Can Hyperbaric Oxygen Therapy (HBOT) help with erectile dysfunction (ED)?

HBOT for Erectile Dysfunction: Evidence-Based Recommendation

HBOT is not currently recommended as a standard treatment for erectile dysfunction based on the most recent and highest quality guidelines, though emerging research suggests potential benefit in select patients who have failed conventional therapy. The 2025 European Association of Urology guidelines on male sexual and reproductive health make no mention of HBOT as a treatment option for ED, focusing instead on PDE5 inhibitors, intracavernous injections, vacuum devices, and other established therapies 1.

Current Guideline-Based Treatment Approach

The established treatment algorithm for ED prioritizes:

• First-line therapy: PDE5 inhibitors (sildenafil, vardenafil, tadalafil, avanafil) with proper education about dosing and timing 1
• Second-line options for PDE5I non-responders: Intracavernous injection therapy, vacuum erection devices, or combination approaches 1
• Adjunctive therapies with limited evidence: Low-intensity shockwave therapy (LI-SWT) may be used in men with mild vasculogenic ED, showing benefit particularly in PDE5I non-responders 1
• Testosterone therapy: For hypogonadal men with low testosterone and reduced sexual desire 1

Research Evidence on HBOT for ED

While guidelines do not support HBOT, several recent research studies show promising results:

Efficacy Data

• A 2018 prospective study of 30 men with chronic ED showed HBOT significantly improved all IIEF domains by 15-88%, with erectile function improving by 88% after 40 daily sessions 2
• Perfusion MRI demonstrated a 153% increase in penile blood flow, indicating angiogenesis as the mechanism 2
• A 2024 controlled study found HBOT produced comparable improvements to daily tadalafil 5mg, with no significant difference in IIEF-5 scores between groups 3
• Multiple studies from 2018-2020 consistently showed significant improvements in IIEF-EF scores following HBOT protocols 4, 5

Important Caveats

• Patient selection matters: Patients with peripheral vascular disease did not improve with HBOT 3
• No effect on testosterone: HBOT improved erectile function but did not change serum testosterone levels 4
• Treatment burden: Protocols typically require 40-60 daily sessions over 8-15 weeks 2, 6
• Cost and accessibility: HBOT is expensive ($600-700 per session) and requires specialized facilities 1

Clinical Application

For patients with ED refractory to PDE5 inhibitors who cannot tolerate or have failed intracavernous injections, HBOT may be considered as an experimental option, particularly in those with:

• Vasculogenic ED without severe peripheral vascular disease 2, 3
• Contraindications to PDE5 inhibitors or intolerable side effects 3
• Willingness to commit to 40-60 treatment sessions 2
• Financial resources and access to hyperbaric facilities 1

Risks to Discuss

• Middle ear or sinus barotrauma (6-17% of patients) 1
• Claustrophobia during chamber confinement 1
• Temporary myopia 1
• Rare seizures from oxygen toxicity 1

Bottom Line

HBOT should not replace established ED treatments but may serve as an alternative for carefully selected patients who have exhausted conventional options. The mechanism appears to be penile angiogenesis and improved blood flow 2. However, the absence of HBOT from current urology guidelines reflects the lack of large-scale randomized trials and the availability of more practical, evidence-based alternatives 1. Patients considering HBOT should understand this is not standard care and requires significant time and financial investment for uncertain benefit.