Over the past decade, low-intensity shockwave therapy has moved from an experimental idea to a recognised treatment option for erectile dysfunction. It is included in the European Association of Urology (EAU) guidelines, and it has been studied in randomised controlled trials. In my clinical experience at Shockwave ReVibe Clinic in Notting Hill Gate, it has helped many men who had relied on medication — or found that medication was no longer working as well.
Despite this, many men in London are still confused about what low-intensity shockwave therapy actually involves. Some have been told it is the same as the shockwave therapy used for sports injuries. Some have read marketing material that overpromises. And some have been treated with devices that are not designed to reach the target tissue.
This guide gives London patients an accurate, plainly written account of what low-intensity shockwave therapy for ED is, how it works, who it is most likely to help, and what results are realistic.
What Is Low-Intensity Shockwave Therapy?
Low-intensity shockwave therapy — often shortened to Li-ESWT — is a non-invasive treatment that delivers acoustic energy waves to tissue. For erectile dysfunction, the waves are directed at the erectile tissue of the penis and the arteries that supply it.
The "low-intensity" part is important. It distinguishes this treatment from the high-intensity shockwaves used to break up kidney stones — a completely different application at much higher energy. Li-ESWT for ED uses low energy levels intended to stimulate the body's own repair processes, not to break up tissue.
It is also different from radial shockwave therapy, which is widely used in sports medicine for superficial musculoskeletal conditions. Radial devices spread pressure waves outward from the skin surface, with the energy concentrated close to the surface. Focal shockwave devices concentrate their energy at a focal point at a depth of approximately 7 cm — enough to reach the erectile tissue and the penile arteries. This difference is explained in more detail below, and in our guide to the different types of shockwave therapy.
How Li-ESWT Treats Erectile Dysfunction
In most men over 40, erectile dysfunction has a vascular cause. The endothelium — the inner lining of the penile blood vessels — stops working as well as it should, the arteries narrow, and less nitric oxide is produced. As a result, blood flow into the erectile tissue during arousal is not enough to achieve or maintain an erection. (For the full picture, see what causes erectile dysfunction.)
Tablets such as sildenafil (Viagra) and tadalafil (Cialis) work by temporarily boosting the existing blood-flow response. They do not repair the underlying damage to the blood vessels, which is one reason some men find they work less well over time.
Focal shockwave therapy works differently. Laboratory and clinical research suggests it acts on the vascular cause in several ways:
- New blood vessel formation (angiogenesis). Shockwaves appear to stimulate growth factors such as VEGF, which encourage the formation of new small blood vessels in the erectile tissue.
- Improved blood vessel lining (endothelial function). Studies suggest shockwave therapy can improve the function of the blood vessel lining and the nitric oxide pathway that is needed for an erection.
- Nerve and tissue repair. Animal studies suggest shockwaves may support nerve regeneration and activate repair cells in the tissue. These effects are promising, but have not yet been fully proven in humans.
Because shockwave therapy aims to improve blood flow itself, rather than working only when a tablet is taken, any improvement can continue after the treatment course has finished.
"Results come more gradually than with a tablet, but when they occur, they reflect an improvement in blood flow rather than an effect that wears off after each dose."
— Dr Kishore Bahl, Shockwave ReVibe ClinicWhat the Clinical Evidence Shows
The evidence for Li-ESWT in ED has grown considerably. Here is an honest summary of key findings. For a deeper review, see the evidence for shockwave therapy in ED.
Gruenwald et al. (2012) — Journal of Sexual Medicine
An early study of men with severe ED who responded poorly to tablets. After a course of shockwave therapy, many of these men were able to achieve erections good enough for intercourse when taking tablets again.
Kitrey et al. (2016) — Journal of Urology
A double-blind, sham-controlled study in men who no longer responded to tablets. A proportion of men who received real shockwave treatment became responders to tablets again, compared with none in the sham group.
Lu et al. (2017) — European Urology
A systematic review and meta-analysis of 14 studies with 833 patients. It found that shockwave therapy improved erectile function scores and penile blood flow compared with sham treatment, with the clearest benefit in men with mild to moderate ED.
EAU guidelines (2024)
The European Association of Urology — the leading European professional body in urology — includes low-intensity shockwave therapy as a treatment option for men with mild vasculogenic ED in its 2024 Guidelines on Sexual and Reproductive Health. The guideline notes that longer-term studies are still needed.
Overall, the evidence is encouraging, particularly for mild to moderate vasculogenic ED. Results vary between men, and not everyone will respond.
Focal vs Radial: Why the Device Matters
If you are researching Li-ESWT for ED in London, you will find clinics using very different devices. This matters more than most patients realise.
Most of the clinical evidence for shockwave therapy in ED comes from focal (and some linear) shockwave devices, which concentrate their energy at depth — approximately 7 cm — where the erectile tissue and penile arteries lie.
Radial shockwave devices, commonly used for plantar fasciitis, tennis elbow and other superficial musculoskeletal conditions, disperse their energy close to the skin. They are designed for a different purpose, and there is little good evidence for them in ED. A patient treated with a radial device for ED is not receiving the treatment that was tested in most of the clinical trials.
| Focal shockwave | Radial shockwave | |
|---|---|---|
| How the energy is delivered | Focused at a point within the tissue | Pressure waves spreading out from the skin surface |
| Depth of energy | Approximately 7 cm | Mainly superficial |
| Reaches erectile tissue and penile arteries | Yes | Limited |
| Evidence for ED | Randomised trials; included in EAU guidelines | Little good evidence |
At Shockwave ReVibe Clinic, ED is treated using a focal shockwave system. Read more about why expert delivery matters.
Who Is Li-ESWT Most Likely to Help?
Based on the published evidence and my clinical experience, focal shockwave therapy for ED is most likely to help:
- Men with mild to moderate vasculogenic ED. This is the group studied in most trials, and where the evidence is strongest. Men with risk factors such as diabetes, high blood pressure, high cholesterol or a history of smoking often fall into this group.
- Men who would like to rely less on tablets. For some men, shockwave therapy improves natural function so that tablets are needed less often or at a lower dose.
- Men whose tablets have become less effective. Research suggests shockwave therapy can help some men respond to tablets again (Kitrey et al., 2016).
- Men who cannot take tablets. Men taking nitrate medicines for heart conditions must not take PDE5 tablets. Shockwave therapy has no drug interactions, although every man still needs a full medical assessment first.
Men after prostate surgery
Shockwave therapy is being studied as part of penile rehabilitation after prostate surgery. The evidence here is still limited, and results are usually less predictable, so this should be discussed carefully at consultation. See shockwave therapy after radical prostatectomy.
Who is less likely to benefit
Li-ESWT is not effective for every man with ED:
- men with severe vascular damage may see smaller improvements, because the repair process needs some working blood vessels;
- men whose ED is mainly psychological are better helped by psychosexual assessment and support;
- men with ED due to other causes — hormonal, neurological or medication-related — need the underlying cause treated first (see Low Libido & Sexual Wellness);
- men with certain blood clotting problems, taking some anticoagulants, or with infection or cancer in the treatment area, may not be suitable.
This is why a proper clinical assessment before treatment is essential. It decides whether you are a suitable candidate and shapes your treatment plan. See what to look for in a private ED clinic in London.
What to Expect at Shockwave ReVibe Clinic
The initial consultation
Every patient begins with a full clinical assessment: medical history, current medications, how the symptoms developed, relevant investigations, and a validated IIEF questionnaire. This gives a baseline before treatment begins, so improvement can be measured objectively.
For many men, ED is also the first conversation about wider heart and circulation health. As part of the assessment, I look at the full clinical picture — not just the presenting complaint. A men's urology consultation covers this in full.
The treatment course
A typical course is 6–12 sessions, depending on your assessment. Each session takes around 20–25 minutes. The applicator is placed on the shaft and base of the penis and the perineum, delivering focused acoustic pulses to the erectile tissue and its blood supply.
Most men describe the sensation as mild pressure or light tapping. No anaesthetic is needed, and you can return to normal activities straight away. Sessions are usually once or twice a week.
The results timeline
The changes that shockwave therapy aims to bring about take time. Many men begin to notice improvement during or shortly after the course, and the full benefit usually develops over the following 6–12 weeks.
Results come more gradually than with a tablet, but when they occur, they reflect an improvement in blood flow rather than an effect that wears off after each dose.
Follow-up
I reassess patients around 12 weeks after treatment, using the IIEF questionnaire and a clinical review, so any improvement is measured objectively. If a further course could help, we discuss it at that appointment.
Fees
- Initial consultation: £59
- Consultation and first session together, if shockwave therapy is suitable and started on the same day: £99
- Further shockwave sessions: £250 each
- No GP referral needed, and all consultations are confidential
Ready to talk? Call 020 3004 0564 or book online. See our full Erectile Dysfunction Treatment London service, or read Shockwave Therapy for ED.
Dr Kishore Bahl
Every Li-ESWT course at Shockwave ReVibe Clinic is delivered personally by Dr Bahl, using a focal shockwave system. Read our complete guide to ED treatment →
Frequently Asked Questions
What does "low-intensity" mean?
It refers to the low energy level used — intended to stimulate repair, not to break up tissue as high-intensity shockwaves do for kidney stones. Li-ESWT is non-invasive and needs no anaesthetic.
Is focal shockwave therapy the same as radial shockwave therapy?
No. They are different devices with different physical properties. Most of the evidence for ED, and the EAU guideline, relate to focal (and some linear) devices, which deliver energy to a depth of approximately 7 cm. Radial devices work mainly near the surface and have little good evidence for ED. See focal vs radial shockwave explained.
How many sessions will I need?
Usually 6–12 sessions, depending on severity. This is decided at your initial consultation and reviewed at follow-up. See how many shockwave sessions you might need.
How long do the results last?
In men who respond, studies have reported benefits lasting a year or more, and some up to two years. The effect can lessen over time, particularly if vascular risk factors continue, and some men benefit from a further course.
Can I use Li-ESWT alongside Viagra or Cialis?
Yes. The two work in different ways and can be used together. For some men, continuing tablets during the course and reducing them as improvement develops is a sensible approach. This is discussed individually at consultation. See shockwave therapy vs Viagra.
Will it work if Viagra has stopped working for me?
For some men, yes. A double-blind, sham-controlled study found that some men who no longer responded to tablets became responders again after shockwave therapy (Kitrey et al., 2016). Your consultation will establish whether it is suitable for you.
Is the treatment painful?
Most men feel only mild pressure or tapping. Some mild tenderness can follow a session. No anaesthetic is needed.
Do I need a GP referral?
No. You can book directly. The initial consultation is £59, and treatment is completely confidential. Book online or call 020 3004 0564.
Is Li-ESWT safe?
Published studies report a good safety profile, with no serious side effects reported in clinical trials. Minor, short-lived effects such as tenderness or redness can occur. A medical assessment beforehand ensures the treatment is suitable for you.
Clinical References
- Gruenwald I, Appel B, Vardi Y. (2012). Low-intensity extracorporeal shock wave therapy — a novel effective treatment for erectile dysfunction in severe ED patients who respond poorly to PDE5 inhibitor therapy. Journal of Sexual Medicine, 9(1): 259–264.
- Kitrey ND, Gruenwald I, Appel B, et al. (2016). Penile low intensity shock wave treatment is able to shift PDE5i nonresponders to responders: a double-blind, sham controlled study. Journal of Urology, 195(5): 1550–1555.
- Lu Z, Lin G, Reed-Maldonado A, et al. (2017). Low-intensity extracorporeal shock wave treatment improves erectile function: a systematic review and meta-analysis. European Urology, 71(2): 223–233.
- European Association of Urology (2024). EAU Guidelines on Sexual and Reproductive Health. EAU Guidelines Office, Arnhem, The Netherlands.
Dr Kishore Bahl is a GMC-registered doctor (GMC 6070860), a former NHS Specialist Doctor in Urology, and founder of Shockwave ReVibe Clinic, 22 Notting Hill Gate, London W11 3JE. To book a consultation, call 020 3004 0564 or visit shockwave-revibe.co.uk.
This article is for general information and does not replace a personal medical consultation. Last reviewed: October 2026