In Singapore, about 1 in 5 men suffer from erectile dysfunction, or the inability to maintain an erection sufficient for sexual intercourse. Some occasional inability to maintain or have an erection is normal, but if it’s ongoing, then it’s probably a sign of erectile dysfunction and should be checked out. 

For years, psychological issues have been thought to be the primary cause of erectile dysfunction and oral medications were often the first line of treatment. But as doctors come to better understand this disease, we now know that erectile dysfunction is caused by many other factors and can be a sign of an underlying medical problem. In such cases, will traditional treatment methods work for everyone? 

Introducing low-intensity extracorporeal shockwave therapy (Li-EWST), an invention that might not only treat symptoms but also possibly cure the cause of organic erectile dysfunction. What is this treatment all about, and to what extent can it help with erectile dysfunction? 

First, let us understand the causes of erectile dysfunction.

What causes erectile dysfunction in men?

Organic erectile dysfunction

Approximately 52% of men aged 40-70 have some degree of sexual dysfunction, and 15-72% of this population have organic erectile dysfunction. While organic causes are more common in older men, it is becoming increasingly prevalent in younger men below 40. Several studies indicate smoking, diabetes and hypertension as the main risk factors. 

Organic erectile dysfunction involves abnormalities in the penile parties or veins. This happens due to: 

  • Arterial insufficiency or hardening of the arteries caused by lifestyle factors such as smoking, high cholesterol, high blood pressure and obesity 
  • Venous leak, where muscle tissue around the body of the penis surrounding the veins atrophy. Venous leak is believed to be an early manifestation of vascular disease and atherosclerosis.

Depression

About 25% of men with depression experience erectile dysfunction, which is often made worse with antidepressants. Serotonin reuptake inhibitors, the most widely prescribed antidepressants, have been found to have significant effects on arousal and orgasms in both men and women.

Neurological conditions

Chronic alcoholism, nerve damage, multiple sclerosis and nerve damage from pelvic operations are some of the conditions that can cause erectile dysfunction.

Drug-induced erectile dysfunction

Apart from antidepressants, a variety of prescription drugs like blood pressure medication, glaucoma eye drops and cancer chemotherapy agents are also associated with erectile dysfunction.

Hormone-induced erectile dysfunction

Steroid abuse, increased prolactin and abnormalities in thyroid hormones are some of the things that can result in erectile dysfunction. The same goes for hormones administered for prostate cancer. Low testosterone levels can often contribute to erectile dysfunction but are rarely the sole cause.

How does shockwave therapy work?

In order to have an erection, there needs to be a good amount of blood in the penis without flowing out too quickly to maintain rigidity. Shockwave therapy uses low-intensity acoustic shockwaves to stimulate the formation of new blood vessels in erectile tissues. This increased blood flow to the penis allows patients to allow and maintain erections for a longer period of time. Further, this method also addresses the underlying pathology of erectile dysfunction, which means it could potentially treat the cause of ED, a condition that’s long been viewed as irreversible. Most treatment methods like drugs allow for erections transiently, but the effects are only temporary as they do not work on the underlying pathology of ED. 

During shockwave therapy, a probe is used to treat specific areas for 15-20 minutes. Usually, 6-12 treatment sessions are required, but this depends on the severity of the dysfunction.

Is shockwave therapy a long term cure?

Because shockwave therapy for erectile dysfunction is a relatively new treatment, we don’t have much knowledge on the durability of effects. However, current data show that the effects tend to wear off with time, and about 30% of patients have benefits that last beyond two years. 

In this sense, shockwave therapy may not be a permanent solution, but it can help patients get off drugs for a period of time. In addition, patients are able to have sex spontaneously instead of planning for it as required with medication.

Is shockwave therapy suitable for everyone?

While shockwave therapy for sexual dysfunction is generally safe and well-tolerated, it, unfortunately, isn’t suitable for all men, especially those who have erectile dysfunction from nerve disorders. Those who do not benefit from oral medication, have a long-standing history of diabetes or who are prone to developing nerve disorders might not react as well to shockwave therapy too. 

So in this sense, it really is on a case by case basis. Shockwave therapy, while still an alternative or additional treatment for men suffering from erectile dysfunction, is gradually gaining acceptance and hopefully, in time to come we can make this treatment useful for everyone.

References

  • Kennedy, S. H., & Rizvi, S. (2009). Sexual dysfunction, depression, and the impact of antidepressants. Journal of clinical psychopharmacology, 29(2), 157–164. https://doi.org/10.1097/JCP.0b013e31819c76e9
  • Young Academic Urologists Men’s Health Group, Fode, M., Hatzichristodoulou, G., Serefoglu, E. C., Verze, P., & Albersen, M. (2017). Low-intensity shockwave therapy for erectile dysfunction: is the evidence strong enough?. Nature reviews. Urology, 14(10), 593–606. https://doi.org/10.1038/nrurol.2017.119