Treating Erectile Dysfunction (ED)
with Extracorporeal Shockwave Therapy (ESWT)
“For years, I prided myself on my health, my confidence; everything about me seemed to be in control. But now, I’m struggling with achieving, sustaining and maintaining an erection. It feels embarrassing, almost like I’m less of a man. I wonder if this will ever change, or if this is just something I have to accept.”
What is Erectile Dysfunction (ED)?
Erectile Dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. It is distinct from issues like low libido or ejaculatory disorders, focusing specifically on erection capability.
What are risk factors for ED?
• Age: common but not inevitable in aging
• Lifestyle: smoking, excessive alcohol consumption, sedentary habits
• Chronic Illnesses: hypertension, high cholesterol, diabetes, obesity
How do I know if I have ED?
If you come to our clinic, we will usually assess you from the following aspects:
• Medical History: Assessing symptoms, health conditions, and medications
• Physical Exam: Checking for cardiovascular, neurological or endocrinal issues
• Tests: Blood tests (hormones, glucose, urinalysis, lipid profile), ultrasound, or psychological evaluation
What options do I have? Options to manage ED include:
Lifestyle Modifications:
• Weight loss
• Exercise
• Quitting smoking
• Reducing alcohol intake
• Controlling diabetes
Medications:
• PDE5 Inhibitors: Sildenafil, Vardenafil, Tadalafil, Avanafil
• Testosterone Therapy: If hormone levels are low
Devices:
Vacuum erection devices
Procedures
• Extracorporeal Shockwave Therapy (ESWT)
• Alprostadil injections/urethral suppositories
Surgery: Penile implants
• Inflatable Penile Prosthesis
• (3-piece hydraulic pump)
• Semi-rigid Penile Prosthesis
What is Extracorporeal Shockwave Therapy (ESWT)?
Extracorporeal Shockwave Therapy (ESWT) is a non-invasive treatment for ED that has not responded to conservative treatments. It uses sound waves to stimulate blood flow to the penis. By promoting the growth of new blood vessels and improving circulation, ESWT can help improve erectile function and restore confidence.
What are shockwaves?
Shockwaves are audible highenergy sound waves. In the medical world, they have been used successfully for the treatment of various medical conditions since around 1980 (for example, in orthopaedics).
Compared to surgery, shockwave therapy is a non-invasive treatment option. This means that the shockwaves are generated outside of the body (extracorporeal) in a therapy system and then travel through the patient’s skin into the tissue.
How does ESWT work?
ESWT works by delivering controlled shockwaves to the tissues of the penis. These waves increase blood flow, stimulate the release of growth factors, and promote tissue regeneration. This results in stronger, longer-lasting erections without the need for medication or surgery.
Why choose ESWT?
• Non-invasive: No needles, no surgery, and no downtime
• Painless: Most sessions require no recovery period
• Safe & Effective: Proven to improve erectile function in many men, even those with vascular ED
• Long-Term Results: Many patients experience lasting improvements, with some reporting continued benefits even after the treatment course is completed
Who can benefit from ESWT?
ESWT is suitable for men who:
• Struggle with mild to moderate erectile dysfunction
• Are looking for a natural treatment without the side effects of medications
• Have not found success with conservative treatments
• Are looking for a non-surgical option to improve sexual performance
It sounds good, is ESWT safe? Yes, ESWT is generally considered safe for the treatment of ED when administered by trained healthcare professionals. However, like any medical treatment, it does come with some potential risks and side effects, although they tend to be mild and temporary.
Common Side Effects:
• Mild pain or discomfort during or after treatment at the site of application
• Redness or slight swelling in the treated area, which typically resolves within hours or days
• Bruising in some cases, though it is not very common
Who should avoid ESWT?
ESWT is generally safe for most men with erectile dysfunction, but there are some groups of people who should avoid it:
• Men with bleeding disorders (e.g., haemophilia)
• Men with active infections or severe skin conditions in the treatment area
• Those with implanted devices like pacemakers or defibrillators, as the shock waves could interfere with the device
1. Positioning:
You will lie down on a treatment table, typically in a comfortable, relaxed position, often lying flat on your back in a locked private room.
2. Localised gel application:
Some gel will be applied to the area of the penis and perineum where the shockwaves will be delivered. The gel helps transmit the shockwaves more effectively to the tissues and ensures comfort by preventing friction from the device.
3. Application of the shock waves:
The ESWT device consists of a shockwave emitter or hand piece that delivers acoustic waves to the target area (the penis and perineum).
The healthcare provider moves the emitter along specific areas of the penis and surrounding regions (e.g., the base of the penis, corpus cavernous) to target the tissues responsible for erectile function.
4. Shockwave delivery:
The device delivers pulses of acoustic waves (shockwaves) at a low to moderate energy level. These waves typically have a frequency of 1-3 Hz and energy levels that range from 0.12 to 0.2 mJ/mm², roughly equivalent to the energy you’d feel from a very gentle finger poke, concentrated into the size of a pinprick.
The shockwaves create micro trauma in the blood vessels and tissues, stimulating the body’s natural healing process. This process promotes angiogenesis (formation of new blood vessels) and improves blood circulation, which is vital for achieving and maintaining an erection.
1. Consultation:
A brief consultation with one of our specialists to assess your condition with baseline assessment like the IIEF-5 (International Index of Erectile Function) score and determine if ESWT is right for you.
2. Treatment:
The ESWT device will be gently placed on the skin of your penis and perineum. The shockwaves will be delivered in a series of short bursts. Usually you would be scheduled for 12 sessions.
3. Post-treatment:
Most men feel little to no discomfort during or after the procedure. There is no downtime, so you can return to your normal activities right away.
Many men report a significant improvement in erectile function after a series of treatments. Results may vary, but clinical studies suggest a high success rate, with many patients experiencing enhanced performance and satisfaction.
If you’re ready to take the next step in treating ED, contact us today to schedule your consultation. Our expert team is here to guide you on the path to better health and confidence.
Here are your scheduled appointments:
1st therapy: 2nd therapy:
3rd therapy: 4th therapy:
5th therapy: 6th therapy:
7th therapy: 8th therapy:
9th therapy: 10th therapy:
11th therapy: 12th therapy:
Notes & Comments
If you have questions or seek for help, please feel free to contact our expert team. Wish you health and confidence!
References:
1. EAU Guidelines on Sexual and Reproductive Health 2024: https://uroweb.org/guidelines/ sexual-and-reproductive-health
2. Erectile Dysfunction: AUA Guideline (2018): https://www.auanet.org/guidelines-and-quality/ guidelines/erectile-dysfunction-(ed)-guideline
3. Canadian Urological Association guideline: Erectile dysfunction 2021: https://www.cua.org/ system/files/Guideline-Files/7572.pdf
4. Chung E, Cartmill R. Evaluation of clinical efficacy, safety and patient satisfaction rate after low-intensity extracorporeal shockwave therapy for the treatment of male erectile dysfunction: an Australian first open-label single-arm prospective clinical trial. BJU Int. 2015;115 Suppl 5:46-49.
5. Olsen AB, Persiani M, Boie S, Hanna M, Lund L. Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction? A prospective, randomized, double-blind, placebo-controlled study. Scand J Urol. 2015;49(4):329-333.
6. Yee CH, Chan ES, Hou SS, Ng CF. Extracorporeal shockwave therapy in the treatment of erectile dysfunction: a prospective, randomized, double-blinded, placebo controlled study. Int J Urol. 2014;21(10):1041-1045.
Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg
Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg