Erectile dysfunction is one of the most common challenges in sexual health, yet the treatment landscape is full of confusion. Pills are everywhere, but not everyone responds to them or even wants to rely on medication forever. Devices and surgeries exist too, but they can be costly, invasive, and frankly not appealing to most people. In recent years, shockwave therapy has drawn attention as a non-drug option that aims to restore natural function.
Most research frames ED as a men’s health issue. I want to note that not everyone who experiences erectile dysfunction identifies as a man. In this post, when I say “patients” or “people with ED,” I mean anyone dealing with erectile changes, regardless of gender identity.
If you start searching, though, you’ll quickly run into mixed messages. Some sources say shockwave works. Others warn it is “unproven.” And to make it even more confusing, there are two types of shockwave: focused and radial. Many patients are told that only the focused version is effective. The truth is a little more complicated, and it matters for anyone exploring treatment.
What the experts say
Most medical guidelines still label shockwave therapy for ED as experimental. Even where it is discussed, focused shockwave is usually presented as the “real” form. Radial shockwave is often brushed off as too superficial, not strong enough to reach the erectile tissue. That leaves patients with the impression that choosing radial therapy is settling for second best.
Looking closer at the body
Here’s where a simple anatomy check helps. The erectile tissue and blood vessels of the penis are not buried deep under layers of muscle. They sit well within the range that radial shockwave can reach. So if blood flow alone was the whole story, radial and focused shockwave really should work equally well. The fact that focused sometimes shows better outcomes means something else is going on.
A story about hidden restriction
I once worked with a patient who had been struggling with panic attacks for years. She had seen therapists, specialists, and nutritionists, but nothing made a difference. When she came in, I noticed that one side of her ribcage barely moved when she tried to breathe. Tracing it back, I found a tiny, almost invisible scar from an old abdominal surgery. That scar had stiffened the tissues around her diaphragm, keeping her from taking a full breath.
After working on the restriction, she immediately noticed she could breathe more freely again. What she hadn’t realized was that her shallow breathing had been feeding her anxiety for years. Within weeks her panic attacks were gone, and she even went back across the country to reclaim her old job.
The point here isn’t about panic attacks, it’s about how symptoms often get blamed on the wrong thing. What looks like a psychological or vascular issue can sometimes be about tissue that is too tight to let the body function normally.
The real barrier in erectile health
Research shows the same kind of pattern in ED. Studies have found fibrosis — scar-like stiffening — and pelvic floor dysfunction in many patients with erectile dysfunction. These changes restrict the tissues around the blood vessels, making it harder for circulation to improve. Even if shockwaves stimulate the vessels, fascia and lymphatic congestion can block the benefits.
This helps explain why radial shockwave sometimes looks weaker in studies. It’s not that the energy can’t reach the target, it’s that the surrounding tissues are not ready to respond.
Why I use radial shockwave differently
Radial shockwave is safe, patient-friendly, and easily reaches the structures involved in erection. On its own, the results may be hit-or-miss. That’s why I combine it with hands-on therapies that free the tissues and clear congestion.
- Myofascial release helps restore mobility and elasticity to restricted tissue.
- Lymphatic drainage reduces fluid buildup and improves the local environment.
Together, these create the conditions where radial shockwave can do its job: improving circulation and supporting natural erectile function.
Rethinking the debate
The debate should not just be radial versus focused. Both can reach the erectile tissues. The better question is whether we are also addressing the tissue environment. Without freeing fascia and improving lymph flow, any device or pill will only go so far.
By combining radial shockwave with manual therapy, we are not just targeting blood flow. We are treating the whole system that makes erections possible. That, in my view, is how we begin to close the evidence gap and give patients a more complete path to recovery.
Further Reading
- Cleveland Clinic overview of a trial comparing focused and radial shockwave for erectile dysfunction: Read here
- Meta-analysis comparing radial and focused shockwave outcomes in Urology (2025): Read here
- Retrospective study comparing focused vs. radial shockwave in Journal of Sexual Medicine (2020): Read here
- Review of fibrosis and erectile tissue changes in Andrology (2024): Read here
- Article on pelvic floor function and sexual health in Sexual and Relationship Therapy (2024): Read here