Shockwave Therapy for Erectile Dysfunction and Penis Rejuvenation
Does shockwave therapy work for erectile dysfunction, and can it be used alongside Cialis or Viagra?
At MDC, shockwave therapy is not treated as an isolated procedure. Erectile dysfunction can have vascular, hormonal, metabolic, psychological and other causes, so we consider the broader patient pathway and arrange appropriate testing or specialist assessment where indicated. For selected patients, shockwave therapy may form part of treatment alongside established options such as PDE5 inhibitors.
Shockwave Therapy and ED Medication Are Not Necessarily Either/Or
Men visiting an erectile dysfunction clinic often assume they have to choose between medication and shockwave therapy.
That is not necessarily the case.
Cialis (tadalafil) and Viagra (sildenafil) belong to a group of medicines called phosphodiesterase type 5 inhibitors, or PDE5 inhibitors. These remain established first-line medical treatments for erectile dysfunction.
Low-intensity shockwave therapy (Li-SWT or Li-ESWT) is different. It uses low-intensity acoustic shockwaves applied to penile tissue and has primarily been investigated in men with vasculogenic erectile dysfunction, where impaired blood flow contributes to erection difficulties.
For selected patients, the two approaches may therefore form part of the same treatment strategy rather than being competing treatments.
The important question is not simply:
“Is shockwave better than Viagra?”
It is:
“What is causing my erectile dysfunction, and which treatment or combination of treatments is appropriate for me?”
How Does Shockwave Therapy for Erectile Dysfunction Work?
An erection depends partly on adequate blood flow into the penis and the ability of the erectile tissue to respond appropriately.
Low-intensity shockwave therapy delivers acoustic energy to targeted penile tissue.
Research has investigated whether this can promote biological processes associated with vascular repair, angiogenesis and improved erectile tissue function. However, the precise mechanisms and the extent to which laboratory mechanisms translate into clinically meaningful improvement are still being studied.
This is fundamentally different from taking a PDE5 inhibitor.
Cialis and Viagra
PDE5 inhibitors enhance the nitric oxide/cGMP pathway involved in erections. They help improve erectile response in the presence of sexual stimulation.
Shockwave therapy
Shockwave treatment is delivered over a course of treatment rather than taken immediately before sexual activity and is intended to influence the underlying erectile-function pathway.
This is why shockwave therapy has attracted considerable interest as a potential restorative rather than purely symptomatic approach to selected forms of ED.
But that does not mean it permanently cures ED, and MDC would not present it that way.
Does Shockwave Therapy Actually Work for ED?
There is clinical evidence showing improvement in erectile-function measures following low-intensity shockwave therapy, but the evidence is not perfect.
The European Association of Urology (EAU) states that low-intensity shockwave therapy can produce a mild improvement in erectile function in men with vasculogenic ED.
The EAU currently recommends considering Li-SWT, with or without PDE5 inhibitors, particularly for selected patients including:
- men with mild vasculogenic erectile dysfunction;
- well-informed patients who do not want or are unsuitable for oral medication; and
- men with vasculogenic ED who respond poorly to PDE5 inhibitors.
A 2025 Cochrane systematic review analysed 21 randomised controlled trials involving 1,357 men.
It concluded that shockwave therapy may have a small effect on erectile function in the short term and may improve erectile function over longer follow-up. However, the certainty of the evidence was rated low, partly because studies used different treatment protocols and had methodological limitations.
More recent research continues to show this mixed picture. A 2026 systematic review and meta-analysis found statistically significant improvements in erectile-function scores but did not find significant improvements across several other functional and penile vascular outcomes, leading the authors to question the clinical relevance for many patients.
What does that mean for a patient?
It means shockwave therapy is a genuine clinical treatment with a growing evidence base, but it should not be marketed as a guaranteed cure.
Patient selection matters.
Can Shockwave Therapy Be Used with Cialis or Viagra?
Yes, in appropriately selected patients, shockwave therapy may be used alongside a PDE5 inhibitor.
The EAU specifically includes Li-SWT with or without PDE5 inhibitors in its recommendation for selected men with vasculogenic ED. It also notes combination approaches as a possible strategy in more difficult-to-treat cases.
There is a logical reason for considering both approaches.
Treatment | Main role |
Viagra (sildenafil) | Medication used to improve erectile response when required |
Cialis (tadalafil) | PDE5 inhibitor that can be used on demand or, in suitable patients, as a daily regimen |
Low-intensity shockwave therapy | Non-invasive treatment investigated primarily for improving erectile function in vasculogenic ED |
Combined approach | May be considered for selected patients following appropriate clinical assessment |
However, patients should not start, stop or alter prescribed ED medication simply because they are receiving shockwave therapy.
Medication decisions should remain under the care of the prescribing clinician.
Who May Benefit Most from Shockwave Therapy?
Evidence currently appears most relevant to men with vasculogenic erectile dysfunction.
This means ED in which reduced or impaired penile blood flow is an important contributor.
Possible contributing factors to vascular ED can include:
- cardiovascular disease or cardiovascular risk factors;
- diabetes;
- high cholesterol;
- high blood pressure;
- smoking;
- obesity and metabolic disease;
- increasing age.
This is also why erectile dysfunction should sometimes be viewed as more than a sexual-performance problem.
It can be associated with broader vascular and metabolic health.
The EAU recommends that men presenting with ED receive appropriate medical and sexual history, examination and laboratory evaluation, including assessment of glucose, lipid profile and total testosterone to help identify reversible or modifiable risk factors.
Why MDC Does Not Start with Shockwave Therapy
At Marylebone Diagnostic Centre, our approach is:
Understand the patient first. Treatment second.
Erectile dysfunction can result from many different factors.
These may include:
vascular health • testosterone and hormones • diabetes • cardiovascular risk • medication • neurological conditions • psychological factors • relationship factors • other urological conditions
Simply booking six shockwave sessions without considering why the patient has ED may therefore miss an important part of the problem.
At MDC, the pathway can include appropriate assessment, blood testing and specialist andrology or urology input before or alongside treatment.
What Can Be Tested When Investigating Erectile Dysfunction?
Not every patient requires every test.
Depending on medical history, symptoms and clinical assessment, investigations may include:
Hormonal Health
Testosterone • SHBG • LH • FSH • Prolactin
These can help identify hormonal factors that may contribute to sexual symptoms.
Metabolic Health
Glucose • HbA1c
Diabetes and impaired glucose regulation are important considerations in erectile dysfunction.
Cardiovascular Risk
Cholesterol • LDL • HDL • Triglycerides
Because vascular health and erectile function are closely connected.
General Health
Additional blood investigations may be appropriate depending on the individual patient’s medical history and symptoms.
MDC provides an Erectile Dysfunction / Impotence Profile alongside broader men’s-health testing.
Erectile Dysfunction / Impotence Profile – Book Now
What Happens During Shockwave Therapy?
Low-intensity shockwaves are delivered to targeted areas of penile tissue using a specialist device.
Treatment is performed without surgery or injections.
A course usually involves multiple treatment sessions rather than one isolated procedure, although protocols differ between devices, clinical studies and individual treatment pathways.
That variation is important.
Current research has used different shockwave generators, energy settings, treatment frequencies and numbers of pulses. The EAU specifically identifies this heterogeneity as one reason the evidence should be interpreted carefully.
There is therefore no responsible reason to promise that one protocol will work for every man.
When Might Shockwave Therapy Not Be the Right Starting Point?
Shockwave therapy should not automatically be the first answer to every case of erectile dysfunction.
For example, a patient may require investigation of:
low testosterone
poorly controlled diabetes
significant cardiovascular risk
medication-related ED
psychological or relationship factors
neurological causes
structural penile conditions
or another underlying medical problem.
In some patients, treating or addressing the underlying factor may be more important than immediately starting shockwave treatment.
What If Viagra or Cialis Is Not Working Well?
Poor response to ED medication does not automatically mean the medication has failed.
The EAU recommends checking that PDE5 inhibitors have been appropriately prescribed and used correctly, including consideration of dose, timing and sexual stimulation. Other underlying factors should also be investigated.
For men with vasculogenic ED who are poor responders to PDE5 inhibitors, low-intensity shockwave therapy is one of the options that may be considered after appropriate assessment.
This is an important group of patients for specialist evaluation.
Is Shockwave Therapy a Permanent Cure for Erectile Dysfunction?
It should not be described as a guaranteed permanent cure.
Some studies report improvements following treatment, including during follow-up after the treatment course has finished, but results vary considerably between studies and patients.
The EAU notes that treatment effects may become evident after treatment and can subsequently decline over time.
The 2025 Cochrane review also concluded that the certainty of current evidence remains promising.
Shockwave Therapy at Marylebone Diagnostic Centre
MDC provides a coordinated erectile dysfunction and andrology pathway in Baker Street, Central London.
Depending on the patient, this can include:
ED assessment
↓
Hormonal, cardiovascular and metabolic blood testing
↓
Specialist andrology/urology assessment where appropriate
↓
Low-intensity shockwave therapy for suitable patients
↓
Review and further management
This means shockwave therapy does not need to sit in isolation from the patient’s broader health.
Shockwave Therapy for ED in London – Book now
Erectile Dysfunction Clinic London – Book Now
Urology & Andrology – Book Now
Testosterone Profile – Book Now
Cardiac Profile – Book Now
Common Questions About Shockwave Therapy for ED
Does shockwave therapy work for erectile dysfunction?
It may improve erectile function in selected men, particularly those with vasculogenic ED. Current European guidelines recognise a mild benefit, while systematic reviews note that the certainty and clinical significance of the evidence remain limited.
Is shockwave therapy better than Viagra?
They work differently and should not be viewed simply as competing treatments. PDE5 inhibitors such as Viagra remain established first-line treatment. Shockwave therapy may be considered in selected patients, including some men with vasculogenic ED who respond poorly to medication.
Can I take Cialis while having shockwave therapy?
Shockwave therapy can be used with PDE5 inhibitors in appropriately selected patients. Patients should follow their prescriber’s instructions and should not independently alter medication because they are receiving shockwave treatment.
How many shockwave sessions do I need for ED?
Treatment protocols vary, and research has used different devices, energy settings, pulse numbers and schedules. The appropriate treatment course should therefore be determined according to the clinical pathway rather than assuming that one protocol is suitable for everyone.
Is shockwave therapy painful?
Low-intensity shockwave therapy is non-invasive. Studies generally report relatively few treatment-related adverse events, although individual experience can vary.
Does shockwave therapy permanently cure ED?
A permanent cure cannot be guaranteed. Some patients experience improvement, but response and duration vary, and current evidence has important limitations.
Who is most suitable for shockwave therapy?
Current European guidance particularly identifies men with mild vasculogenic ED, selected men who prefer a non-invasive alternative to oral treatment, and vasculogenic ED patients who respond poorly to PDE5 inhibitors.
Should erectile dysfunction be investigated before treatment?
Yes. ED can be associated with hormonal, metabolic, cardiovascular, psychological and other medical factors. Appropriate assessment can help identify possible causes and determine which treatment options are most suitable.
The MDC Clinical View
At MDC, we do not believe every man with erectile dysfunction should automatically receive the same treatment.
Shockwave therapy can be a useful option for selected patients, particularly where vascular erectile dysfunction is suspected, but patient selection and appropriate investigation matter.
For some men, medication may be appropriate. For others, shockwave therapy may be considered alone or alongside medication. And for some patients, investigation identifies another issue that needs attention first.
The objective is not simply to treat the erection.
It is to understand the patient’s erectile health and determine an appropriate pathway.
Book an Erectile Dysfunction Assessment in London
If you are experiencing erectile dysfunction – whether you currently take Viagra or Cialis, have stopped responding as well to medication, or would like to understand other treatment options – MDC can help you investigate the possible causes and discuss the appropriate next step.
Marylebone Diagnostic Centre
73 Baker Street, Marylebone, Central London
Book ED Assessment – Book Now
Common questions
Does shockwave therapy work for erectile dysfunction?
At MDC, shockwave therapy is not treated as an isolated procedure for erectile dysfunction. Erectile dysfunction can have multiple causes including vascular, hormonal, metabolic, and psychological factors, so a broader patient assessment is considered with appropriate testing or specialist evaluation where indicated. For selected patients, shockwave therapy may form part of treatment.
Can I use shockwave therapy alongside Cialis or Viagra?
For selected patients yes, shockwave therapy may form part of erectile dysfunction treatment alongside established options such as PDE5 inhibitors (which include Cialis and Viagra). Because erectile dysfunction can have various causes, MDC arranges appropriate testing or specialist assessment to determine suitable treatment combinations for individual circumstances.
What causes erectile dysfunction?
According to the article, erectile dysfunction can have vascular, hormonal, metabolic, psychological, and other causes. The European Association of Urology defines it as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. A comprehensive diagnostic work-up is recommended to identify underlying factors.
Is shockwave therapy enough on its own for ED?
Potentially yes, at MDC shockwave therapy is not treated as an isolated procedure for erectile dysfunction. Because the condition can have multiple underlying causes including vascular, hormonal, metabolic, and psychological factors, a broader patient pathway is considered with appropriate testing or specialist assessment, and shockwave therapy may form part of treatment for selected patients.
References
- Salonia A, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, et al. European Association of Urology Guidelines on Sexual and Reproductive Health-2021 Update: Male Sexual Dysfunction. European urology. 2021;80(3):333-357. doi:10.1016/j.eururo.2021.06.007 PMID:34183196 Link
- Salonia A, Capogrosso P, Boeri L, Cocci A, Corona G, Dinkelman-Smit M, et al. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Hypogonadism, Erectile Dysfunction, Premature Ejaculation, and Peyronie’s Disease. European Urology. 2025;88(1):76-102. doi:10.1016/j.eururo.2025.04.010 Link
- B Brock G. A simplified approach to the treatment of erectile dysfunction Based on the Canadian Urology Association Erectile Dysfunction Guidelines. Journal of Sexual & Reproductive Medicine. 2002;02(20). doi:10.4172/1488-5069.1000028 Link
- Bokarica P. Re: K. Hatzimouratidis, I. Eardley, F. Giuliano, I. Moncada, A. Salonia. Guidelines on Male Sexual Dysfunction: Erectile Dysfunction and Premature Ejaculation. European Association of Urology Web site. http://uroweb.org/guideline/male-sexual-dysfunction/. Updated 2015. European Urology. 2015;68(4):e77. doi:10.1016/j.eururo.2015.06.013 Link
- Salonia A, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Vardi Y, et al. European Association of Urology guidelines on priapism. European urology. 2014;65(2):480-9. doi:10.1016/j.eururo.2013.11.008 PMID:24314827 Link
- Puppo V, Puppo G. Re: K. Hatzimouratidis, I. Eardley, F. Giuliano, et al. Guidelines on Male Sexual Dysfunction: Erectile Dysfunction and Premature Ejaculation. The Netherlands: European Association of Urology; 2015. http://uroweb.org/guideline/male-sexual-dysfunction/. European Urology. 2015;68(6):e136-e137. doi:10.1016/j.eururo.2015.08.026 Link
- Hatzimouratidis K. Reply to Pero Bokarica’s Letter to the Editor re: K. Hatzimouratidis, I. Eardley, F. Giuliano, I. Moncada, A. Salonia. Guidelines on Male Sexual Dysfunction: Erectile Dysfunction and Premature Ejaculation. European Association of Urology Website. http://uroweb.org/guideline/male-sexual-dysfunction/. Updated 2015. European Urology. 2015;68(4):e78. doi:10.1016/j.eururo.2015.06.014 Link
Written by Mr Tharb Faisl
Writer / Scientist
Medically reviewed by Mr Giulio Garaffa
Consultant Urological Surgeon
Last medically reviewed: 9 September 2026
