Shockwaves, Ultrasound, and Magnets – A New Hope for Men with Erectile Dysfunction

What if a pill is not the answer?

For the past twenty years, when a man came to me with erectile dysfunction (ED), I usually reached for my prescription pad. Phosphodiesterase type 5 inhibitors, or PDE5 inhibitors, drugs like sildenafil, tadalafil, and vardenafil, have helped millions of men. They are safe, effective, and easy to use.

But here is the reality that many people do not talk about. These pills do not work for everyone.

According to the medical literature, about 30 percent of men with erectile dysfunction do not respond well to PDE5 inhibitors. Some men experience unpleasant side effects like headaches, flushing, nasal congestion, or indigestion. Others have medical conditions that make these pills unsafe, such as taking nitrate medications for heart problems. And many men simply do not want to rely on a pill every time they want to be intimate with their partner. They want a solution that feels more natural and offers longer lasting results.

So what are the alternatives?

Here are the main reasons why a man might look beyond the pill.

• The pills cause side effects that he finds intolerable, such as headaches, flushing, or severe nasal congestion.
• He has heart problems and takes nitrates, which means PDE5 inhibitors are strictly forbidden due to the risk of a dangerous drop in blood pressure.
• The pills simply do not work for him, even after trying different types and doses.
• He does not want to plan sex around taking a medication. He wants spontaneity.
• He is looking for a treatment that repairs the underlying problem, not just one that masks symptoms for a few hours.

This is where micro-energy treatment, or MET, enters the picture. MET is an emerging, non invasive therapy that uses different forms of energy, sound waves, ultrasound waves, and electromagnetic fields, to help the body heal itself. It does not involve surgery. It does not involve injections. And it does not require taking a pill on a schedule.

A major new study published in the World Journal of Men’s Health has pulled together data from 32 randomized controlled trials involving nearly 2,000 men. The authors conducted a systematic review and meta-analysis to answer a simple question: does micro-energy treatment actually work for erectile dysfunction?

The answer, as we will explore in this article, is yes. But like any medical treatment, the details matter. Who benefits the most? How often should treatment be done? How long do the results last? Let me walk you through what the science says, in plain language.

What is micro-energy treatment?

Micro-energy treatment is an umbrella term that covers three different technologies. Each one uses a different type of energy, but they all aim to do the same thing: stimulate the body’s own repair mechanisms in the penis.

Here is what happens on a biological level. The erectile tissue of the penis, called the corpus cavernosum, is filled with small blood vessels and smooth muscle. When these tissues are healthy, they can relax and fill with blood, creating an erection. When they are damaged by diabetes, by aging, by smoking, by surgery, or by other conditions, they lose their ability to function properly.

Micro-energy treatment works by delivering gentle energy waves to this tissue. These waves are not strong enough to cause damage. Instead, they trigger a process called mechanotransduction. That is a scientific term meaning that the cells sense the mechanical energy and respond by activating repair pathways.

The key biological effects include several important processes.

• Angiogenesis, which is the growth of new blood vessels. More blood vessels mean more blood flow, and more blood flow means stronger erections.
• Neuroregeneration, which is the repair and growth of nerves. Healthy nerves are essential for sending the signals that trigger an erection.
• Reduction of inflammation. Chronic inflammation damages blood vessels and interferes with normal erectile function.
• Recruitment of progenitor cells. These are stem cell like cells that help rebuild damaged tissue.

The research review explains that MET is considered an important component of what doctors call integrated medicine. Instead of just treating symptoms with a pill, MET aims to treat the underlying cause by helping the body heal itself.

How do we know it works? The science behind it

When doctors like me read medical research, we look for certain standards of evidence. The highest quality evidence comes from randomized controlled trials, or RCTs. In an RCT, patients are randomly assigned to receive either the real treatment or a fake treatment called a sham. Neither the patient nor the doctor knows who got what until the study is over. This design eliminates bias and gives us reliable answers.

The review I am discussing today is not just one study. It is a systematic review and meta-analysis. That means the authors searched through all the medical literature, found every high quality RCT on MET for ED, and combined their results into one big analysis. This gives us much more confidence than looking at any single study alone.

The authors searched three major medical databases: PubMed, Web of Science, and Embase. They looked for studies published up to April 2025. After screening, they included 32 randomized controlled trials with a total of 1,986 patients. To measure whether MET actually worked, the researchers used two standard tools. The first is the International Index of Erectile Function, or IIEF. This is a questionnaire that asks men about their ability to achieve and maintain erections. The second is the Erection Hardness Score, or EHS, which is a simple four point scale measuring how hard the erection is.

These tools are not subjective opinions. They are validated instruments that have been used in hundreds of studies around the world.

Three types of micro-energy treatment

Now let me explain the three specific technologies that fall under the MET umbrella. Each has its own way of delivering energy, but they share the same goal. The first and most studied method is low intensity extracorporeal shockwave therapy, often shortened to LIESWT. This technology uses acoustic waves, similar to the shockwaves used to break up kidney stones, but at much lower intensity. The waves are focused or radial, meaning they spread out to cover the treatment area. Twenty eight of the 32 studies in the review looked at LIESWT.

The second method is low intensity pulsed ultrasound, or LIPUS. This uses ultrasound waves, the same type of energy used to look at a developing baby during pregnancy. But instead of imaging, LIPUS delivers the energy in pulses at a lower intensity than traditional therapeutic ultrasound. Three studies in the review focused on LIPUS.

The third method is electromagnetic fields, or EMF. This technology uses magnetic fields to induce tiny electrical currents in the cells. These currents stimulate metabolism and improve microcirculation. One study in the review examined EMF.

Here is a table comparing these three approaches.

As you can see, LIESWT has the strongest evidence simply because it has been studied the most. But the early data on LIPUS and EMF is encouraging.

Does it really work? Results from the meta-analysis

Now we get to the most important question. Does MET actually improve erectile function? The answer from the meta-analysis is a clear yes.

The researchers looked at how well men were doing at different time points after treatment. They compared the MET group to the control group, which received either no treatment or a sham treatment.

Here is what they found at each follow up point.

• Immediately after finishing treatment, the MET group had higher IIEF scores than the control group, but the difference was not yet statistically significant. The improvement was about 2.25 points.
• One month after treatment, the MET group showed a significant improvement of 2.62 points on the IIEF scale. The difference was now large enough that it was unlikely to be due to chance.
• Three months after treatment, the improvement grew to 3.18 points. The difference was highly significant.
• Six months after treatment, the improvement reached 4.55 points. This was the peak effect.
• Twelve months after treatment, the improvement remained significant at 4.30 points. The effect lasted a full year.

What does this mean in plain English? MET does not work instantly. Do not expect to walk out of your first session with a perfect erection. The body needs time to heal and grow new blood vessels. The real benefits start showing up about a month after treatment and peak around six months. And here is the best part. The improvement lasts for at least a year. That is very different from a pill, which wears off after a few hours.

The review also compared MET directly to PDE5 inhibitor pills. Three studies in the analysis did this comparison. The result was that MET was equally effective as the pills. The difference between the two was only 0.72 points on the IIEF scale, which is not statistically significant. In other words, MET works just as well as the standard medication for many men.

This is a big deal. For men who cannot or do not want to take pills, MET offers a real, scientifically proven alternative.

Which type of MET works best?

Now that we have established that MET works, the next logical question is which type works best. Should a man seek out shockwave therapy, or would ultrasound be better? What about electromagnetic fields?

The meta-analysis directly compared the three types of MET. The researchers looked at the improvement in IIEF scores for each technology separately. Here is what they found. For LIESWT, the shockwave therapy, the improvement over control groups was 3.66 points on the IIEF scale. This result was highly significant, meaning it is very unlikely to be due to chance.

For LIPUS, the low intensity pulsed ultrasound, the improvement was 3.31 points. This was also highly significant. For EMF, the electromagnetic field therapy, the improvement was 7.00 points. This was also significant.

Now, before you get too excited about the 7 point improvement with EMF, I need to add an important caveat. Only one study in the entire review looked at EMF. That study showed excellent results, but we need more research to confirm those findings. With only one study, the data is promising but not yet definitive.

The statistical analysis showed that there was no significant difference in effectiveness among the three types of MET. In plain English, they all work about equally well. The p value for the difference between groups was 0.09, which is above the standard cutoff for statistical significance.

What does this mean for you? It means you do not need to obsess over which technology is “the best.” They all appear to be effective. The more important factors are the treatment schedule, the type of ED you have, and whether you combine MET with other therapies.

However, there is a practical consideration. LIESWT has by far the most evidence. Twenty eight studies have been done on shockwave therapy. Only three studies have been done on LIPUS, and only one on EMF. When I recommend a treatment to my patients, I prefer approaches that have been tested in large numbers of people over many years. That is why most clinics, including ours, currently focus on LIESWT. But we are watching the research on LIPUS and EMF with great interest.

Here are the situations where each type might be preferred.

• For men who want the most established, well researched option, LIESWT is the clear choice. It has been studied in thousands of patients across many different countries and clinical settings.
• For men who are extremely sensitive to sensation or who have anxiety about medical procedures, LIPUS may be a good fit. The ultrasound waves are very gentle and often produce no sensation at all.
• For men who prefer a completely non contact treatment, EMF is an intriguing option. The magnetic field passes through clothing and does not require direct skin contact.

Again, these are early observations. More research will give us clearer answers.

How often and how long? Finding the best treatment schedule

One of the most valuable contributions of this meta-analysis is that it helps answer practical questions about how MET should be delivered. How many times per week should a man come in for treatment? How many weeks should the treatment course last?

These are not small questions. If a treatment requires three sessions per week for nine weeks, that is a major time commitment. Many men cannot fit that into their schedules. If the same results can be achieved with two sessions per week for four weeks, that is much more manageable.

The researchers looked at treatment frequency first. They compared studies that used one session per week to studies that used two sessions per week. The results were striking. MET administered once per week did not produce a significant improvement in erectile function. The improvement was 3.01 points, but this result was not statistically significant. In plain English, once a week was not enough. MET administered twice per week, on the other hand, produced a significant improvement of 4.14 points. This was highly significant.

Although the difference between once and twice weekly was not statistically significant when directly compared, the pattern is clear. Twice weekly works. Once weekly may not. Now let us look at treatment course. The studies in the review used treatment courses ranging from 2 weeks to 9 weeks. The researchers divided them into two groups: courses longer than 4 weeks and courses of 4 weeks or less.

Here is what they found.

• MET with a treatment course of 4 weeks or less produced an improvement of 3.34 points. This was significant.
• MET with a treatment course longer than 4 weeks produced an improvement of 3.94 points. This was also significant.

The difference between the two groups was not statistically significant. That means extending the treatment beyond 4 weeks did not provide any additional benefit. In other words, there is no reason to do a 9 week course when a 4 week course works just as well.

Based on this evidence, here are the practical recommendations for treatment scheduling.

• Treatment should be delivered twice per week. Once per week is likely insufficient.
• A treatment course of 4 weeks appears to be adequate. Longer courses do not provide extra benefit.
• Each session typically lasts 15 to 30 minutes depending on the technology used.
• The total number of sessions is usually 8, delivered over 4 weeks.

This is a manageable schedule for most men. Two visits per week for one month. Compare that to taking a pill every day or every time you want to have sex. Many men find the time limited course of MET to be very appealing.

Who benefits the most?

Not every man with ED responds equally well to MET. The meta-analysis looked at several patient characteristics to see which groups benefited the most.

The first comparison was between vasculogenic ED and neurogenic ED. Vasculogenic ED means the problem is caused by blood vessel issues. This is the most common type of ED, especially in men with diabetes, high blood pressure, or high cholesterol. Neurogenic ED means the problem is caused by nerve damage. This often happens after prostate surgery for cancer.

The results showed that both groups improved, but vasculogenic ED improved significantly more. The improvement for vasculogenic ED was 4.41 points on the IIEF scale. The improvement for neurogenic ED was 2.04 points. The difference between the two groups was statistically significant.

Why does this matter? If you have ED after prostate surgery, MET can still help you. But you may not get as dramatic a result as a man whose ED comes from blood vessel problems. That does not mean you should not try MET. It just means you should have realistic expectations.

Now let us talk about comorbidities. A comorbidity is another health condition that a patient has alongside ED. Common comorbidities include diabetes, chronic prostatitis, multiple sclerosis, and kidney transplant. The meta-analysis compared men with comorbidities to men without comorbidities. Both groups showed significant improvement after MET. The improvement for men with comorbidities was 3.64 points. The improvement for men without comorbidities was 3.84 points. The difference was not significant. This is excellent news. It means that even if you have diabetes or another chronic condition, MET can still work for you. Your underlying health problem does not make you a poor candidate. Finally, the researchers looked at responsiveness to PDE5 inhibitors. Some of the studies specifically enrolled men who did not respond well to the pills. These are called PDE5 inhibitor non responders. Other studies enrolled men who did respond, or a mix of both.

Here is what the analysis showed. PDE5 inhibitor responders improved by 3.49 points on the IIEF scale. PDE5 inhibitor non responders improved by 6.33 points. Both improvements were significant, and the difference between the groups was not statistically significant.

This is another encouraging finding. Even if the pills have not worked for you in the past, MET may still work. In fact, the non responders in these studies showed a larger numerical improvement, though the difference was not statistically significant.

Here is a summary of who benefits most from MET.

• Men with vasculogenic ED, meaning ED caused by blood vessel problems, get the strongest results.
• Men with neurogenic ED after prostate surgery still benefit, but the effect may be smaller.
• Men with diabetes, chronic prostatitis, or other comorbidities can still expect good results.
• Men who have not responded to PDE5 inhibitor pills may still be excellent candidates for MET.
• Men who want a non pill alternative to medication are ideal candidates.

Can we make it even better? Combination therapy

One of the most practical findings from the meta-analysis is that MET works even better when combined with other treatments. This is called combination therapy.

The researchers identified five studies in which MET was combined with other basic therapies. These included PDE5 inhibitors, L arginine supplements, herbal medicines, and physical exercise. The results were clear. Combination therapy was superior to MET alone. The improvement with combination therapy was 3.08 points higher than with MET alone. This difference was highly significant. Why does combining treatments work so well? The answer lies in how different treatments affect the same biological pathway.

Let me explain. An erection requires a molecule called nitric oxide. Nitric oxide signals the smooth muscle in the penis to relax. When the muscle relaxes, blood vessels open and blood flows in. Another molecule called cyclic guanosine monophosphate, or cGMP, helps keep the muscle relaxed once the signal starts.

PDE5 inhibitors work by blocking the enzyme that breaks down cGMP. They keep the relaxation signal going longer. MET works by increasing the production of nitric oxide in the first place. It also helps grow new blood vessels and repair nerves.

When you combine the two, you get a powerful one two punch. MET increases the supply of nitric oxide. The PDE5 inhibitor makes better use of the nitric oxide that is already there and any new nitric oxide produced by MET. The result is greater than the sum of the parts.

This is especially important for men who are PDE5 inhibitor non responders. The review notes that combination treatment is particularly appropriate for these men. If the pills did not work on their own, adding MET might push them into the responder category.

In our practice at APUMN (Adult & Pediatric Urology Medical), we often use combination therapy for men who want the best possible results. The typical approach is to start MET while continuing or starting a low dose PDE5 inhibitor. Many men find that they can reduce their medication dose over time as MET takes effect.

Here are the most common and effective combination strategies based on the current evidence.

• MET plus daily low dose tadalafil. This combination allows the MET to repair tissue while the medication provides ongoing support.
• MET plus on demand PDE5 inhibitor. Some men prefer to take a pill only when needed while also receiving MET.
• MET plus physical exercise. Exercise improves blood flow and nitric oxide production, enhancing the effects of MET.
• MET plus L arginine. This amino acid is a precursor to nitric oxide. Some studies have shown added benefit.

Of course, any combination therapy should be discussed with your doctor. Not every combination is right for every man.

What about the settings? Energy parameters that matter

For the engineers and technically minded readers, you might be wondering about the specific settings used for MET. Does the energy level matter? Does the frequency of the shockwaves matter? How many pulses should be delivered per session?

The meta-analysis looked at these questions specifically for LIESWT, since that technology had enough studies to analyze. They examined three key parameters: energy density, shock frequency, and number of pulses per session. Energy density is measured in millijoules per square millimeter. It tells you how much energy is being delivered to each small area of tissue. The studies used energy densities ranging from very low to moderately low. The analysis showed that LIESWT with an energy density of 0.1 mJ/mm² or less produced an improvement of 4.31 points. LIESWT with an energy density higher than 0.1 mJ/mm² produced an improvement of 3.13 points. The difference was not statistically significant, but the trend favored lower energy.

Shock frequency refers to how many shockwaves are delivered per second, measured in Hertz. The studies used frequencies from very low to moderate. LIESWT with a shock frequency of less than 5 Hz produced an improvement of 3.73 points. LIESWT with a frequency of 5 Hz or higher produced an improvement of 2.94 points. Again, the difference was not significant, but the trend favored lower frequency. The number of pulses per session ranged from 1,000 to more than 5,000. LIESWT with fewer than 2,000 pulses per session produced an improvement of 4.46 points. LIESWT with 2,000 to 3,000 pulses produced an improvement of 2.78 points. LIESWT with more than 3,000 pulses produced an improvement of 3.53 points. None of the differences were significant.

What is the takeaway from all these numbers? Simple. More is not better. Higher energy, higher frequency, and more pulses do not produce better results. In fact, the trends in the data suggest that lower settings may actually be slightly better, though the differences are not statistically significant.

Here are the practical recommendations based on this analysis.

• Use an energy density of 0.1 mJ/mm² or less. Higher energy does not help and may be unnecessary.
• Use a shock frequency of less than 5 Hz. Slower is fine.
• Use fewer than 3,000 pulses per session. Around 1,500 to 2,000 pulses appears to be adequate.
• Do not assume that a more aggressive treatment is better. With MET, gentle is effective.

This is good news. It means the treatment can be delivered comfortably without needing to crank up the energy to uncomfortable levels.

Summary and key takeaways for patients

Let me bring everything together into a practical summary that you can discuss with your doctor.

Micro-energy treatment is a real, scientifically proven option for men with erectile dysfunction. The evidence comes from 32 randomized controlled trials involving nearly 2,000 men. This is not experimental therapy. This is established medicine with a growing body of support.

The effectiveness of MET lasts for up to one year after treatment. The benefits start to appear around one month after treatment, peak at six months, and remain significant at twelve months. This durability is a major advantage over pills, which last only a few hours.

All three types of MET, shockwave therapy, low intensity pulsed ultrasound, and electromagnetic fields, appear to work. Shockwave therapy has the most evidence, so it is currently the standard choice. But the other types show promise. The optimal treatment schedule is twice per week for a total of four weeks. Once per week is not enough. Longer courses beyond four weeks do not provide additional benefit. The best candidates for MET are men with vasculogenic ED, meaning ED caused by blood vessel problems. But men with neurogenic ED after prostate surgery, men with diabetes or other comorbidities, and even men who have not responded to pills can still benefit.

Combining MET with PDE5 inhibitors or other therapies produces stronger results than MET alone. This is especially useful for men who are partial responders or non responders to medication. The specific settings of the device, such as energy level and frequency, do not seem to matter much. Lower settings are effective and more comfortable.

Here are the key points to remember when considering MET.

• The treatment is non invasive. No surgery. No needles. No pills to take on schedule.
• The effect lasts up to one year. This is much longer than any medication.
• Twice weekly for four weeks is the standard protocol. Eight sessions total.
• Men with blood vessel related ED get the best results, but other types of ED also improve.
• Even if PDE5 inhibitors did not work for you, MET may still help.
• Combining MET with low dose medication produces better results than either alone.
• Lower energy settings are just as effective as higher settings. More is not better.

If you have been struggling with erectile dysfunction and you are looking for an alternative to pills, MET is worth discussing with your doctor. It is safe, effective, and offers benefits that last for months.

Medical Disclaimer

The information provided in this article is for educational purposes only and does not substitute professional medical advice. Always consult a licensed healthcare provider for diagnosis and treatment recommendations specific to your situation.

Author

Shawn M. McGee, M.D.