Erectile Dysfunction and Shockwave Therapy

Erectile dysfunction is a deeply personal and distressing problem that describes a condition where an erection is either not possible or is not sufficient for the desired task of sexual activity.  It is a condition that can have multiple causes and therefore you must discuss it with a healthcare professional to ensure you get the right diagnosis. Loss in blood flow / vascular perfusion is one of the leading causes of erectile dysfunction. Shockwave may provide a solution in up to 90% of men **.

 

We know that smoking, alcohol, a poor diet, diabetes, pelvic surgery, prostate cancer and prostatecomy, and lack of exercise can have an impact (for some) on erectile function.  We also know that stress can have a negative impact on erections.  Poor blood flow to the peipheraries can also affect erectile funciton and can be the result of chronic disease, and where this is the case, smoking and poor lifestyle habits must be halted.  

 

The Erection:

 

When we become aroused, messages from the brain signal to the penile muscles (Corpus Carvernosa) to relax.  This allows blood to enter the eretile tissue of the Corpus Carvenosa and essesentially inflates the penis.  The blood infiltrates the spaces and tissue to achieve an erect state. The Tunica Albugenia then helps to trap the blood in the penis and keep it erect in an erect state.

The erectile tissue (Corpus Carvenosa and Crpus spongiosum) are extensions from the pelvic muscles of the Bulbospongiosus and Ischiocarvenosus.  It must be noted that these are different.  The penile muscles are smooth and therefore not under conscious control.  The latter two muscles are skeletal muscle and therefore more easily controlled. Therefore, it must be remembered that erectile states are complex and have multiple interactions.  

Blood flow is very complex with the main branches coming off the pudendal artery.  This passes throught he pelvic muscleature and therefore has ample opportunity to be impeded and influenced by pelvic muscle activity. Furthermore, loss in adequate flow due to age of lifestyle choices can reduce blood flow. 

 

 

Causes:

 

  • Problems affecting the flow of blood to your penis
  • Conditions of the nervous system, which is made up of your brain, nerves and spinal cord
  • Changes or disease causing change in hormone levels
  • Physical structure problems in the penis 
  • Diabetes
  • Smoking
  • Psychological and emotional wellbeing
  • Intra-pelvic pain syndromes like Chronic Pelvic pain 
  • Post surgical injury to nerves and muscular tissue (Prostatectomy / TURPS) 
  • Cycling 

We could always recommend you see your GP 1st to rule out any other co-morbid factors. 

 

Assessment:

1st we will complete a thorough assessment of the pelvis, genitalia, lumbar spine, hips and nervous system. 

An ultrasound scan will be performed to ensure the pelvic muscles are working properly.  It may be necessary to perform a penile bloodflow assessment (off site). 

From here, we will determine the best way forward the the most likely treatments to improve your condition. 

 

Shockwave:

Using Shockwave has been show to help with erectile dysfunction by increasing blood flow.

 

 

 

 

 

 

 

 

The shockwave is directed at the penile tissue and the perinium to target the regions where maximum blood flow is greatest. 

Shockwave Therapy can lead to a significant improvement of the erectile function and has been show to improve the International Index of Erectile Function which lasts at least 3 months (Man, L. et al., Urology, Elsevier, 119, 67 – 103, 2018) and more recently has been shown to last up to 6 months **. 

It works well on patients who have had success with the use of viagra or cialis but has been shown to improve erectile function in those who are non responders to viagra and cialis  The low intensity sound waves focus their energy on the small blood vessels and regenerate the vascularisation of the erectile tissue.  This leads to increased perfusion and therefore better erectile function.  

It is appropriate to repeat the sessions for at least 6 to 8 weeks and in a consistent weekly manner.  In some instances it is necessary to repeat 2 sessions a week.  

If you are not taking phosphodiesterase type 5 inhibitors you may wish to ask your GP for this medication. 

 

Treatment willl also include: 

  • Pelvic floor exercises to release your pelvic floor
  • Specialised Breathing and relaxation work.  Relaxation through breathing has been found to be hugely beneficial for all types of conditions. 
  • Re-education of the  pelvic floor, hip and abdominal musculature
  • General exercise

We often recommend involving your partner as this will help with marital or relationship problems and in some cases can greatly expedite your recovery.  In some cases we will suggest you see a counsellor as this can be hugely beneficial.  Our minds and body are connected and we know about the harms that stress and anxiety can bring.