Sending shockwaves through his penis could help a man get an erection—at least that’s the idea behind a new experimental therapy for erectile dysfunction. Known as shockwave therapy, the method was first tested in 2010, and additional research on the subject has since caused quite a buzz the scientific community.
Erectile dysfunction (ED) mostly affects men over the age of 40, even though younger men sometimes experience it too. Approved by the FDA exactly twenty years ago, the use of viagra (and other similar medications known as PDE5 inhibitors) has powered a massive improvement for patients. Penile injections have also helped. However, these treatments don’t offer long-term solutions. Popping pills in preparation for sex also leaves little room for spontaneity, and this can be a mood killer for some couples.
In the last few decades, another important development has come from penile implants, which have helped those men who don’t respond well to the drugs. But as with the other treatments, the underlying pathology is not addressed, so it’s just a quick fix, if at all. And of course, there are the side effects of the pills, which include headache, stomach pain and blurry vision.
Scientists have been working relentlessly to restore patients’ ability to get it up on their own, without the need to plan each sexual encounter. Shockwave therapy has emerged as a potential long-term solution in this context. “Everybody would agree that tablets, implants, and injection therapy can be very effective. But shockwave therapy is attractive because if we can prove that it does work, it would be curative,” says Mikkel Fode, Denmark-based urologist and fellow at the European committee for Sexual Medicine. “Patients would get back to normal sexual function. This potential for a cure is the reason shockwave therapy has become so popular.” Keep your pants on though—these are still early days. Shockwave therapy has, so far, been more about exploration than answers.
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The technique has traditionally been used in the treatment of other conditions, in cardiovascular medicine in particular, but also to treat kidney stones or tendonitis. The basis of the therapy is quite straightforward: Low-intensity energy waves—the ‘shockwaves’—are delivered to the body part that doctors want to target. This promotes the growth of new blood vessels from old ones. Experts reason that if they could get new blood vessels to form in the penis, these vessels might then be able to allow enough blood to flow in and to produce an erection.
Readers may wince at the thought of a shockwave probe to the peen, but it's not as painful as the name suggests. From the first pilot trial in 2010, researchers were able to show that it is in fact well tolerated. In the first study, among the twenty men who had been recruited, it appeared that half of them did not need to use viagra to get an erection six months after the intervention. Based on this initial success, a lot of small studies have been published. Although they focus on a limited number of patients at a time, the findings are promising overall and explain the growing scientific interest in shockwave therapy.
But here’s the catch: People that come into the clinic to try it out know they’re not receiving a fake treatment. They are convinced that they're being treated for ED with a sophisticated new therapy and that they are being seen by experienced doctors. All of this can have a positive psychological effect. It’s therefore possible that several of the good results seen in the studies can be boiled down to a placebo effect, experts say.
“It’s more interesting to look at randomized trials, where you divide people into two groups, one receiving the real treatment and the other a sham treatment. The results seem to be a bit less encouraging here,” Fode explains. “There are five randomized trials published at this point, with two showing clear benefits, two others not, while the last one is impossible to interpret. So it's difficult to conclude anything at this point about whether shockwave therapy really does work for ED.”
Perhaps even more problematic is the fact we still don’t know how best to apply the treatment. Scientists are unsure how long they should treat patients for, over how many sessions, and exactly which part of the penis they need to target. It’s also unclear if the positive effects seen right after most trials are here to stay.
Noam Kitrey is a urologist at Sheba Medical Centre in Israel, who works with the group who first investigated shockwave therapy for ED back in 2010. He and his colleagues recently gathered data that show that after two years, the benefits of shockwave therapy may not be sustained in all men. Their work also adds to a body of growing evidence that the approach may only really be helpful for mild forms of ED. “The results of our recent study prove that the positive effect of shockwave treatment declines over time. Approximately half of the patients keep the response after two years. Patients with more severe erectile dysfunction lose the positive effect even quicker,” Kitrey says.
In the US, shockwave therapy for ED is not FDA-approved, and patients have to enroll in clinical trials if they want to try it. The problem is that many devices are already being advertised as shockwave therapy, outside of those studies. “But [those are] not shockwave therapy at all. These devices might produce some kind of vibrations and it’s possible they may help one particular individual,” says Shubham Gupta, assistant professor of urology at Kentucky University. “Their use is however not backed up by solid evidence. Without more data, it’s probably not reasonable right now to offer shockwave therapy outside clinical trials.”
Gupta, nevertheless, expects that shockwave therapy will be a game-changer in the treatment of ED over the next decade, but only if scientists manage to design rigorous treatment protocols, and perhaps only for a restricted number of men. Moving to the next stage and into a world where shockwave therapy can be routinely prescribed will require a greater number of large, multi-center, randomized trials that follow patients on the long-term. In the meantime, investigations for other, even more experimental therapies, such as stem-cell therapy, are expected to continue, providing men with a wide range of options to regain control of their sex lives in the future.
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