Low-Intensity Shockwave Therapy for Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction (ED) is a type of penile disorder. It affects your ability to get and maintain an erection firm enough for sexual intercourse.

Your feelings play a major role in getting and maintaining an erection. Feeling relaxed, confident and aroused is essential. But it’s normal to sometimes have erection issues. Erection problems can occur if you feel nervous, anxious, frustrated or tired. Drinking alcohol and/or using substances can also have an effect. It can also result from other conditions or as a side effect of certain medications or cancer treatments.

If you’re having difficulty getting or maintaining an erection, it’s a good idea to schedule an appointment with a healthcare provider for further discussion.

In many cases, ED can be the first symptom of another underlying problem, including heart disease. It’s important to talk to a healthcare provider if you have problems getting and maintaining an erection.

Other names for erectile dysfunction include:

• Impotence.
• Impotency.

What are the types of erectile dysfunction?

Healthcare providers separate ED into several categories:

• Vascular erectile dysfunction. Vascular ED includes causes that affect the blood vessels that send blood to the tissues in your penis that allow you to get and maintain an erection, or the valves in the penis that normally hold blood inside. Vascular ED is the most common type of ED.
• Neurogenic erectile dysfunction. Neurogenic ED occurs as a result of nerve problems, which prevent signals from traveling from your brain to your penis to create an erection. This can happen because of trauma, pelvic surgery, radiation therapy or neurologic conditions like stroke, spinal stenosis and multiple sclerosis (MS).
• Hormonal erectile dysfunction. Hormonal ED refers to ED that happens as a result of testosterone deficiency, or in some cases as a result of thyroid issues.
• Psychogenic erectile dysfunction. Psychogenic ED involves psychological conditions (conditions that affect your thoughts, feelings or behavior) that can cause ED.

How common is erectile dysfunction?

Erectile dysfunction is the most common sex-related condition that men and people assigned male at birth (AMAB) report to healthcare providers, especially as they age and develop other health issues.

What is the usual age for erectile dysfunction?

Providers and medical researchers estimate that erectile dysfunction affects over 50% of people who identify as male between the ages of 40 and 70. And those numbers may be higher — many don’t seek help for the condition due to embarrassment or shame.

What are the symptoms of erectile dysfunction?

Erectile dysfunction symptoms include:

• Only sometimes being able to get an erection before sexual intercourse.
• Being able to get an erection before sexual intercourse but not being able to maintain it during sexual intercourse.
• Complete inability to get an erection.
• Requiring a lot of stimulation to maintain an erection.

What causes erectile dysfunction?

There are many possible causes of ED, including conditions that affect your:

• Circulatory system. Your circulatory system includes the blood vessels that carry blood throughout your body. Your penis needs adequate blood flow to become erect and maintain an erection. Your penis also relies on a series of valves to close when it fills with blood — in some cases, these valves stop working as they should.
• Nervous system. Your nervous system includes your brain, spinal cord and nerves. They work together to send electrical impulses that help your body move and feel, including your penis.
• Endocrine system. Your endocrine system includes the glands that create and release hormones. Hormones help tell your body to perform certain functions. Testosterone may help open up (vasodilate) your blood vessels, which helps blood flow to your penis.

The factors may include:

Certain conditions or diseases

• Diabetes and diabetes-related neuropathy.
• High blood pressure (hypertension).
• High cholesterol (hyperlipidemia).
• Vascular disease.
• Chronic kidney disease.
• Atherosclerosis.
• Peyronie’s disease.
• Low testosterone (testosterone deficiency).
• Stroke.
• Epilepsy.

Injuries (trauma) to your penis and surrounding areas can also cause ED. They include:

• Penile fracture.
• Injuries to your pelvis bones (hip bones, sacrum and tailbone), bladder, prostate and spinal cord.
• Pelvic surgery, including prostate, colon or bladder cancer surgery.
• Radiation therapy.

Certain medications

Erectile dysfunction is a common side effect of many prescription drugs. Common medications that list ED as a potential side effect include:

• Antidepressants.
• Anti-anxiety medications (anxiolytics).
• Blood pressure medications.
• Diuretics.
• Antihistamines.
• Chemotherapy drugs.
• Parkinson’s disease drugs.
• Prostate cancer drugs.
• Antiarrhythmics.
• Sedatives.
• Muscle relaxers.
• Antiseizure medications.

Other substances

Substances that have addiction potential may cause ED, including:

• Alcohol.
• Amphetamines.
• Barbiturates.
• Cocaine.
• Marijuana.
• Methadone.
• Nicotine.
• Opioids.

These substances can affect and suppress your central nervous system. They can also cause severe damage to your blood vessels, which may lead to permanent erectile dysfunction.

Psychological and/or emotional conditions

• Depression.
• Anxiety.
• Stress.
• Fear of sexual intercourse or intimacy (genophobia).
• Low self-esteem.

What is the primary cause of erectile dysfunction?

Conditions that affect your body’s ability to deliver blood to your penis are the most common cause of ED.

Who does erectile dysfunction affect?

You may have a greater risk of getting ED if you:

• Are 40 or older.
• Have diabetes.
• Have a body mass index (BMI) over 25.
• Have depression.
• Are physically inactive.
• Smoke.

How is erectile dysfunction diagnosed?

A healthcare provider can diagnose ED and determine its cause. They’ll review your medical history and perform a physical exam. They’ll also ask you questions about your personal and sexual history. These questions may make you feel embarrassed or awkward. But it’s important to be honest with the provider in order to quickly determine the cause. The questions may include:

• Are you currently taking any medications, including prescription drugs, over-the-counter drugs, herbal supplements, dietary supplements and nonmedical drugs?
• Has a healthcare provider ever diagnosed you with depression or anxiety?
• Do you often feel stressed?
• Are you experiencing any relationship problems?
• How often are you able to get erections?
• How hard are your erections?
• How long are you able to maintain an erection?
• Do you lose your erection because you ejaculate sooner than you would like?
• When did you first notice symptoms of erectile dysfunction?
• What exactly happened when you first had erectile dysfunction symptoms?
• Do or did you experience erections at night or during the morning?
• What sexual positions do you regularly engage in?

The provider may also ask to talk with your sexual partner. Your partner may be able to offer additional insight on potential causes.

The provider may order tests to confirm their diagnosis and determine the cause of your ED.

What tests will be done to diagnose erectile dysfunction?

It depends on what your healthcare provider suspects is causing erectile dysfunction. Your provider may order:

• Blood tests.
• Complete blood count (CBC).
• Lipid panel.
• Liver function tests.
• Kidney function tests.
• Thyroid tests.
• Testosterone test.
• Urinalysis (urine test).
• Penile Doppler ultrasound.
• Tests that measure if the nerves in your penis respond to vibrations (penile biothesiometry).
• Drugs that temporarily make your penis erect (vasoactive injection).
• Magnetic resonance angiogram (MRA).

Before testing, your provider will explain what’s involved with a test and answer any questions you have. If you don’t feel comfortable, you can decide not to do the test at any time.

What is the best way to fix erectile dysfunction?

The first step in treating erectile dysfunction is identifying the underlying cause. A healthcare provider will help determine the best treatment for you. Treatment options may include:

• Cardiovascular exercise. Vigorous cardiovascular exercise for at least 45 minutes three times per week may help reverse some cases of mild ED. Cardiovascular exercises may include brisk walking, jogging, swimming, bicycling and jumping rope.
• Quitting smoking. For men with mild ED, quitting smoking can lead to improvement after several months.
• Talking to a sex therapist.
• Oral medications that help increase blood flow to your penis, including sildenafil (Viagra®), vardenafil (Levitra®), tadalafil (Cialis®) or avanafil (Stendra®). Oral medications start to work within an hour.
• Penile low-intensity focused shockwave therapy (LiSWT). This noninvasive treatment improves blood flow by using sound waves. It can take two months to see improvement.
• Medications you inject directly into your penis to create an erection, including alprostadil (Caverject®), papaverine (Papacon®), phentolamine (Regitine®) or a combination of multiple medications. Injectable medications start to work within 10 minutes.
• Vacuum constriction device (penis pump). Penis pumps start to work almost immediately.
• Testosterone replacement therapy, which is available as a gel, injection, patches and pellets. Testosterone replacement therapy starts to work within four weeks.
• Penile implant procedure. A penile implant is a procedure in which a surgeon places a device into your penis to make it hard. The device doesn’t affect sensation, peeing or orgasm.

Will ED go away on its own?

ED will not likely go away on its own without changes to your lifestyle or some kind of treatment.

Can ED be prevented?

Certain lifestyle changes can help lower your risk of developing erectile dysfunction, including:

• Reducing your cholesterol.
• Being more physically active, especially doing cardiovascular exercises like running, jogging or bicycling.
• Maintaining a healthy weight for you.
• Getting high-quality sleep.
• Eating healthy foods with low saturated fats, such as fruits, vegetables and whole grains.
• Stopping smoking.
• Reducing or stopping drinking.

What can I expect if I have erectile dysfunction?

The outlook for ED is good and it’s a very treatable condition. Though there aren’t cures for some causes of ED, many treatment options can help you get and maintain an erection hard enough for sexual intercourse.

When should I see a healthcare provider?

Talk to a primary care physician or a urologist if you suspect you have erectile dysfunction. They can help diagnose ED, identify its cause and recommend the best treatment option for you. A urologist is a healthcare provider who specializes in diagnosing and treating conditions that affect your reproductive system and urinary system.

When should I go to the ER?

Go to your nearest emergency room if you’re taking medication for erectile dysfunction and have a painful erection that lasts longer than two to four hours. This may be a sign of priapism, which can cause permanent damage to your penis without treatment.

What questions should I ask a healthcare provider?

• Is it normal to have erectile dysfunction?
• How do you know I have erectile dysfunction?
• What’s causing my erectile dysfunction?
• What ED treatment option do you recommend?
• Can erectile dysfunction cause other conditions that affect my sexual health?
• Can I still orgasm if I have ED?
• Can you recommend a sex therapist?
• Can you recommend a support group for people who have erectile dysfunction?
• Am I a candidate for a penile implant procedure?

How does it feel when you can’t get an erection?

Erectile dysfunction can cause you to feel many different emotions. You may feel embarrassed, frustrated, guilty, ashamed, angry or “less than.” This can lead to more serious long-term emotions, like anxiety and depression. But you don’t have to live with these feelings. ED is common, and it doesn’t reflect your worth as a person. Healthcare providers are available to help.

What can I do if my partner has erectile dysfunction?

Erectile dysfunction is a sensitive topic for many people. The following tips can help you support your partner if they have erectile dysfunction:

• Encourage open communication. Tell your partner you care about their feelings and well-being. Find appropriate times to talk to your partner that won’t make them feel vulnerable.
• Remind your partner that they’re not alone. ED is common, and treatment is available. Therapists and support groups can help your partner process their feelings.
• Encourage healthy habits. Focus on the benefits of regular exercise, healthy foods and cutting back on substances that may cause ED.
• Get informed. Your partner will feel supported if you have accurate, up-to-date information on erectile dysfunction and its treatment options.
• Offer to go with your partner to their appointments. You can help your partner ask questions, take notes and relay information to a healthcare provider that can help them in making a diagnosis. Respect their privacy if they prefer to see a provider alone.
• Express your feelings in other ways. Sexual intercourse isn’t the only way to increase intimacy between partners. You can show your partner you care through physical contact such as holding hands or back rubs, spending time with them, kissing, writing notes, being patient and being a good listener.

A note from Cleveland Clinic

Erectile dysfunction (ED) is common, especially as you get older. It can cause embarrassment, low self-esteem and other more serious psychological conditions. But you shouldn’t feel ashamed or embarrassed to have ED. It may be your body’s way of telling you that something isn’t right. It’s important to have an open conversation with a healthcare provider about your symptoms and how they affect your quality of life. They can diagnose ED, determine its cause and recommend the most appropriate treatment for you.