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J Sex Med. 2014 Jun;11(6):1376-91. doi: 10.1111/jsm.12520. Epub 2014 Mar 19.

Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: a narrative review and meta-analysis.

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Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.



Erectile dysfunction (ED) is an increasing health problem that demands effective treatment. There is evidence that phosphodiesterase-5 inhibitors (PDE5-Is) and psychological intervention (PI) are effective treatment options; however, little is known about their comparative efficacy and the efficacy of combined treatments.


The aim of this systematic review and meta-analysis is to evaluate the comparative efficacy of PI, PDE5-Is, and their combination in the treatment of ED.


Primary outcome was ED symptoms, and secondary outcome was sexual satisfaction of the patient.


A systematic literature search was conducted in order to identify relevant articles published between 1998 and 2012. We included randomized controlled trials and controlled trials comparing PI with PDE5-I treatment or one of them against a combination of both.


Eight studies with a total number of 562 patients were included in the meta-analysis. The results of the included studies are inconclusive, though they show a trend towards a larger effect of combined treatment compared with PI or PDE5-I treatment alone. The meta-analysis found that, overall, combined treatment was more efficacious for ED symptoms than PDE5-I treatment or PI alone. Combined treatment was more efficacious than PDE5-I use alone on sexual satisfaction. No differences were found between PDE5-Is and PI as stand-alone treatments. None of the moderators (treatment duration, methodological quality, or researcher allegiance) altered the effects.


The combination of PI and PDE5-Is is a promising strategy for a favorable outcome in ED and can be considered as a first-choice option for ED patients. Stronger RCTs are required to confirm this initial finding.


Erectile Dysfunction Therapy; Health Services Research; Impotence; Intervention; Male; Meta-Analysis; Patient Satisfaction; Phosphodiesterase Inhibitor; Randomized Controlled Trial; Sex Counseling; Sexual Dysfunction; Systematic Review

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