Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a modern therapeutic option for erectile dysfunction (ED). The European Association of Urology (EAU) has classified it as a first-line treatment for ED. The use of Li-ESWT is recommended in appropriately informed patients with mild erectile dysfunction (EF). The recommendations include the use of LI-ESWT for patients who respond poorly to drug therapy and those who, for individual reasons, are unable or unwilling to use vasoactive substances. It is worth noting that the level of recommendation is described as weak (insufficient evidence of efficacy, indicating the need for further research). The mechanism of action of Li-ESWT is not well understood, but it is known that it affects the formation of new blood vessels, promotes quantitative and qualitative improvement of vascular endothelial cells, and increases the production of nitric oxide (has a nutritional effect, generating congestion). Improvement of erectile function in people undergoing Li-ESWT was noted in patients with vascular ED, and importantly, studies are underway to apply this form of therapy to other etiopathogenesis of ED. Li-ESWT results in an improvement in EF as measured by the International Index of Erectile Function (IIEF), an increase in the average Erectile Hardness Score (EHS), and an improvement in quality of sexual life; however, the level of increase remains clinically unsatisfactory. The efficacy of Li-ESWT has been confirmed in studies in patients with the most advanced vascular ED. Importantly, there were no side effects both during and after therapy and the improvement in EF was sustained long-term (up to 2 years). The advantages of Li-ESWT therapy are associated with the removal of the cause of vasogenic ED, which transfers into improved sexual performance, allows patients to regain spontaneity of intercourse and prompts wider use of this innovative therapy.