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ED & Sexual Medicine — Southern California

FIRM WAVE®

the acoustic wave therapy treatment series

The drug-free option built around how erections actually work. Our own acoustic wave therapy series — no pills to time, no needles, no surgery — delivered in a private room over a series of in-clinic sessions, with your response measured as you go.

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  • No drugs, no needles, no surgery
  • In-clinic sessions
  • Your response measured, not assumed

Individual results vary. Acoustic wave therapy for ED is considered experimental and investigational. Its use for ED and Peyronie's disease is off-label and has not received specific FDA clearance or approval. A medical consultation is required before any treatment.

The results and experiences featured on this site are examples, not promises. Individual results and patient experience vary. A medical consultation and prescription are required before any medication is provided.

What It Is

One name for how we deliver it

The Firm Wave® treatment series is Dr. Vigor's own acoustic wave therapy program for erectile dysfunction — short in-clinic sessions of low-intensity acoustic wave treatment, delivered over a recommended series, under physician supervision, and only after an evaluation says it fits. You may have seen the category called shockwave therapy. There are no drugs to take, no needles, and no surgery.

Why a treatment series has a name: acoustic wave therapy is a category, and anyone can offer it. The Firm Wave® treatment series is how it's delivered here — the protocol, the cadence, the evaluation in front of it, the clinical supervision around it, and the measurement that tells you whether it's doing anything for you. The name is a commitment to how, not a claim about how much.

The Idea

Built around the blood-flow side of the problem

Blood flow is the most common physical driver of ED, and it's the one this treatment is aimed at. The idea behind acoustic wave therapy is simple: gentle acoustic waves applied to erectile tissue are thought to prompt the body's own repair response — supporting the small blood vessels and the vessel lining that inflow depends on.[1] In the published research, that shows up as improved erectile-function scores for many men, with the strongest signals in mild-to-moderate ED with a vascular cause.[2] Individual results vary.

That's a restorative idea rather than an override. Prescription options work on the relax signal for a few hours at a time. A treatment aimed at inflow is working on a different target — the plumbing itself — which is why men who want a non-drug path, or whose pills have stopped being enough, ask about it first. Human confirmation of the mechanism is still maturing, and no treatment on this ladder works for everyone.

Why Men Choose It

The appeal is pretty simple

Most men who ask about the Firm Wave® series want the same handful of things. Something that isn't another pill. Something that doesn't involve a needle or an operating room. Something they can fit into a normal week. And something a physician is actually supervising, with an evaluation in front of it and a plan behind it.

That's a reasonable list, and this series meets it. Some men choose it alongside prescription options rather than instead of them — the two aren't in competition, and your clinician will tell you honestly which order makes sense for your case. And for the men it helps, what it gives back is the thing that matters: reliability and confidence — in one randomized protocol study, most men reached a clinically meaningful improvement over a course of sessions.[3] Individual results vary — which is why your response gets measured rather than promised.

The Experience

Private room, brief visit, back to your day

A Firm Wave® session is brief and happens in a private treatment room. There's no anesthetic and no needle involved, and with little to no downtime, a session fits around work — most men go straight back to their day afterward.

The series runs over multiple sessions on a cadence your clinician sets after your evaluation — you'll get the specifics for your plan there, not from a webpage. Two expectations to bring with you: where improvement occurs in published studies, it builds over the series rather than arriving in a single session,[4] and your response gets reviewed as you go, so the plan can change if it should.

The Evidence

Straight talk about the science — the encouraging part first

Acoustic wave therapy is one of the more promising non-drug ideas in ED care, and it has a real trial literature behind it. Randomized trials and pooled reviews report improved erectile-function scores for many treated men, with the strongest and most consistent signals in mild-to-moderate ED with a vascular cause.[5] Men who still respond to pills at least partly, and men with fewer other medical problems, tend to do best in the research.[6] Pooled analyses also report more treated men reaching an erection hardness rated sufficient for intercourse.[7] And it is consistently well tolerated — see the safety section below, because that part of the picture is good. Individual results vary.

Honest medicine adds the rest. Not every man responds. The trials are small, their protocols differ, and the pooled effect across all of them is modest, with the research still maturing.[8] How long improvement lasts is still being worked out.[9] Professional societies classify acoustic wave therapy for ED as experimental and investigational — and its use for ED and Peyronie's disease is off-label, without specific FDA clearance or approval.[10] That's a fact about the category, and we state it everywhere the series is offered.

Here's what the two halves add up to: a promising, well-tolerated, non-drug option — worth having on the table for the right man, offered after an evaluation, and never positioned as a replacement for treatments that are established. Your response is tracked with the same validated questionnaires the researchers use, at the start and as the series runs. If the numbers move, you'll see it. If they don't, we'll say so, and we'll talk about what else is on the ladder. Individual results vary — which is exactly why we measure instead of promise.

Dr. Vigor Editorial Team

Safety

Well tolerated — and screened before it's scheduled

In published trials, acoustic wave therapy is well tolerated. Reported side effects are mild and temporary — brief tenderness or minor bruising at the treatment area — and serious adverse events have been uncommon.[11] For a treatment you're considering adding to your calendar, that's a reassuring profile, and it's part of why we're comfortable offering it.

Worth saying plainly: a good safety profile is not the same thing as proof that a treatment works. Those are two separate questions, and we answer both honestly on this page.

Who should wait, or pass, is a call your clinician makes at your evaluation. Screening covers anything that would make treatment inappropriate or worth postponing — an active infection or skin problem in the area being treated is the obvious example, and your own history and medications may raise others. Nothing gets scheduled before that conversation happens.

Also Discussed For

Peyronie's disease

Acoustic wave therapy also comes up for Peyronie's disease — scar tissue that can bend erections or make them painful. The encouraging part of that research is on the pain side: studies report reduced erection-related pain in treated men.[12] Individual results vary. Evidence for curvature change is more mixed. Its use for Peyronie's disease, like its use for ED, is off-label and investigational. If curvature or pain is part of your story, the Peyronie's page walks through the full set of options — established and investigational — and the evaluation sorts out which fit.

Peyronie's disease, explained

Where It Fits

Part of a full plan — and it pairs well

The Firm Wave® treatment series may be discussed alongside prescription options, the Vigor Shot™ procedure, or a hormonal workup — your clinician's call to frame, your choice to make, after the evaluation. Where low testosterone is part of the story, that conversation belongs to the Calibrated TRT® program, and for the men it fits, it's often the first thing to get right.

The Vigor Shot™ procedure is a PRP treatment, and autologous PRP preparations are not FDA-approved for sexual-medicine uses. Its own page carries the full evidence picture.

See every ED treatment option

FAQ

Questions, answered

What is the Firm Wave® treatment series?

The Firm Wave® treatment series is Dr. Vigor's own acoustic wave therapy program for erectile dysfunction — a drug-free, non-surgical option delivered in short in-clinic sessions over a recommended series, under physician supervision, and only when evaluation supports it. Studies report improved erectile-function scores for many men, with the strongest signals in mild-to-moderate vascular ED.[2] Individual results vary. Acoustic wave therapy for ED is investigational and off-label, and we state that everywhere the series is offered.

Does acoustic wave therapy work for ED?

For many men in published studies, yes — trials report improved erectile-function scores, with the best results in mild-to-moderate ED with a vascular cause.[5] Honest medicine adds that results vary, not every man responds, the studies are small, and the research is still maturing. That's why your response is measured with validated questionnaires as the Firm Wave® series runs — so you'll know whether it's working for you instead of wondering.

Is it FDA-approved?

No — and it's stated everywhere the series is offered. Acoustic wave therapy has no specific FDA clearance or approval for ED — its use for ED and Peyronie's disease is off-label and considered experimental and investigational. It doesn't change what the studies report. It does mean the decision is made with the whole picture in front of you.

Does it hurt? Is there downtime?

In published trials, side effects were mild and temporary, and there's no anesthetic and no needle involved. Most men return to their day after a session, with little to no downtime. What a Firm Wave® session feels like still varies by man, and your clinician walks you through it at the consult. Patient experiences vary.

How long is a session, and how many will I need?

Sessions are brief and take place in a private treatment room. The Firm Wave® series runs over multiple sessions on a cadence your clinician sets with you after your evaluation. Where improvement occurs in studies, it builds over the series — no single session delivers it — so your plan is reviewed as you go.

How will I know if it's working?

Because we measure it. Your response is tracked with validated questionnaires — the same instruments used in the published research — at the start of your Firm Wave® series and as it runs. You find out from your own numbers. If they're moving, we keep going. If they're not, we say so and talk about what else is on the ladder.

What does the Firm Wave® series cost?

Series pricing depends on the plan your clinician recommends. You'll know your full cost before you start, reviewed with you before you enroll. Call 949-570-0800 and ask — nobody will make you book to find out. HSA/FSA accepted for eligible services.

Citations & References

The research behind this page

Every clinical statement on this page is footnoted to peer-reviewed research, a professional-society guideline, or an official regulatory source. Each reference was resolved and checked against its published record before it was placed here.

  1. Fode M, Hatzichristodoulou G, Serefoglu EC, Verze P, Albersen M; Young Academic Urologists Men’s Health Group. Low-intensity shockwave therapy for erectile dysfunction: is the evidence strong enough? Nat Rev Urol. 2017;14(10):593–606. PMID 28741629. Proposed mechanisms reviewed: neovascularization, endothelial and nitric-oxide signaling, and progenitor-cell recruitment.
  2. Sokolakis I, Hatzichristodoulou G. Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials. Int J Impot Res. 2019;31(3):177–194. doi:10.1038/s41443-019-0117-z. Kitrey ND, Vardi Y, Appel B, et al. Low intensity shock wave treatment for erectile dysfunction—how long does the effect last? J Urol. 2018;200(1):167–170. doi:10.1016/j.juro.2018.02.070. Meta-analysis of ten sham-controlled RCTs (873 men) with vasculogenic ED: IIEF-EF +3.97 points versus sham. Long-term response was best maintained in men with milder ED.
  3. Kalyvianakis D, Memmos E, Mykoniatis I, Kapoteli P, Memmos D, Hatzichristou D. Low-intensity shockwave therapy for erectile dysfunction: a randomized clinical trial comparing 2 treatment protocols and the impact of repeating treatment. J Sex Med. 2018;15(3):334–345. PMID 29396020. Randomized protocol comparison: 62% of men reached a clinically meaningful IIEF-EF improvement after 6 sessions and 71% after 12.
  4. Kalyvianakis D, Memmos E, Mykoniatis I, Kapoteli P, Memmos D, Hatzichristou D. Low-intensity shockwave therapy for erectile dysfunction: a randomized clinical trial comparing 2 treatment protocols and the impact of repeating treatment. J Sex Med. 2018;15(3):334–345. PMID 29396020. Vardi Y, Appel B, Kilchevsky A, Gruenwald I. Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? Short-term results of a randomized, double-blind, sham controlled study. J Urol. 2012;187(5):1769–1775. PMID 22425129. Trial protocols deliver treatment across a course of sessions; response is assessed after the course, not after a single session.
  5. Sokolakis I, Hatzichristodoulou G. Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials. Int J Impot Res. 2019;31(3):177–194. doi:10.1038/s41443-019-0117-z. Lu Z, Lin G, Reed-Maldonado A, Wang C, Lee YC, Lue TF. Low-intensity extracorporeal shock wave treatment improves erectile function: a systematic review and meta-analysis. Eur Urol. 2017;71(2):223–233. PMID 27321373. Vardi Y, Appel B, Kilchevsky A, Gruenwald I. Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? Short-term results of a randomized, double-blind, sham controlled study. J Urol. 2012;187(5):1769–1775. PMID 22425129. Sham-controlled trials and pooled analyses report improved erectile-function scores; the 2012 double-blind trial also showed improved penile hemodynamics versus sham.
  6. de Oliveira PS, Ziegelmann MJ. Low-intensity shock wave therapy for the treatment of vasculogenic erectile dysfunction: a narrative review of technical considerations and treatment outcomes. Transl Androl Urol. 2021;10(6):2617–2628. doi:10.21037/tau-20-1286. Kitrey ND, Vardi Y, Appel B, et al. Low intensity shock wave treatment for erectile dysfunction—how long does the effect last? J Urol. 2018;200(1):167–170. doi:10.1016/j.juro.2018.02.070. Reported predictors of response include vasculogenic ED, fewer comorbidities, and prior response to PDE5 inhibitors; findings on baseline severity are mixed across analyses.
  7. Sokolakis I, Hatzichristodoulou G. Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials. Int J Impot Res. 2019;31(3):177–194. doi:10.1038/s41443-019-0117-z. Pooled odds of reaching an Erection Hardness Score of 3 or more (hardness sufficient for penetration) were higher with treatment than with sham.
  8. Ergun O, Kim K, Kim MH, et al. Low-intensity shockwave therapy for erectile dysfunction. Cochrane Database Syst Rev. 2025;7(7):CD013166. doi:10.1002/14651858.CD013166.pub3. PMID 40654049. Fode M, Hatzichristodoulou G, Serefoglu EC, Verze P, Albersen M; Young Academic Urologists Men’s Health Group. Low-intensity shockwave therapy for erectile dysfunction: is the evidence strong enough? Nat Rev Urol. 2017;14(10):593–606. PMID 28741629. Cochrane 2025: 21 RCTs, 1,357 men; short-term IIEF-EF mean difference 3.89 points, which may not be perceived as clinically important; certainty of evidence low for all outcomes.
  9. Kitrey ND, Vardi Y, Appel B, et al. Low intensity shock wave treatment for erectile dysfunction—how long does the effect last? J Urol. 2018;200(1):167–170. doi:10.1016/j.juro.2018.02.070. Brunckhorst O, Wells L, Teeling F, Muir G, Muneer A, Ahmed K. A systematic review of the long-term efficacy of low-intensity shockwave therapy for vasculogenic erectile dysfunction. Int Urol Nephrol. 2019;51(5):773–781. doi:10.1007/s11255-019-02127-z. About half of initial responders maintained benefit at two years; twelve-month results vary across studies, with function generally remaining above baseline.
  10. Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633–641. PMID 29746858. Liu JL, Chu KY, Gabrielson AT, et al. Restorative therapies for erectile dysfunction: position statement from the Sexual Medicine Society of North America (SMSNA). Sex Med. 2021;9(3):100343. PMID 34000480. Salonia A, Bettocchi C, Boeri L, et al. European Association of Urology guidelines on sexual and reproductive health—2021 update: male sexual dysfunction. Eur Urol. 2021;80(3):333–357. doi:10.1016/j.eururo.2021.06.007. AUA: low-intensity shockwave therapy should be considered investigational. SMSNA: restorative therapies are not advocated for routine clinical use and belong in adequately powered controlled trials. EAU: may be considered in mild vasculogenic ED (weak recommendation).
  11. Ergun O, Kim K, Kim MH, et al. Low-intensity shockwave therapy for erectile dysfunction. Cochrane Database Syst Rev. 2025;7(7):CD013166. doi:10.1002/14651858.CD013166.pub3. PMID 40654049. de Oliveira PS, Ziegelmann MJ. Low-intensity shock wave therapy for the treatment of vasculogenic erectile dysfunction: a narrative review of technical considerations and treatment outcomes. Transl Androl Urol. 2021;10(6):2617–2628. doi:10.21037/tau-20-1286. Little to no effect on treatment-related adverse events versus sham; adverse events across RCTs were mild and transient with no treatment-related dropouts, including among men on anticoagulant or antiplatelet therapy.
  12. Palmieri A, Imbimbo C, Longo N, et al. A first prospective, randomized, double-blind, placebo-controlled clinical trial evaluating extracorporeal shock wave therapy for the treatment of Peyronie’s disease. Eur Urol. 2009;56(2):363–369. PMID 19473751. Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie’s disease: AUA guideline. J Urol. 2015;194(3):745–753. PMID 26066402. Randomized placebo-controlled trial: significant reduction in penile pain; AUA guideline: clinicians may offer shock wave therapy to improve penile pain and should not use it to reduce curvature or plaque.

Getting Started

Start with the evaluation. FINISH STRONG®.

Getting started is simple — and private.

  1. Step 01

    Talk

    A focused consult — by phone or in person, virtual if you like.

  2. Step 02

    Test

    An in-person visit: vitals and bloodwork before any products or services.

  3. Step 03

    Tune

    Proven protocols do the groundwork. Your clinician makes the call — your plan, adjusted over time to your labs and how you actually feel.

Call 949-570-0800 Book a consult

Individual results vary. Treatment only when clinically appropriate.

Dr. Vigor® clinics in California are 100% physician-owned. The Firm Wave® treatment series is provided only after evaluation by a licensed clinician, and only when clinically appropriate. Acoustic wave therapy for erectile dysfunction is considered experimental and investigational; its use for ED and Peyronie's disease is off-label and has not received specific FDA clearance or approval. Results, where they occur, build over a recommended series of sessions, are not guaranteed, and vary by individual. Not all men are candidates. A medical consultation and prescription are required before any medication is provided. Treatment plans are set by the patient's own licensed clinician, who alone determines diagnosis, prescribing, and course of treatment — protocols inform that judgment and never replace it. Dr. Vigor is a concierge clinic group and does not bill insurance. HSA/FSA accepted for eligible services. Services available at Dr. Vigor clinic locations in California.

Dr. Vigor® clinics in California are 100% physician-owned. The Firm Wave® treatment series is provided only after evaluation by a licensed clinician, and only when clinically appropriate. Acoustic wave therapy for erectile dysfunction is considered experimental and investigational; its use for ED and Peyronie's disease is off-label and has not received specific FDA clearance or approval. Results, where they occur, build over a recommended series of sessions, are not guaranteed, and vary by individual. Not all men are candidates. A medical consultation and prescription are required before any medication is provided. Treatment plans are set by the patient's own licensed clinician, who alone determines diagnosis, prescribing, and course of treatment — protocols inform that judgment and never replace it. Dr. Vigor is a concierge clinic group and does not bill insurance. HSA/FSA accepted for eligible services. Services available at Dr. Vigor clinic locations in California.

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