Sexual dysfunction is but a very common medical disorder many of us see on a daily basis across all
What is sexual dysfunction?
Broadly sexual dysfunction is any physical or psychological problem that prevents you or your partner
from getting sexual satisfaction. Male sexual dysfunction is a common health problem affecting men of
all ages but is more common with increasing age. Treatment can often help men suffering from sexual
The main types of male sexual dysfunction are:
• Erectile dysfunction (difficulty getting/keeping an erection)
• Premature ejaculation (reaching orgasm too quickly)
• Delayed or inhibited ejaculation (reaching orgasm too slowly or not at all)
• Low libido (reduced interest in sex) 
Let’s keep our discussion to Erectile dysfunction which probably is the most common issue faced by
man as early as at the age of 40 or younger sometimes. Hormonal and metabolically most are well but
there is a circulatory issue that is virtually impossible to cure but manageable with medications at a use
Let’s not forget that a very important health indicator is morning erections in a male and it has been proven that a significant population of men below 40 who actually have ED, may actually have
‘hidden’ Cardiovascular disease as it is a fact that the blood vessels in the penis are the smallest of the
most essential arteries in the human body. Based on that understanding it is extrapolated that if you
have a young ED patient there is a good chance his cardiac vessels may too be dysfunctional.
Thus there is an urgency to refer your under 40, with no other metabolic or hormonal problem, to the
cardiologist first before to your urologist!
Now coming back to curing ED. PDE5 inhibitors, i.e. Viagra and Cialis, do not cure ED. Neither do
vacuum devices. They merely help in the one-off performance but it doesn’t sort the problem out for
good. You could liken it to given Paracetamol for Pneumonia maybe!
The only curative option in the past for ED was a penile implant.Penile implant: Till recently this was the only hope for a potential cure for ED. However, this is invasive and requires surgical expertise.
The only curative option in the past for ED was a penile implant. Till recently this was the only hope for a potential cure for ED. However, this is invasive and requires surgical expertise.
However, now there is a novel new treatment, which is potentially curative in nature and is no longer
in the experimental stage with major urology guidelines across world recognising it as a treatment
option.This is called Low-intensity shock wave therapy for ED.
Now there is a novel new treatment, which is potentially curative in nature and is no longer in the experimental stage with major urology guidelines across world recognising it as a treatment option.This is called Low-intensity shock wave therapy for ED.
Shockwave therapy uses the same science used for shock wave treatment for stones in urology. In a nutshell, the shock waves promote angiogenesis and help restore normal blood flow to the penis. This therapy is has LEVEL 1 evidence to support its role in the treatment of ED.
Recently there was a review paper published in Natures urology reviews which critically analyse this. I
commend the authors for the extensive work.
Some excerpts from that are the following:
“The available systematic reviews suggest the presence of level 1 evidence”
“Both the scientific community and the companies promoting this technology must take responsibility to speed up and improve research in order to produce and publish robust evidence on Li-ESWT for ED.”
“In addition, the long-term effects of Li-ESWT treatment are still not understood — in particular, any harmful effects of Li-ESWT, such as fibrosis, or development of Peyronie’s disease due to repeated
microtrauma, must be assessed.”
“Shockwave therapy has been shown to induce immediate vasodilatation which gives rise to the
hypothesis that shockwave treatment could modulate the production of NO or other vasodilators.”
“Li-ESWT is the first treatment option for ED that has the potential to improve pharmacologically
unassisted erectile function. The concept is unprecedented and revolutionary, and the effects at molecular and tissue level are largely unknown, although neoangiogenesis might have a key role.
Following a series of single-arm trials, which almost unanimously show a benefit, several monocentric
RCTs have now been published with mixed results.”
(Excerpts from Nature reviews in urology: Low-intensity shockwave therapy for erectile dysfunction: is
the evidence strong enough? Mikkel Fode 1, Georgios Hatzichristodoulou 2, Ege Can Serefoglu 3,
Paolo Verze 4 and Maarten Albersen 5 on behalf of the Young Academic Urologists Men’s Health