PRP vs Shockwave Therapy for Erectile Dysfunction
Updated: Aug 19
Low-intensity shockwave therapy and platelet-rich plasma are both offered for erectile dysfunction, but the evidence is not equivalent. Shockwave therapy has a weak guideline recommendation for selected men with vasculogenic ED. PRP injections remain investigational and are advised only in clinical-trial settings.
Shockwave is non-invasive but not certain to help. PRP uses the patient’s blood but still involves penile injections and uncertain benefit.
PRP vs shockwave: the main differences
Treatment type: shockwave delivers acoustic pulses; PRP requires blood preparation and penile injection.
Best-studied group: shockwave evidence is mainly in selected vasculogenic ED; an effective PRP subgroup has not been established.
Guideline position: weak recommendation for shockwave in selected cases; insufficient evidence for routine PRP.
Risks: shockwave can cause discomfort or bruising; PRP can cause pain, swelling, bleeding or infection.
Protocol certainty: both vary between clinics, but PRP preparation is especially heterogeneous.
Combination: extra benefit from using both together has not been proven.
What is low-intensity shockwave therapy?
A handheld device delivers low-intensity acoustic pulses to selected penile areas. Research suggests possible effects on vascular signalling and erectile tissue, but the ideal device, energy settings, treatment sites and session schedule are not universally agreed.
Evidence is most relevant to mild or moderate vasculogenic ED. Results are less predictable in severe ED, major nerve injury or advanced structural disease. Average improvement is usually modest and may reduce over time.
Read the complete shockwave therapy evidence guide.
What is PRP for erectile dysfunction?
PRP is prepared by centrifuging a sample of the patient’s blood and injecting the platelet-rich fraction into erectile tissue after local anaesthetic. Products differ in platelet concentration, white-cell content, activation, volume and injection technique.
Small studies report variable changes in erectile-function scores, but current evidence does not establish routine effectiveness, an ideal protocol or reliable duration. Autologous treatment does not mean risk-free treatment.
Read about the P-Shot procedure, evidence and risks.
Which option has stronger evidence?
For carefully selected vasculogenic ED, low-intensity shockwave therapy has stronger support than PRP, but the guideline recommendation remains weak. This does not mean every acoustic-wave device or every patient will benefit.
PRP remains investigational. It should not be described as a proven drug-free substitute for tablets or a general sexual-enhancement treatment.
Can PRP and shockwave be combined?
They can be offered together, including within a pathway marketed as P-Shocks, but there is no reliable evidence that the combination creates a synergistic benefit. Higher cost and more procedures do not prove greater effectiveness.
See the broader comparison: P-Shocks vs P-Shot.
How do established ED treatments compare?
Lifestyle and cardiovascular risk treatment, PDE5 inhibitor tablets, psychosexual therapy, vacuum erection devices, intracavernosal injections and penile prosthesis surgery have defined roles in standard care. Choice depends on cause, severity, goals and contraindications.
Read what happens at an erectile dysfunction clinic in London.
Who might consider shockwave therapy?
A vascular contribution to ED is likely after assessment.
Symptoms are mild or moderate and expectations are realistic.
Cardiovascular risk factors and medicines have been reviewed.
Established options have been discussed.
The patient accepts uncertain and usually modest benefit.
Who should be cautious about PRP?
Men with a bleeding disorder, anticoagulant treatment or platelet abnormality.
Anyone with active genital infection or unexplained penile findings.
Patients expecting permanent enlargement, restored sensitivity or a certain duration.
Men whose ED has not been assessed for vascular, hormonal, medication-related or psychological causes.
Questions to ask before choosing
What is the diagnosed cause and severity of my ED?
What evidence applies to someone with my condition?
Which device or PRP preparation will be used?
How will improvement be measured?
What are the risks, alternatives, full cost and follow-up?
What happens if treatment does not help?
Frequently asked questions
Is PRP more natural than shockwave?
PRP is autologous, but ‘natural’ does not establish effectiveness or remove injection risk. Shockwave avoids injections but still has variable benefit.
Which works faster?
There is no dependable timetable that applies to every patient. Studies assess outcomes over different periods and some patients do not improve.
Can either treatment replace sildenafil or tadalafil?
Not reliably. PDE5 inhibitor tablets remain established first-line treatment for many men when safe and appropriate.
Can either treatment increase penis size?
Reliable permanent enlargement has not been demonstrated.
Is one session enough?
There is no universally validated one-session PRP or shockwave protocol. A clinic should justify the proposed schedule rather than sell a fixed package before assessment.
Related guides
PRP and shockwave assessment in London
Dr Fabio Castiglione assesses erectile dysfunction at Holistic Andrology, 9 Harley Street, London W1G 9QY. The consultation reviews established treatment first and explains where shockwave therapy and PRP sit within current evidence.
For clinic information or to request an assessment, visit P-Shocks London.
Medical review and evidence
Medically reviewed by Dr Fabio Castiglione, Consultant Urologist and Andrologist. Last reviewed: 19 August 2026.
Low-intensity shockwave therapy has a weak guideline recommendation for selected vasculogenic ED. Evidence for PRP remains insufficient for routine clinical use, and combined treatment has not shown a reliable synergistic benefit.
This article is for general education and is not a diagnosis or individual medical recommendation. A consultation should review medical and sexual history, current medicines, examination findings and tests when clinically indicated.
Clinical sources
European Association of Urology: Management of Erectile Dysfunction
About the author
Dr Fabio Castiglione
Consultant Urologist and Andrologist in London. Holistic Andrology, 9 Harley Street, London W1G 9QY.
GMC reference number: 7541824
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