Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: A narrative review and meta-analysis
Open accessAbstract
INTRODUCTION: 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. AIM: 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. MAIN OUTCOME MEASURES: Primary outcome was ED symptoms, and secondary outcome was sexual satisfaction of the patient. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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Psychological treatment may help promote treatment adherence, integrate medical aids into the sexual relationship, and resolve psychological correlates such as anxiety, negative thoughts, distress, self-confidence, intimacy, and communication problems.
“Psychological treatment may help to promote treatment adherence, integrate the treatment (ie, medical aids) into the sexual relationship and resolve psychological correlates such anxiety, negative thoughts, distress, self-confidence, intimacy, and communication problems between partners.59,109”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [109]
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- Authors
- Schmidt, H. M., Munder, T., Gerger, H., Frühauf, S., & Barth, J.
- Affiliations
- University of Bern (CH)
- Corresponding author
- Barth, Jürgen
- Venue
- The Journal of Sexual Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-06-01
- Volume
- 11
- Issue
- 6
- Pages
- 1376-1391
- ISSN
- 1743-6095 (ISSN-L)
- 1743-6109
- OpenAlex
- W1914654329
- Cited by
- 84
- References
- 65
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 4 · 2023: 8 · 2022: 2 · 2021: 10 · 2020: 4 · 2019: 7 · 2018: 9 · 2017: 8 · 2016: 7 · 2015: 9 · 2014: 1
- FWCI
- 1.15
- Type
- journal article
- Language
- en
- Open access
- green
- research.ou.nl
- Licence
- Locations
- The Journal of Sexual Medicine (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- BORIS (University Library Bern) (submittedVersion)
- edoc (University of Basel) (submittedVersion)
- DSpace (Open University in the Netherlands) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Urology › Urological Disorders and Treatments
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Keywords
- erectile dysfunction, phosphodiesterase-5 inhibitors, psychological intervention, combination therapy, sexual satisfaction, treatment efficacy, drug efficacy comparison
- MeSH terms
- Adult, Aged, Combined Modality Therapy, Humans, Erectile Dysfunction, Male, Middle Aged, Psychotherapy, Sex Counseling, Randomized Controlled Trials as Topic, Treatment Outcome, Patient Satisfaction, Young Adult, Phosphodiesterase 5 Inhibitors
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