Prof. Dr. Emel Akoğlu
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Andrology & Men's Health
Shockwave therapy for erectile dysfunction
How low-intensity shockwave therapy is used for erectile dysfunction, what the clinical trials do and do not show, who is most likely to benefit, how many sessions are involved, what a course costs in Turkey against the UK, US and Germany, how it compares with tablets, injections and implants, the side effects and the checks to ask a clinic about.
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Prof. Dr. Zerrin Biçik Bahçebaşı
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Shockwave therapy for erectile dysfunction: what it is and how it works
Shockwave therapy for erectile dysfunction (ED), properly called low-intensity extracorporeal shockwave therapy (Li-ESWT), uses a handheld probe to send low-energy acoustic pulses through the skin of the penis. The pulses are far weaker than those used to break kidney stones. The idea is that they stimulate the growth of new small blood vessels (angiogenesis), improve blood flow into the erectile tissue and may help damaged tissue to repair. It is therefore aimed at the vascular cause of ED rather than at masking the symptom the way a tablet does. Clinics in Turkey offer it as a course of short outpatient sessions with no anaesthetic and no incision.
It is one of the more heavily marketed ED treatments, so it is worth knowing what is proven and what is not. This guide explains the mechanism, what trials show, who is most likely to benefit, how a course runs, what it costs in Turkey compared with the UK, US and Germany and how to compare it with other options. For the wider choice of men's health treatments see urology treatments in Turkey.
Does shockwave therapy work for erectile dysfunction? What the evidence says
The evidence is encouraging but not conclusive. Randomised, sham-controlled trials and meta-analyses report that Li-ESWT improves erectile function scores, such as the IIEF-EF questionnaire, in many men with mild to moderate vasculogenic ED (ED due to reduced blood flow), and that some men who did not respond to tablets become responders. The European Association of Urology guidelines say it may be considered for men with mild vasculogenic ED and describe the treatment as still investigational in other groups. The limits are important: trials vary in the device, energy and number of sessions used, many are small, follow-up is usually six to twelve months, and the benefit is on average modest. Li-ESWT is not an FDA-approved ED treatment in the United States, and professional bodies stress that it should be provided as part of a proper medical assessment. A clinic that calls it a cure or a guaranteed fix is overstating the case.
Who is most likely to benefit?
The best results are seen in men with mild to moderate ED of vascular origin, who still respond at least partly to tablets such as sildenafil or tadalafil, and who are otherwise healthy. Results are less predictable in men with severe ED, long-standing diabetes with nerve damage, ED after radical prostatectomy or pelvic surgery, or ED mainly driven by anxiety or low testosterone. Psychological causes are not treated by shockwave. A doctor should ask about your cardiovascular health first: the NHS notes that ED can be an early sign of heart disease, and a check of blood pressure, cholesterol, blood sugar and hormones is sensible before any treatment.
What happens during a shockwave session, and how many are needed?
You lie on a couch, a gel is applied and the therapist places the probe at several points along the shaft and at the base of the penis, sometimes also on the perineum and the inner part of the erectile tissue. Each session delivers a set number of pulses, commonly 1,500 to 3,000, and lasts about 15 to 30 minutes. Most protocols use six to twelve sessions, once or twice a week, over three to six weeks, and some clinics suggest a second course after a break of a few months. You may feel a tapping or mild discomfort; no anaesthetic is normally needed. You can walk out and resume normal activities straight away.
Shockwave therapy for erectile dysfunction cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges for a full course, not hospital quotes.
| Country | Approximate cost range (full course) |
|---|---|
| Turkey | €400 – €2,000 |
| United Kingdom | €900 – €3,500 |
| United States | €1,500 – €5,000 |
| Germany | €900 – €3,000 |
What changes the price: the number of sessions in the course, the device and energy used, whether the initial examination and any blood tests are included, and whether a repeat course is covered. A package may charge a per-session fee or a fixed course price, so ask which. Check that the quote states the number of sessions, because a course of six sessions and one of twelve cost different amounts, and ask what happens if you need a repeat course.
Shockwave, tablets, injections or implant: how do the options compare?
First-line treatment for most men is a PDE5 inhibitor tablet together with changes in lifestyle. If tablets fail, the next steps are injections into the penis, vacuum devices or, in severe cases, surgery. Shockwave sits beside these as an option for mild to moderate vascular ED, and newer approaches such as P-Shot, Botox for erectile dysfunction and red light therapy for ED are also marketed, generally with less evidence behind them. When other treatments are not working, a penile prosthesis is the established surgical solution.
| Option | Best suited to | Typical limits |
|---|---|---|
| Shockwave therapy | Mild to moderate vascular ED, partial tablet responders | Modest average benefit; repeat courses may be needed |
| PDE5 tablets | Most men as first-line treatment | Needed each time; unsuitable with nitrates |
| Injections or vacuum device | Men who do not respond to tablets | Needs technique; some find them inconvenient |
| Penile prosthesis | Severe ED not helped by other treatments | Surgery; permanent, irreversible |
Shockwave therapy for ED: what results to expect and what before and after means
There is no visible before and after, as nothing changes in appearance. The measure is function: erections that are firmer, easier to start and better maintained, assessed by a questionnaire such as the IIEF and by your own report. Improvement, when it comes, is usually noticed from about four to six weeks after the course and may continue for a few months. Some men need tablets less, some still need them, and some notice no change. The effect may fade after a year or more, which is why some clinics offer a repeat course. Be wary of photographs, testimonials and claims of permanent results; ask the clinic for the outcome measures it records.
Who should not have shockwave therapy?
It is usually not offered if you have an active penile or urinary infection, a bleeding disorder or take blood thinners without medical advice, a penile implant or other device in the treatment area, a suspected tumour in the area or untreated severe heart disease where sexual activity is unsafe. Penile curvature and Peyronie's disease need a specific assessment. If you have uncontrolled diabetes, high blood pressure or low testosterone, treating those usually comes first. A reliable clinic will examine you and ask for blood tests before the first session.
Side effects, safety and recovery
Shockwave therapy has a good short-term safety record in studies. The commonest effects are mild discomfort during the session, temporary redness or a little bruising, and occasionally small spots of bleeding under the skin or short-lived soreness. Serious complications are rarely reported, but long-term safety data beyond one to two years are limited. There is no recovery period: you can go back to work and normal activity at once, and most clinics advise waiting a short time before sex after a session, which they will specify. Contact the clinic if you notice swelling, pain that continues, blood in the urine or signs of infection.
Planning a trip to Turkey for shockwave therapy
A course of six to twelve sessions over three to six weeks does not fit a short holiday, unless the clinic compresses sessions into a few days, which is a question to ask: pulses delivered too close together may differ from the protocols tested in trials. Some clinics offer a shorter schedule or two or three sessions a week; others suggest a first visit abroad and continuing the course at home. Ask the clinic for the protocol in writing: number of pulses, energy settings and interval between sessions, and compare it with published schedules. Our page on how it works explains how the plan and price are agreed.
How to choose a clinic: red flags and questions to ask
Look for a urologist or andrologist who examines you, asks about your heart health and checks your hormones before starting, and who tells you honestly that the benefit varies. Red flags include guaranteed results, no examination, a quote that does not state the number of sessions and treatment of men with severe ED without explaining the limits. Questions to ask:
- Which device and energy level are used, and how many pulses per session?
- How many sessions are in the course, and how far apart?
- Will I be examined and tested before the first session?
- What happens if there is no improvement?
- Is a repeat course included or charged separately?
Send your details through our free quote page and a clinic will reply with a written plan and price.
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Frequently asked questions
It is a treatment in which a probe sends low-energy acoustic pulses through the skin of the penis, with the aim of promoting new blood vessels and improving blood flow. It is given as a course of short outpatient sessions without anaesthetic.
Trials show a modest average improvement in men with mild to moderate vascular ED, but results vary and many studies are small. It is not a guaranteed cure and works least predictably in severe ED or after prostate surgery.
Approximate ranges for a full course are €400 to €2,000 in Turkey, against about €900 to €3,500 in the UK. The number of sessions, the device and whether examinations are included change the price.
Most protocols use six to twelve sessions, once or twice a week, each lasting 15 to 30 minutes. Some clinics suggest a repeat course after a break if the effect fades.
Most men feel a tapping sensation or mild discomfort, and no anaesthetic is normally needed. You can usually resume normal activity straight after each session.
Improvement is usually noticed from about four to six weeks after the course and may last from several months to a year or more. Long-term data are limited, and some men need a repeat course.
Studies report few side effects, mainly mild discomfort, redness or small bruises. Long-term safety data beyond one to two years are limited, so choose a clinic that examines you first and records your results.
They do different jobs. Tablets treat the symptom each time you take them, while shockwave aims to improve blood flow over time. Many men use both, and tablets remain the first-line treatment for most.
It is usually not given with an active infection, a bleeding disorder, a suspected tumour in the area or untreated severe heart disease. A doctor should examine you and check your health before the first session.
A full course takes three to six weeks if sessions are weekly, so ask the clinic whether it offers a shorter schedule or whether you continue at home. Agree the protocol in writing before you travel.
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