my approach.
