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

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

Abstract

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.

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

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Combined Modality Therapy / methods
  • Erectile Dysfunction / physiopathology
  • Erectile Dysfunction / therapy*
  • Humans
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Phosphodiesterase 5 Inhibitors / therapeutic use*
  • Psychotherapy / methods*
  • Randomized Controlled Trials as Topic
  • Sex Counseling / methods
  • Treatment Outcome
  • Young Adult

Substances

  • Phosphodiesterase 5 Inhibitors