It’s an intimate scenario that will, undoubtedly, be familiar to most men in midlife.
In his younger years, Dr David Shusterman insists his sex life was strikingly healthy and normal – and that he was always able to rise to the occasion when the occasion arose.
But by his mid-40s, something had subtly changed.
While he was still able to perform, even after a long day at work and a few glasses of wine, he had started to notice a certain lack of ‘firmness’.
As a urologist who specializes in male sexual health, he says he knew he didn’t have full-blown erectile dysfunction – unlike many of his patients.
But he also knew all too well that a loss of firmness can be an early warning sign of the condition, and he didn’t want to leave anything to chance.
‘I’ve seen how difficult erectile dysfunction can be,’ says Shusterman.
‘Of course I was anxious. About 50 percent of my patients had erectile dysfunction, and I didn’t want to become part of that 50 percent.
‘Viagra does help, but patients are looking for natural ways to improve, because medications just put a band aid on it, they do not treat the root cause.’
So, when European researchers unveiled a new device that they claimed could treat the condition at a medical conference he was attending in Boston, Massachusetts, in 2017, he knew he had to try it – and that it would benefit his patients.
Dr David Shusterman is pictured above in July 2024 with his partner Regina Mukhtarova at Maria and Ken Fishel’s Polo in the Hamptons, New York
The treatment, known as low-intensity extracorporeal shockwave therapy, or Li-ESWT, has been used in medicine for decades to break up kidney stones and aid tissue healing and blood vessel growth.
But mounting evidence suggests it could also be a viable treatment for erectile dysfunction.
The machine emits gentle sound waves which, when applied to the penis, may help stimulate blood flow and encourage the growth of new blood vessels, helping to improve erections.
And, unlike medications such as Viagra, the effect is long-term.
After having the benefits explained to him – and being told there were no side effects – Shusterman purchased the device there and then.
He took it back to his Manhattan clinic and used it on himself – in order to check whether it measured up to the claims.
He found it really did. And his partner noticed too.
‘She asked me, “Have you done anything?”,’ Shusterman told the Daily Mail.
‘I said, “Yes, it’s this new treatment”. Then she said, “it’s firmer.”‘
Shusterman, who works as a urologist in Manhattan, said many of his patients who used the device had had success
Pictured above is the low-intensity extracorporeal shockwave therapy device
He said that at the time, other urologists he knew told him he was ‘crazy’ to test the device on himself.
But today, he added, many of them have one.
For many of the 50-year-old doctor’s patients, he said the treatment had helped. Of more than a thousand patients who have received the therapy, he said 80 percent saw an improvement in the firmness of their erections.
His patients get three to six sessions with the device, each about a week apart, that last for 30 minutes.
It costs about $200 to $250 per session.
So, could shockwave therapy really be the permanent, drug-free solution for erectile dysfunction that millions of men have been waiting for?
The need is certainly clear.
About 30 to 50 million American men suffer from erectile dysfunction – a condition that can devastate confidence and put huge strain on even the strongest relationships.
It also raises the risk of depression, anxiety, a loss of confidence – and, in severe cases, may even be a contributing factor to suicide.
Since the late 1990s, millions of men have relied on a class of drugs known as PDE5 inhibitors – including Viagra, Cialis and Levitra – to treat erectile dysfunction.
These medications work by relaxing blood vessels and increasing blood flow to the penis, helping men achieve and maintain an erection.
But these drugs are far from a perfect fix. They must be taken every time a man wants to have sex, can take anywhere from 30 to 60 minutes to work, and often require couples to plan intimacy around a pill.
They also do not work for everyone.
Studies suggest that up to 30 to 40 per cent of men fail to get a satisfactory response from the drugs – particularly those with diabetes, cardiovascular disease or men recovering from prostate cancer treatment.
For these patients, the alternatives can feel invasive and deeply unromantic.
Men whose steps are small (an average of 153cm per two steps) are more likely to have erectile dysfunction compared to men with larger steps (an average of 166cm per two steps)
Some men use vacuum devices – plastic tube-like pumps that fit over the penis and use suction to pull blood into the tissue, helping create an erection.
A tight rubber ring is then placed around the base of the penis to keep the blood trapped there during sex.
Others inject medication directly into the side of the penis using a very small needle shortly before intimacy, triggering blood vessels to widen and allowing an erection to develop.
However, doctors say many men find the treatment uncomfortable, anxiety-inducing or difficult to sustain long term.
There is also a risk of pain, bruising, scarring and prolonged erections that require emergency medical treatment.
In the most severe cases, men may opt for surgery to have a penile implant inserted – usually inflatable cylinders placed inside the penis which can be manually pumped up before sex using a small device hidden inside the scrotum.
However, experts stress this is generally considered a last-resort treatment.
Only around 20,000 to 30,000 men in the US undergo the surgery each year, despite millions living with erectile dysfunction.
This has left a space for a growing number of new treatments for the condition – including shockwave therapy – which aim to offer men a more long-term solution rather than a temporary fix.
Li-ESWT was first approved by the FDA in 1984 as a treatment for kidney stones.
The technology uses targeted sound waves that can pass harmlessly through skin and tissue to break apart hard material inside the body without the need for surgery.
In men with erectile dysfunction, researchers believe these pulses may help break up tiny fatty deposits and scarring inside blood vessels, improve circulation and stimulate the growth of new blood vessels in the penis – helping restore stronger, more reliable erections over time.
The waves are also thought to trigger the body’s natural healing response and improve tissue function.
Shusterman only offers the treatment to men for whom Viagra-type drugs are still having at least some effect.
Experts believe this is because Li-ESWT appears to work best in patients whose blood vessels and erectile tissue are damaged but still functioning to some degree.
For men with more advanced erectile dysfunction – particularly those with severe nerve damage after prostate cancer surgery or extensive blood vessel disease – there may not be enough healthy tissue left for the treatment to restore normal function, meaning more invasive options are often required.
The limited research into the approach carried out so far has been encouraging.
A 2025 study that analyzed data from 12 trials that used the treatment, including 882 men with the condition found it significantly improved erections compared to a sham therapy.
In a separate 2024 analysis, four out of five articles reported improvements in erections at least three months after using the therapy compared to placebo.
Despite this, however, experts note that the treatment is not approved by the FDA and is still considered to be experimental.
The American Urological Association, which represents US urologists, says that its use should be restricted to medical trials.
Shusterman said his patients have not suffered any side effects from using the device.
Manufacturers warn that the device may cause pain during the procedure, bleeding or bruising along the penis, blood in urine, skin infection on the penis, painful erections and penile curvature that worsens.
For Shusterman, he says that he has now used the device once every three months for nine years – and plans to keep doing so.
‘I think it is good for erectile function and for preservation of function,’ he said.
‘When my partner says, “what did you do?”, that means it’s working for me.’
