Posts Tagged ‘penile shockwave therapy’

Penile Shockwaves To Improve Erections

June 24, 2017

Andrew Siegel MD   6/24/17

Storz image DUOLITH_SD1_ultra_URO_003Thank you Storz Medical and Robert Remington ( for above image of a shock wave unit used for the treatment of erectile dysfunction; note treatment of both the external (left side of image) and internal aspects of the penis (right side of image)

Shockwaves are acoustic vibrations that carry energy, e.g. the sound waves generated by clapping your hands. Compression and expansion of a medium creates a mechanical force that can be put to practical use. Since the 1980s, urologists have used focused shockwave therapy to pulverize kidney stones, revolutionizing their treatment.  A much tamer form of shockwaves–low energy shockwave therapy–is a new treatment for erectile dysfunction.  When applied to the penis, shock wave therapy causes cellular micro-trauma and mechanical stress, stimulating the growth of new blood vessels and nerve fibers that ultimately improves penile blood flow and erectile function. The long and the short of it is that the physical energy from shockwaves can be tapped into to cause a benefit that can prove advantageous in the bedroom.  

Shockwave therapy–which triggers renewed circulation and induces structural changes that can regenerate and remodel damaged tissues–been used for many medical purposes:

  • chronic wounds
  • neuropathy
  • cardiac disease
  • plantar fasciitis
  • tennis elbow

Shockwave Treatment for Erectile Dysfunction

Erection quality is all about pressurized blood filling and remaining in the erectile chambers of the penis. Although erectile dysfunction (E.D.) typically has many underlying causes, some of the key reasons are aging and lifestyle-related changes in penile arterial blood flow as well as alterations in the integrity of penile erectile tissue. Most treatments for E.D. to date—pills, urethral suppositories, injection therapy, and prosthetic implants—do not treat the underlying cause of the problem nor modify the natural history of the disease.   Penile shockwave therapy can be considered “revolutionary,” since it is a disease-modification paradigm, ultimately changing the health of the erectile tissues and improving penile blood flow .

Penile shocks stimulate penile circulation via growth of new blood vessels, growth of new nerve fibers (neural regeneration), stem cell activation and cellular proliferation, and protein synthesis. On a molecular level, the cell membrane, mitochondria and endoplasmic reticulum respond the most profoundly to shockwaves.  As the cells are mechanically stressed, multiple adaptive pathways triggered, inducing structural changes that are capable of regenerating  and remodeling penile tissue.

In research carried out by Dr. Tom Lue, shockwave therapy was used to treat diabetic rats that had the arteries and nerves responsible for erections surgically tied off. Cellular activation, regeneration of erectile tissue (smooth muscle and endothelial cells), and improved penile blood flow and erectile function was clearly demonstrated.

The pilot human study on penile shockwaves for E.D. was performed in 2010 by Yoram Vardi. 20 patients were treated twice weekly for three weeks, with application of shockwaves to five separate sites on the penis.  This study showed a meaningful increase in erectile rigidity and durability of erections using the International Index of Erectile Function (IIEF) as a metric with improved overall satisfaction and ability to penetrate. An additional study showed positive short-term effects in men who previously had responded well to oral erectile dysfunction medications.  To date, clinical trials have shown both subjective improvement in erectile dysfunction as well as objective increased penile blood flow and erectile rigidity.  In a large randomly controlled trial with over 600 subjects, the average improvement in IIEF was a significant 6.4.

Treatment variables include the shockwave energy, number of shocks delivered, the sites treated and duration of the treatment. For E.D., low energy shockwaves that are less focused than those used for kidney stone fragmentation are used.  Too little energy has proven ineffective, while too much energy can actually kill cells, resulting in scarring and erectile dysfunction.  There seems to be a “sweet spot” in terms of the energy level that will optimize erectile function that is generally about 2-10% of the power of shockwave therapy for kidney stones.  A recent study used ten once-weekly treatment sessions.  During each session, 600 shocks were applied to the erectile chambers of both the internal and external penis with a total of 6000 shocks applied over the course of the 10-week period.  The procedure was found to be well tolerated aside from a slight pricking or vibrating sensation that is perceived during the delivery of the shockwaves.

Bottom Line: Low energy penile shockwave therapy is an exciting new treatment option for men with E.D.  Safe and well tolerated, it works by causing mechanical stress and trauma to erectile tissues, stimulating the growth of new blood vessels and nerve fibers and potentially enabling penile tissue to regain the ability for spontaneous erection.  It uniquely modifies the disease, unlike most traditional E.D. treatments that function as “Band-Aids.”  Further clinical investigation is necessary to determine optimal treatment protocols.  It is highly likely that in the near future, low energy penile shockwave therapy will be approved by the FDA for the treatment of E.D.

For more information on Sonicwave technology from STORZ see FullMast website.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health

Co-creator of the PelvicRx male pelvic floor exercise program:


What’s Up And Coming In Male Sexual Dysfunction?

May 30, 2015

Andrew Siegel MD  5/30/15


Technological advances and innovations have occurred in the field of sexual medicine. Trending and novel approaches to ED will be reviewed and my comments will follow (in blue).

Many treatments for ED are essentially “Band-Aids” that do not correct the problem at its root cause, but manage the problem on an on-demand basis, typically beneficial for one sexual encounter. This is the case with all of the new technologies that will be discussed with the exception of pelvic floor muscle training (PFMT) and shockwave therapy, both of which provide an ED management that can be rehabilitative or curative.

Exercises To Improve Your Sexual Function

You go to the gym for cardiovascular health and strength training, but who thinks about the important group of muscles that contribute to erectile rigidiity, erectile durability, and healthy ejaculatory function?  Pelvic floor muscle training (PFMT) is a natural, safe, non-invasive means of empowering men, improving many sexual and urinary conditions. These exercises will gradually achieve the status, traction and common use in men as Kegel exercises have in women through PFMT programs like Private Gym (  PFMT can help fix one of the common underlying factors that contribute to ED—poorly functional pelvic floor muscles. Impaired pelvic floor muscles promote the outflow of penile blood from the erectile chambers and result in lower erectile blood pressures and softer erections.

PFMT is strongly trending to become a routine first-line approach for the management of male sexual dysfunction. I predict that in the near future, many men with healthy sexual function will use PFMT to maintain healthy function and to help prevent  typical age-related declines, just as exercise in general is used to maintain health and wellness and slow the aging process.

External Penile Support Devices

The Erektor, manufactured by Global Life Technologies (, is an externally applied mechanism that provides length and rigidity to the penis. It is worn during intercourse in order to permit sufficient rigidity for penetration. It consists of two cylindrical rings attached to a rigid rod that is customized to one’s penile length. The penis is stretched and placed within the rings and the rod sits on the undersurface of the penis.

Think scaffolding…Functional, but not much of a crowd pleaser! What is she going to think? Great name, though…Erektor.

The Penile Cast is an external cast that the penis is placed into to gain the ability to penetrate. It provides rigidity to the shaft and some sensation is possible through cutouts.

Think hollow dildo. She’d probably prefer using this one alone, without you attached to it!

Penile Vibrator

Penile vibratory stimulation is a means of provoking an erection in men who suffer with ED. Additionally, it is a mechanism to provoke ejaculation in men who have a spinal cord injury rendering them incapable of ejaculating. Developed by Reflexonic (, the Viberect was FDA approved for ED in 2011. The device has two arms that are placed in contact with the penile shaft that apply the vibrations, and the vibratory stimulation will cause an erection and ultimately ejaculation.

The company was kind enough to send me a sample device, which I have in the office. It is somewhat bulky and cumbersome, appearing like an oversized stapler. It is a bit on the noisy side, but effectively causes an erection and ejaculation. Perhaps the next generation will be smaller and quieter. It may prove useful in penile rehabilitation after radical prostatectomy.

Penile Shockwave Therapy

Shockwaves are acoustic waves carrying energy that can be focused and targeted. For many years, urologists have used shockwave therapy to pulverize kidney stones. Low intensity shockwave therapy is a novel treatment for ED that when applied to the penis causes cellular micro-trauma and mechanical stress, which causes growth of new blood vessels and improved blood flow.

It has been used in the treatment of chronic wounds, neuropathy, cardiac disease and has been recently trialed for ED. A pilot study in humans applied the shockwaves to five separate sites on the penis resulting in an increase in rigidity and durability of erections using the International Index of Erectile Function as a metric. An additional study showed positive short-term effects in men who previously responded well to oral ED medications. Clinical trials have shown both subjective improvement in ED as well as objective increased penile blood flow and erectile rigidity. Shockwave therapy has the potential of altering one of the underlying causes of the ED, poor arterial inflow of blood.

Intriguing, with promising results from preliminary trials with further clinical investigation necessary and need for optimal treatment protocols to be determined.

Impulse Magnetic Therapy

Certain types of magnetic fields are capable of enhancing blood circulation and increasing cellular oxygen uptake. Magnetic stimulation thus has the potential for inducing increased blood flow to the penis with studies suggesting that magnetic field therapy can improve ED.

Also interesting, with promising results from preliminary trials with further clinical investigation necessary and the need for intensity, frequency and duration protocols to be established.

Tissue Engineering

There is abundant ongoing research in the field of creating—in the lab—biological substitutes to replace injured, diseased or malfunctioning tissues and organs. Although the future appears encouraging, as of now there are no bioengineered tissue substitutes applicable to poorly functioning or damaged penile tissues.

Not ready for prime time when it comes to the penis.

Nanotechnology (Nanoparticle Delivery System)

Nanoparticles are packaged molecules—comparable in size to viruses—that can encapsulate biologically active materials, such as the oral ED medications or nitric oxide, the chemical mediator of erections. A gel that contains such nanoparticles can be applied to the skin of the penis to achieve an erection. This has the potential advantage of the active medication being delivered to the target organ and not distributed throughout the body, avoiding side effects. To date this technology has only been tested in laboratory animals.

Any word preceded by “nano-“ sounds very cutting edge and high tech! Great concept, but who knows? Human clinical trials need to be performed. Testing has resulted in excellent quality erections in our rat friends.

Endovascular Treatment

One cause of ED is blockage of pelvic arteries by fatty deposits, which do not permit sufficient blood flow to achieve an erection. Endovascular treatment is a non-invasive therapy of focal vascular lesions (small and localized areas of arteries that are clogged), an alternative to open surgery to bypass obstructed vessels. A drug-eluting stent (a device that not only bypasses an obstruction, but also releases medication) is placed in a blocked internal pudendal artery. The stent elutes Zotarolimus, a medication that is used to prevent the artery from reblocking. An initial clinical trial has shown improvement in ED in appropriate patients with focal vascular lesions.

In a patient with arteriogenic ED due to pudendal artery blockage, this may prove advantageous, just as drug-eluting stents have been beneficial for coronary artery blockages that would otherwise have required open coronary bypass. The jury is still out, with expanded clinical trials necessary.

The “P-Shot”

Named after the Greek God of Fertility, the Priapus Shot or the “P-Shot” claims to increase the size of the penis by 10-20% and produce harder and longer lasting erections. Platelet rich plasma (PRP) is extracted from the patient’s own blood and injected into the penis. The patient is required to use a penis pump over the course of the treatment. The premise is that growth factors in the PRP promote the growth of new blood vessels to the penis. Providers of the P-Shot claim it is the most significant advancement in cosmetic surgery in decades.

The claims are anecdotal, hypothetical, with little scientific research and evidence supporting them. The jury is still out on this one, but it sure sounds interesting.

Wishing you the best of health,

2014-04-23 20:16:29


A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback:

Co-founder of Private Gym:–available on Amazon and Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.