Shockwave /
Shockwave Therapy

How Sound Waves Treat Erectile Problems

What is known in orthopaedics as a treatment for heel spurs and tendon irritation has established itself in andrology as one of the most effective non-surgical methods against vascular erectile dysfunction: extracorporeal shockwave therapy (ESWT).

No incision, no anaesthesia, no downtime — and a biological mechanism of action that addresses the problem at its root instead of merely masking the symptom.

This page explains how the treatment works, who benefits from it, what the studies show — and how it is optimally combined with other therapies.

Shockwave Therapy for ED or Andropause

Specialist consultation — also via telemedicine. Treatment at the private clinic K61.

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What is extracorporeal shockwave therapy?

Extracorporeal shockwave therapy (ESWT) uses low-energy acoustic pressure waves that are directed from outside through the skin into the target tissue. The word extracorporeal means: the waves are generated outside the body and introduced from outside — without an incision, without a needle, without anaesthesia.

In urology and andrology, specifically focused or radial shockwaves are used that act on the erectile tissue and the supplying blood vessels. The treatment lasts 20–30 minutes per session and is almost painless for most patients.

Shockwave Therapy:
At a Glance

Method:

Extracorporeal acoustic pressure waves, applied externally
Duration:

20–30 minutes per session
Pain:

Minimal — slight tingling or warmth possible
Anaesthesia:

Not required
Downtime:

None — normal everyday activity possible immediately afterwards
Number of sessions:

6–12 sessions, 1–2 per week
Onset of effect:

From the 3rd–4th session, full effect 3–6 months after completion

How does the shockwave work?
The biological mechanism

The decisive advantage of ESWT over PDE-5 inhibitors: it does not treat the symptom but stimulates the biological regeneration of the tissue. The sound waves trigger several therapeutic processes at the cellular level:

Neovascularisation — new blood vessels form

The shockwaves stimulate the release of growth factors (VEGF, FGF) in the erectile tissue. These stimulate the formation of new small blood vessels (capillaries) — a process referred to as neovascularisation. The result: better blood circulation, more blood flow into the erectile bodies during sexual arousal.

Stem cell activation

The mechanical stimulation by shockwaves activates dormant stem cells (mesenchymal stem cells) in the penile tissue. These differentiate into endothelial cells and smooth muscle cells — the building blocks of healthy erectile tissue.

Improvement of NO production

Nitric oxide (NO) is the central messenger of the erection — it causes the dilation of the vessels in the erectile bodies. ESWT stimulates endothelial NO synthase (eNOS), improves NO production and thus directly the erectile response.

Breakdown of micro-calcifications

In chronic erectile dysfunction and especially in Peyronie's disease (penile curvature), fibrotic plaques and micro-calcifications form in the erectile tissue. Shockwaves can mechanically dissolve these and improve the tissue environment.

Who is shockwave therapy suitable for?

ESWT is not a universal solution for all erectile problems. Its mechanism of action — neovascularisation and tissue regeneration — unfolds its full benefit in vascular disorders and those caused by tissue changes.

Indication	Why ESWT is effective here
Vascular erectile dysfunction	Arteriosclerotic changes in the erectile tissue vessels are the most common organic cause of ED. ESWT stimulates the formation of new vessels and improves blood flow directly at the cause.
Andropause with erectile problems	Testosterone deficiency impairs erectile tissue circulation. ESWT acts as a complement to hormone therapy and improves the tissue quality of the erectile bodies.
PDE-5 inhibitor non-responders	In men who do not respond sufficiently to sildenafil or tadalafil, ESWT shows clinically relevant improvements — often the effectiveness of the medications returns afterwards.
Peyronie's disease (early stage)	Fibrotic plaques in the tunica albuginea can be broken up by shockwaves — reduction of pain and curvature possible in the early stage.
Preparation for P-Shot	ESWT prepares the tissue optimally: improved blood flow and activated stem cells maximise the effect of the subsequently injected growth factors of the P-Shot.
Diabetic and neurogenic ED	Limited effectiveness in purely neurogenic causes — but in diabetic microangiopathy a vascular component is often present that responds to ESWT.

Not suitable for: primarily psychological ED without an organic component · active infections in the treatment area · blood clotting disorders or anticoagulation · penile implants.

Is shockwave therapy the right option for you?

The specialist assesses this based on your laboratory values and medical history — in a 30-minute initial consultation.

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Shockwave vs. PDE-5 inhibitors: treating the cause instead of masking the symptom

PDE-5 inhibitors are effective and fast — but they treat the symptom, not the cause. ESWT targets the vascular basis of erectile dysfunction. Both approaches have their place — and both can be combined.

	Shockwave therapy (ESWT)	PDE-5 inhibitors (for comparison)
Mechanism of action	Tissue regeneration, neovascularisation	Inhibition of cGMP breakdown → longer vessel dilation
Onset of effect	From session 3–4, full effect after weeks	30–60 minutes after intake
Sustainability	Permanent (structural change)	Only during the duration of the tablet's effect
Application	Series of 6–12 sessions at the clinic	Taken orally as needed
Sexual spontaneity	Fully preserved (no tablet needed)	Restricted (timing of intake)
Suitable for	Vascular ED, PDE-5 non-responders, tissue damage	All degrees of severity as symptomatic support
Side effects	Minimal — slight local sensitivity	Flushing, headaches, visual disturbances possible

The combination ESWT + P-Shot: synergistic and evidence-based

Shockwave therapy and the P-Shot (PRP stem cell therapy) complement each other ideally — one prepares the tissue, the other delivers the regenerative building blocks.

More about the P-Shot and P-Shot Pro

Why the combination is more than the sum of its parts

ESWT first: shockwaves improve blood circulation and activate stem cells in the tissue.
Then P-Shot: the injected PRP meets optimally prepared, well-perfused tissue.
The growth factors act more intensively — more activated receptors, better blood flow.
Recommended sequence: ESWT series (6–8 sessions over 6–8 weeks) → then P-Shot
In pronounced cases: a second P-Shot treatment possible after a further 3–6 months.

The treatment process at the AndroKlinik

From the consultation to the completion of the treatment series — structured and without unnecessary detours:

Timing	What happens	Recommendation	Note
Initial consultation (video)	Medical history, laboratory order, indication assessment	Possible via telemedicine	Medical history form in advance via link
Findings evaluation	Laboratory values, therapy planning ESWT ± P-Shot	Within 48h after lab	Clarification of combination with other therapies
Sessions 1–3	First ESWT series, protocol according to findings	1–2x weekly, 20–30 min.	Slight sensitivity possible, normal
Sessions 4–6 (–12)	Continuation, first effect noticeable	Weekly or biweekly	Effect continues to improve after completion
Follow-up check	Evaluation of IIEF improvement, planning of subsequent steps	4–6 weeks after the last session	Possibly recommend P-Shot or repetition
Progress check	Stability check, laboratory values if needed	After 3–6 months	Document long-term effect

Frequently asked questions about shockwave therapy

Is shockwave therapy painful?

Most patients describe the treatment as almost painless — a slight tingling, a sensation of pressure or a feeling of warmth during the application is normal and passes immediately afterwards. Anaesthesia is not required. Immediately after the session, normal everyday activity can be resumed.

How long does the effect of ESWT last?

Since ESWT triggers structural changes in the tissue — new blood vessels, regenerated tissue — the effect is significantly more sustainable than that of a medication. Studies describe lasting improvements over 12–24 months after a complete treatment series. In the case of a progressing underlying condition (e.g. diabetes, arteriosclerosis), a refresher series may be advisable after 1–2 years.

Can I continue to take PDE-5 inhibitors during the ESWT series?

Yes — taking PDE-5 inhibitors during the ESWT series is generally not contraindicated and can even be advisable: it ensures erectile quality during the ongoing treatment until the ESWT effect has fully set in. The combination is often used with good results.

How many sessions do I need?

The standard protocol comprises 6–12 sessions over 6–12 weeks. The exact scope depends on the severity of the ED, the laboratory values and the individual response. After half of the planned sessions, the doctor assesses the response and adjusts the protocol if necessary.

Does the health insurance cover the costs?

ESWT for erectile dysfunction is a self-pay service — it is not reimbursed by statutory health insurance funds. The treatment is billed as a private service according to the GOÄ. Guideline prices can be found on our services page.

Does ESWT also work for psychologically caused ED?

The effectiveness of ESWT is best proven for vascular ED. In cases with a purely psychological main cause without an organic component, the effect is limited. In practice, however, mixed forms are often present — an organic component that is then overlaid by psychological factors. The specialist clarifies the main component in the initial consultation.

Treat the cause now—
not just the symptom

Shockwave therapy at the AndroKlinik — accompanied by specialists, outpatient, nationwide.

About the author

Dr. med. Timo A. Spanholtz
Specialist in Plastic and Aesthetic Surgery - Specialist in Men's Health and Intimate Surgery

Dr. Spanholtz is the founder and chief physician of the AndroKlinik. With many years of clinical experience in men's health, andrology and reconstructive urology, he supports patients from the entire German-speaking region.