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  • Erectile dysfunction

    What is erectile dysfunction?

    Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

    Having erection trouble from time to time isn't necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

    If you're concerned about erectile dysfunction, talk to your doctor — even if you're embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.


    Erectile dysfunction symptoms might include persistent:

    • Trouble getting an erection

    • Trouble keeping an erection

    • Reduced sexual desire

    When to see a doctor

    A family doctor is a good place to start when you have erectile problems. See your doctor if:

    • You have concerns about your erections or you're experiencing other sexual problems such as premature or delayed ejaculation

    • You have diabetes, heart disease or another known health condition that might be linked to erectile dysfunction

    • You have other symptoms along with erectile dysfunction


    Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.

    Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

    Physical causes of erectile dysfunction

    In many cases, erectile dysfunction is caused by something physical. Common causes include:

    • Heart disease

    • Clogged blood vessels (atherosclerosis)

    • High cholesterol

    • High blood pressure

    • Diabetes

    • Obesity

    • Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol

    • Parkinson's disease

    • Multiple sclerosis

    • Certain prescription medications

    • Tobacco use

    • Peyronie's disease — development of scar tissue inside the penis

    • Alcoholism and other forms of substance abuse

    • Sleep disorders

    • Treatments for prostate cancer or enlarged prostate

    • Surgeries or injuries that affect the pelvic area or spinal cord

    • Low testosterone

    Psychological causes of erectile dysfunction

    The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

    • Depression, anxiety or other mental health conditions

    • Stress

    • Relationship problems due to stress, poor communication or other concerns

    Risk factors

    As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection.

    Various risk factors can contribute to erectile dysfunction, including:

    • Medical conditions, particularly diabetes or heart conditions

    • Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction

    • Being overweight, especially if you're obese

    • Certain medical treatments, such as prostate surgery or radiation treatment for cancer

    • Injuries, particularly if they damage the nerves or arteries that control erections

    • Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions

    • Psychological conditions, such as stress, anxiety or depression

    • Drug and alcohol use, especially if you're a long-term drug user or heavy drinker


    Complications resulting from erectile dysfunction can include:

    • An unsatisfactory sex life

    • Stress or anxiety

    • Embarrassment or low self-esteem

    • Relationship problems

    • The inability to get your partner pregnant


    The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example:

    • Work with your doctor to manage diabetes, heart disease or other chronic health conditions.

    • See your doctor for regular checkups and medical screening tests.

    • Stop smoking, limit or avoid alcohol, and don't use illegal drugs.

    • Exercise regularly.

    • Take steps to reduce stress.

    • Get help for anxiety, depression or other mental health concerns.

    Focused shockwave therapy machine used for Erectile dysfunction Care.

  • Study: Focused Shockwave as an Alternative to Medication for Erectile Dysfunction

    ED affects millions of men worldwide, and while medications like sildenafil can provide temporary relief, they don’t address the underlying causes of the condition. That’s where low-intensity extracorporeal shockwave therapy (Li-ESWT), also known as focused shockwave therapy comes in. This non-invasive treatment has shown lasting results in improving erectile function and overall satisfaction in patients, offering a potential alternative to medications.

    If you own a focused device or are considering purchasing one, the chances are that you have considered whether you should add this treatment to your clinic’s repertoire. One of your primary questions would be what can shockwave provide for these patients that they can’t get from medication?

    Multiple clinical trials using Storz Duolith focused system have validated the efficacy of Li-ESWT in improving erectile function (Ayala et al, 2017; Chung et al, 2015; Olsen et al, 2015; Tsai et al, 2017). The major advantage of Li-ESWT is the restoration of the ability to have spontaneous erections. Until now however no comparative study of sildenafil versus Li-ESWT has been conducted concerning the satisfaction aspect. In this blog post, we’ll explore the latest research on Li-ESWT and compare its efficacy to sildenafil for ED treatment.

    The Treatment Satisfaction in Patients and Their Partners Treated with Low-Intensity Extracorporeal Shock Wave Therapy and Sildenafil

    In a recent study by Wang and Colleagues published this year, researchers performed a comparative analysis of Li-ESWT and sildenafil, to assess ED treatment satisfaction of patients and their partners.


    The study was a comparative analysis of Li-ESWT and sildenafil for ED treatment. They enrolled 72 participants in the study (42 in the Li-ESWT group and 30 in the sildenafil group). Inclusion criteria were men who had a complaint of ED for at least 6 months. Men with unstable medical conditions (including clinically significant hepatobiliary or renal disease, and unstable cardiovascular disease) or psychiatric condition were excluded. All the participants completed the IIEF-EF and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires. The primary outcome was the satisfaction of the patients and their partners, as measured by EDITS.


    The results showed that Li-ESWT had better satisfaction than on-demand sildenafil in young ED patients and their partners, while efficacy was similar. The study found that Li-ESWT is a valid non-invasive alternative to medications like sildenafil for ED treatment. It has shown comparable efficacy and may even be superior in terms of overall satisfaction. These results are promising and suggest that Li-ESWT could be an effective alternative to
    medications for some patients with ED.

    Key takeaways from this study

    1. Consider focused shockwave as a viable alternative or in addition to PDE5i drugs like sildenafil for men with ED who are seeking treatment.
    2. Use standardized subjective outcome measurements (EDITS) to evaluate treatment satisfaction in patients and their partners.
    3. Educate patients about the potential limitations of PDE5i drugs like sildenafil in the long-term.
    4. Consider the patient’s age, medical history, and preferences when recommending a treatment modality for ED.


    For men with erectile dysfunction, it’s important to know that there are alternative treatment options available, beyond medications like sildenafil. This study has demonstrated that focused shockwave is comparable to sildenafil in terms of efficacy and may even be superior in terms of overall
    satisfaction. The benefits of focused shockwave include its non-invasive nature, lack of side effects, and potential for long-term improvement in erectile function. If you’re struggling with ED, talk to your healthcare provider about all of your treatment options, including Li-ESWT. Don’t be afraid to ask questions and advocate for yourself. With the right treatment plan, you can regain your sexual health and improve your quality of life!

    Benoy Mathew,
    Focused Shockwave Specialist,
    ED Clinics, UK