Background: Erectile dysfunction is a common disease that has a significant negative impact on the quality of life of individuals. Low-intensity shockwave therapy (LI-ESWT) has been considered a new method for treating patients with erectile dysfunction. Objectives: To evaluate the safety and efficacy of LI-ESWT in the treatment of patients with erectile dysfunction. Methods: A systematic review was conducted in the major databases, including PubMed, Cochrane Library, Embase, Scopus, and Web of Science up to February 2018. In order to find more articles, the reference list of the key review articles was searched as well. The quality of the studies was evaluated with the Cochrane Collaboration’ s tools. The outcomes included The International Index of Erectile Function (IIEF), Erection Hardness Score (EHS), and adverse events. Meta-analysis was performed using RevMan software, version 5. 3. Results: Seven randomized clinical trials involving 519 patients met the inclusion criteria. A significant improvement was observed in IIEF (mean difference [MD] = 4. 54, 95% CI 0. 44-8. 63) and EHS (risk ratio [RR] = 2. 99, 95% CI 1. 16-7. 70) in the intervention groups compared to the control groups. Sub-analysis showed that shockwave therapy significantly improved IIEF at 6, 9, and 10 weeks after the treatment (P < 0. 05), and the EHS was improved at 5, 6, and 9 weeks (P < 0. 05). There was also a significant improvement in the intervention groups in IIEF and EHS for 1500 and 3000 pulses, respectively (P < 0. 05). No significant side effects were reported. Conclusions: The findings of this study indicate LI-ESWT improves erectile dysfunction in patients, and it is safe and well-tolerated by patients.