Objective: Penile extracorporeal low-intensity shock wave therapy (LIST) to the penis has recently emerged as a novel and promising modality in the treatment of erectile dysfunction. LIST can improve penile blood flow and endothelial function by stimulating angiogenesis in the penis. Design and Method: We applied LIST to patients with mild to moderate vasculogenic ED who responded well to the use of PDE5i. The treatment protocol consisted of one treatment sessions per week for 6 weeks, a 6 -week no-treatment interval. Each session comprised the application of 3000 shock waves (energy intensity of 4 mJ/mm3) to each penile shaft and 1000 shock waves for each crura. Results: The results showed that 6 weeks after treatment, erectile function improved in the 85% of the cases, good result was achieved in 10% and no results in 5% of the patients. The average increase in the IIEF-EF domain score was 8.8 points. Furthermore, erectile function and penile blood flow were measured using nocturnal penile tumescence (NPT) and color-power Doppler of the penis. All NPT parameters improved as recorded by significant increases in the duration of the erections and penile rigidity. Conclusions: The treatment options for ED have greatly expanded and include PDE5i, intracavernosal injections, and penile prostheses. Our experience presented here demonstrate that LIST of the corpora cavernosa is a novel therapeutic option for ED. LIST may have a fundamental effect on penile endothelial function, increasing penile blood flow, and improving erectile function and consequently sexual satisfaction.