The Canadian Musician, Alex Lifeson, better known as the guitarist from the rock band Rush once said: “The shock of any trauma, I think changes your life. It’s more acute in the beginning and after a little time, you settle back to what you were. However, it leaves an indelible mark on your psyche.” This is very true in many men who suffer from sexual dysfunction after major life event or trauma. Erectile dysfunction after an illness, such as heart attacks or strokes is not uncommon, even though the overall bodily functions had appeared to resume some degrees of normality. A stroke, also known as CVA (Cerebral Vascular Accident) is when the poor blood flow to the brain results in cell death. The main risk factors for strokes are hypertension, smoking, obesity, dyslipidemia and diabetes. These are also the same cardiac co-morbidities that are the main causes for erectile dysfunction. As ischemic stroke is caused by blockage of a blood vessel can be minor, the symptoms of a stroke in some sufferers may not be permanent. However, the long-term shock after the acute trauma may be persistent, especially psychological impact cannot be under-estimated. The American neuro-psychiatrist, who was the recipient of the 2000 Nobel prize in physiology and medicine for his research work on the physiological basis of neuron once said: “In order to produce learned fear, you take a neutral stimulus like a tone, and you pair it with an electric shock. Tone shock, tone shock, so the animal learns that the tone is bad news. But you can also do the opposite, shock it at other times, but never when the tone comes on.” The “learn-fear” principle is a reflection of the complexity of the brain, would the rule be applicable when the shock is on the different “brain” such as the penis? The topic of our discussion this week is the use of shock waves to “wake up the dragon” in men who suffers from erectile dysfunction. Dear Dr. G, My Name is Zul and I am 57 years old. In the beginning of the year, I had suffered from a stroke, which resulted in lost of function on the left side of my body. I confess it was a scary moment of my life. I am considered lucky, as most of my bodily functions had returned to normal after four months of physiotherapy. Now, I exercise regularly, I control my blood pressure religiously and eat healthily to control my cholesterol and diabetes. Although, I am near 100% recovered, my sexual function is still completely dead! I have tried the blue pills, and have reasonable response, but I really would like to have a more natural way of sexual function without needing medications. I have read in a recent newspaper article that shock wanes can be used to “wake up” the penis. It sounded like some sort of hoax. Is it true? Can you tell me whether it is safe to “shock” the penis? Is it painful? How does it work? What sort of negative impact will it have on the organ? Shockwaves treatment in medicine is a treatment modality that is well established since 1980’s. The therapy had transformed the urinary stone treatment substantially and made such minimal invasive intervention possible for many patients. The utilisation in such technologies has been replicated in various medical specialties, such as orthopedics and rheumatology. In recent years, the principles of shockwaves had also been applied in cardiology. The effects of the shockwaves had been observed to induce the long-term impact of vasodilation and formation of new capillaries in the treated tissues. This had led to the promising potential of such applications in patients with occlusions in the coronary arteries resulting in angina. Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a indeed a novel modality that has been recently developed for treatment men with erectile dysfunction, to literally shock the penis back to life. Unlike, the current treatment modalities such as medications, LI-ESWT aims to restore the erectile mechanism in order to enable the natural and spontaneous erection with the formation of neovascularization. The intensity of the shock waves is one tenth of what is used in kidney stone fragmentation, and this has the impact of cellular micro trauma, which in turn stimulates the release of angiogenic factors for the formations of new blood vessels and perfusions. In the first randomized, double blind, sham controlled study on ED patients demonstrated that LI-ESWT had a positive short-term clinical and physiological effect on erectile function of men who respond to medications. The treatment regime ranging between six to twelve courses, and generally well tolerated by the patients. Although the outcome of the therapy is promising, this is quite variable on the severity and etiology of ED. The professor of moral philosophy at the Academy of Geneva, Henri Federic Amiel once said: “Without passion man is a mere latent force and possibility, like the flint which awaits the shock of the iron before it can give forth its spark”. The shock wave treatment of penis to “bring back the life” of sexual function has definitely generated passions in enthusiastic clinicians and patients, lets hope the shocks can proof to generate lasting sparks that will keep the fire of passions burning forever. Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. The column “Ask Dr G” is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. 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