Read on to find out more about Low Intensity Extracorporeal Shockwave Therapy

Low Intensity Extracorporeal shockwave therapy (LiESWT) is a research supported treatment modality that has applications for a variety of conditions such as wound healing and orthopedic conditions including sprains, strains and joint inflammation. An electrode inside a dome of water sends short, frequent sparks of energy which create soundwaves traveling through the applied tissue, causing an increase in blood flow, as well as decreased inflammation. 

There is also a body of research that supports the use of Low Intensity Shockwave Therapy for a variety of urologic conditions such as erectile dysfunction and chronic pelvic pain syndrome. 

Erectile dysfunction (ED), or the inability to achieve and maintain erections adequate for sexual intercourse, is one of the most common conditions affecting middle-aged and older men. There are many common medical conditions such as hypertension, diabetes mellitus, cardiovascular disease, endocrine disorders, and psychological conditions such as depression, stress, and anxiety that contribute to sexual dysfunction. Hypertension, diabetes and cardiovascular disease cause insufficient blood supply of the penile tissue which is essential for achieving erection, and there are many medications whose side effects can affect erectile dysfunction.¹ Currently, erectile dysfunction is treated with medication such as phosphodiesterase type 5 inhibitors. However, a considerable number of patients do not respond well to drug therapy and these medications do not treat any of the underlying causes of erectile dysfunction.²

Moreover, erectile dysfunction is directly related to endothelial dysfunction, as the release of nitric oxide from the vascular endothelial cells of the penile arteries is essential for the relaxation of the smooth muscle cells in order to fill erectile tissue with blood. 

Current clinical evidence suggests that LiESWT significantly increases penile rigidity and function by allowing for increased angiogenesis and neovascularization (formation of new blood vessels), as well as increasing erectile tissue smooth muscle cells, resulting in improved penile blood flow and endothelial function, thus treating the cause of Erectile Dysfunction (or ED).³ 

Chronic pelvic pain syndrome (CPPS) is a common condition that can greatly impact quality of life. The pelvic floor has many essential functions such as maintaining continence of both bowel and bladder, allowing for proper sexual function including orgasm, and providing stability to the abdomen and spine. Thus, pain and associated impairments with the pelvic floor can lead to a variety of dysfunction with important bodily functions. Current clinical evidence supports the use of LiESWT in the treatment of CPPS as it promotes angiogenesis and increased perfusion of overactive, ischemic tissues, thus releasing trigger point and reducing muscular tone.⁴ 

There is also a body of emerging evidence that supports the use of Low Intensity Shockwave Therapy (LiESWT) for the treatment of stress urinary incontinence (SUI).

SUI is the involuntary leakage of urine upon physical effort, exertion, coughing or sneezing. In a 2020 study, results revealed that 8 weeks of weekly shockwave therapy (LiESWT) meaningfully improved urine leakage via pad test, post-void residual urine leakage, urinary frequency and nocturia.⁵ Moreover, this type of shockwave therapy is reported to have an anabolic effect on muscular tissue and is thought to strengthen the pelvic floor muscles when it is applied. ⁶

Frequency of treatment is usually provided 1 time per week, up to 2 times per week for more acute conditions. Some patients find benefit from as little as 1-3 sessions, but more typically for 6-9 sessions. 

Our team at Fusion Wellness and Physical Therapy is committed to providing the highest level of evidence-based care and utilizing the most advanced and innovative treatment techniques. That is why we are conducting a research study to determine the effectiveness of low intensity shockwave therapy for patients with dyspareunia, or pain with intercourse. We are searching for volunteers to participate in this high quality study. Those who qualify to participate will receive a reduced rate on all visits related to the study!  

If you are interested in this opportunity, please read the following criteria to determine if you are eligible:

Must answer YES to the following: 

1. Do you currently have pain with intercourse or vaginal penetration?
2. Were you assigned female sex at birth, and do you have your own vaginal tissue?
3. Do you have the ability to access the informed consent form and other outcome measures electronically? Meaning do you have computer and email access to view and complete components of the study?

Must answer NO to the following: 

1. Have you started hormonal therapy within the past 2 weeks?
2. Have you received pelvic floor physical therapy within the past 2 weeks?
3. Do you currently have an active infection? (e.g. herpes, yeast infection, UTI)
4. Have you had surgery within the past 12 weeks?
5. Have you given birth within the past 6 weeks?
6. Do you have a history of gynecologic cancer?
7. Have you had pelvic radiation?
8. Are you currently receiving treatments for cancer?
9. Are you currently pregnant?
10. Are you currently using lidocaine or cortisone to treat your dyspareunia?
11. Have you received shockwave before?

If you are interested in trying this innovative treatment, please reach out to us at our Sherman Oaks office! 

Debbie Dy PT, DPT, Board-Certified Orthopedic Clinical Specialist 

References:  

1. Pan, M. M., Raees, A. & Kovac, J. R. Low-Intensity Extracorporeal Shock Wave as a Novel Treatment for Erectile Dysfunction. Am. J. Mens. Health 3-5 (2015). doi:10.1177/1557988315574511
2. Lu, Z. et al. Low-Intensity Extracorporeal ShockWave Therapy Treatment Improves Erectile Function: A Systematic Review and Meta-Analysis. Eur. Urol. 2838, 1-11 (2016)
3. Sokolakis, I. et al. The Basic Science Behind Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: A Systematic Scoping Review of Pre-Clinical Studies. Journal of Sexual Medicine (2019). doi:10.1016/j.jsxm.2018.12.016
4. Wang, H. J., Tyagi, P., Chen, Y. M., Chancellor, M. B. & Chuang, Y. C. Low energy shockwave therapy inhibits inflammatory molecules and suppresses prostatic pain and hypersensitivity in capsaicin induced prostatitis model in rats. Int. J. Mol. Sci. (2019). doi:10.3390/ijms20194777
5. Long CY, Lin KL, Lee YC, Chuang SM, Lu JH, Wu BN, Chueh KS, Ker CR, Shen MC, Juan YS. Therapeutic effects of Low intensity extracorporeal low energy shockwave therapy (LiESWT) on stress urinary incontinence. Sci Rep. 2020 Apr 2;10(1):5818. doi: 10.1038/s41598-020-62471-4. PMID: 32242035; PMCID: PMC7118154.
6. Yuan, P. et al. Efficacy of  low-intensity extracorporeal shockwave therapy for the treatment of chronic prostatitis/chronic pelvic pain syndrome: A systematic review and meta-analysis. Neurology and Urodynamics (2019). doi:10.1002/nau.24017