NESA X-Signal (performance anxiety) Clinical Evidence
HCPC: PH80026 | ISSM: M.37761
Written by: Joshua Hearne-Wilkins, Urology Specialist & Independent Nurse Prescriber (NMC: 11l00400e)
Last clinically reviewed:
Published:
Next review due:
Clinical governance statement
All treatments undertaken by MansMatters (Shockwave Clinics Ltd) are subject to clinical review before they are introduced into practice and at regular intervals thereafter. This review considers the safety profile of each intervention, including contraindications and adverse effects as specified in the manufacturer’s instructions for use or the Summary of Product Characteristics; the regulatory status of each medical device and medicinal product; the position of current UK and European clinical guidance, including the European Association of Urology (EAU), the National Institute for Health and Care Excellence (NICE) and the British Association of Urological Surgeons (BAUS); the qualifications and scope of practice of the treating clinicians; the stage and severity of the condition being treated; and the requirements for informed consent. Each patient is assessed individually, and treatment is offered only where it is clinically appropriate.
The basis of clinical evidence
Clinical evidence is derived from several sources, which carry different weight. Systematic reviews and meta-analyses pool the results of multiple studies and provide the highest level of evidence. Randomised controlled trials, including sham-controlled trials, compare a treatment against a control group under defined conditions. Prospective and retrospective cohort studies, published in peer-reviewed journals, describe outcomes in defined groups of patients over time, and the replication of results by independent research groups in different countries strengthens confidence in a finding. Laboratory and mechanistic studies explain how a treatment is thought to act. In-clinic observational studies and structured outcome audits record the results achieved in routine practice and contribute to the developing evidence base, particularly for newer and combined treatments. Long-term follow-up establishes the durability of results and the safety of a treatment over time.
The evidence relevant to this treatment is summarised below. All citations are hyperlinked to the original source.
Is it safe?
NESA X-Signal is manufactured by NESA World (Spain) and is a Class IIa medical device (NESA World). It delivers very low microcurrents (0.1 to 0.9 mA) through electrodes in gloves and anklets, below the threshold of sensation and with no heating. Across the published trials, no device-related adverse events have been reported (Conde-Santos et al., Medicina 2026). As set out by the manufacturer, it isn’t suitable if you have a pacemaker, implanted defibrillator or nerve stimulator, or an infection at the electrode sites.
What the evidence shows
Not all erectile dysfunction has a physical cause. Performance anxiety affects an estimated 9 to 25% of men (Pyke, Sex Med Rev 2020), and men with erectile dysfunction show a pattern of dominance of the "fight or flight" nervous system, which works against the relaxed state an erection needs (Lee et al., Int Neurourol J 2011; Costa et al., Appl Psychophysiol Biofeedback 2021). NESA aims to rebalance this. In a triple-blind, sham-controlled trial in 43 women with overactive bladder, it reduced daily urination and improved sleep (Conde-Santos et al. 2026), and a multicentre trial in dementia found better sleep quality than control (Teruel-Hernández et al., Int J Environ Res Public Health 2023). Research into NESA in erectile dysfunction is continuing.
Guidelines and regulation
The European Association of Urology strongly recommends psychosexual and cognitive-behavioural therapy for erectile dysfunction with a psychological cause, combined with medical treatment where indicated (EAU Guidelines 2025/2026), and the American Urological Association advises referral to reduce performance anxiety (AUA Guideline 2018). We use NESA alongside these approaches. Treatment is given by registered clinicians in a clinic registered with the Care Quality Commission.
Independent research
NESA’s research base is at the University of Las Palmas de Gran Canaria, with trials published in peer-reviewed journals in urinary symptoms, sleep and athletic recovery (Blasco-Bonora et al., J Clin Med 2025). A 2026 meta-analysis of electrical stimulation in erectile dysfunction found a 5-point gain in erectile function scores (Fernández-Pascual et al., Int J Impot Res 2026), although that research used a different, motor-level technology.
How NESA compares
For performance anxiety, psychosexual and cognitive-behavioural therapy have guideline support, and tablets can break the anxiety cycle. NESA is a low-risk, drug-free option used alongside them, not instead of them. We signpost psychosexual therapy at the same time.
How NESA is thought to work
NESA applies sustained, very low microcurrents at the hands and feet to shift the balance of the autonomic nervous system away from the "fight or flight" state towards the relaxed state that an erection requires. The published trials in bladder function, sleep and recovery are consistent with an effect on autonomic function.
Long-term results and our experience
The published studies followed patients for up to seven months. We use NESA, usually with NanoVi Exo, in a calm treatment room and record outcomes for every patient.
Who is most likely to benefit
Men whose assessment points to performance anxiety or stress as the main factor, for example with normal night-time erections and a situational pattern; men who want a non-drug option alongside psychosexual support; and men with associated sleep disturbance or stress. It is not suitable for men with the conditions listed under "Is it safe?".
Before your treatment
Your clinician will assess whether psychological factors are the main driver of your erectile dysfunction, check for implanted devices and skin conditions, and discuss psychosexual therapy and other options. You will be asked to give your consent before treatment begins. Sessions last around 60 minutes; a course is usually 10 to 15 sessions, twice weekly.
Further clinical trials and reviews
The following peer-reviewed trials and reviews are also relevant. Each is linked to the original source.