Table 4.
Effects of interventions for erectile dysfunction as reported in the included systematic reviews
| Treatment (follow-up period) | Number of studies (participants) | Outcome | Effect size (95% CI) | Significant between-group difference |
|---|---|---|---|---|
| Phosphodiesterase type 5 inhibitor | ||||
| Tadalafil vs placebo (unclear)28 | 8 (1,877) | IIEF-EF | MD = 8.07 (7.18–8.96) | Yes |
| Vardenafil vs placebo (unclear)28 | 6 (1,151) | IIEF-EF | MD = 7.05 (5.60–8.50) | Yes |
| Sildenafil vs placebo (unclear)28 | 12 (3,404) | IIEF-EF | MD = 6.03 (5.38–6.68) | Yes |
| Udenafil vs placebo (unclear)28 | 5 (1,620) | IIEF-EF | MD = 5.92 (4.58–7.26) | Yes |
| Mirodenafil vs placebo (12 weeks)59 | 3 (364) | IIEF-EF | MD = 8.13 (6.64–9.61) | Yes |
| Avanafil (100 mg) vs placebo (8–12 weeks)56 | 5 (1,984) | IIEF-EF | MD = 3.92 (2.68–5.15) | Yes |
| Avanafil (200 mg) vs placebo (8–12 weeks)56 | 5 (1,984) | IIEF-EF | MD = 4.92 (3.66–6.19) | Yes |
| Selective serotonin antagonist inhibitors | ||||
| Trazodone vs placebo (post intervention) (4–13 weeks)60 | 6 (396) | “Positive treatment response” | RR = 1.6 (0.8–3.3) | No |
| Statins | ||||
| Statins vs placebo/no medication (12–104 weeks)72 | 11 (713) | IIEF-5 | MD = 3.4 (1.7–5.00) | Yes |
| Hormone therapy | ||||
| Testosterone vs placebo (12–156 weeks)57 | 13 (1,806) | IIEF-EFD | MD = 2.31 (1.41–3.22) | Yes |
| DHEA vs placebo (24 weeks)62,∗ | 1 (40) | IIEF-5 | Not pooled. The study showed significant differences between the groups. | Yes |
| Penile injections | ||||
| Intraurethral alprostadil (prostaglandin E1 vs placebo (postintervention)68 | 2 (1,101) | “At least one successful intercourse” | OR = 7.22 (5.68–9.19) | Yes |
| Prostaglandin E1 vs sex therapy (12–26 weeks)26 | 2 (86) | “Persistence of erectile dysfunction” | RR = 1.11 (0.62–1.97) | No |
| Shockwave therapy | ||||
| Shockwave therapy vs sham (postintervention) (13–56 weeks)55 | 7 (602) | IIEF-EF | MD = 4.17 (−0.50 to 8.83) | Yes |
| Complementary and alternative medicine | ||||
| Acupuncture vs sham therapy (unclear)73 | 2 (81) | IIEF-5 | Not pooled. 1 study showed significant effect (RR = 7.53 [1.13–50.00]) whereas another study was not significant (RR = 1.40 [0.67–2.91]) | Unclear |
| Physical activity vs usual care (8–104 weeks)65 | 7 (483) | IIEF | MD = 3.88 (2.35–5.41) | Yes |
| Lifestyle intervention vs usual care (12–104 weeks)72 | 4 (597) | IIEF-5 | MD = 2.40 (1.19–3.61) | Yes |
| Pycnogenol vs placebo (16 weeks)3,70,† | 1 (21) | IIEF-5 | MD = 6.00 (3.33 to 8.67) | Yes |
| Red ginseng vs placebo (unclear)64 | 6 (349) | Improvement of erectile dysfunction | RR = 2.38 (1.72 to 3.29) | Yes |
| Maca vs placebo (12 weeks)22 | 1 (50) | IIEF-5 | Not pooled. One trial reported significant differences between the groups | Yes |
| Yohimbine vs placebo (unclear)63,‡ | 7 (419) | Unclear | OR = 3.85 (2.22 to 6.67) | Yes |
| Chinese herb formula vs placebo (12 weeks)66 | 1 (200) | Total clinical effective rate | RR = 4.19 (2.85 to 6.17) | Yes |
| Chinese herb formula vs Simvastatin (12 weeks)66 | 4 (322) | IIEF-5 | Not pooled. Individual studies showed positive results. MD = 4.10 (3.62 to 4.58); MD = 2.87 (1.66 to 4.08) | Yes |
| Psychological therapies | ||||
| Psychological vs waiting list control (postintervention)27,§ | 7 (235) | Symptom severity | d = 0.53 (−0.08 to 1.14) | No |
| Sex therapy vs waiting list control (postintervention)27 | 3 (115) | Symptom severity | d = 0.21 (−0.31 to 0.74) | Yes |
| Marital therapy vs waiting list control (postintervention)27 | 1 (16) | Symptom severity | d = 0.17 (−2.61 to 2.94) | Unclear |
| Educational intervention vs waiting list control (postintervention)27 | 1 (20) | Symptom severity | d = −0.04 (−2.81 to 2.73) | Unclear |
| Group psychotherapy vs waiting list (26 weeks)26 | 5 (100) | “Persistence of erectile dysfunction” | RR = 0.40 (0.17 to 0.98) | Yes |
| Psychological interventions vs PDE5-Is (postintervention)32 | 3 (207) | Erectile dysfunction symptoms | d = −0.28 (−1.19 to 0.64) | No |
| Sex therapy vs intracavernosal injection (unclear)26 | 1 (29) | “Persistence of erectile dysfunction” | RR = 0.49 (0.14 to 1.67) | No |
| Sex therapy vs vacuum devices (6 weeks)26 | 1 (45) | Response to treatment | RR = 0.40 (0.14 to 1.14) | No |
| Combined therapies | ||||
| PDE5-Is plus hormone therapy vs PDE5-Is (12 weeks)71 | 5 (894) | IIEF | MD = 0.49 (−0.16 to 1.15) | No |
| Statins plus lifestyle modification vs usual care (12–104 weeks)72 | 6 (740) | IIEF-5 | MD = 2.66 (1.86 to 3.47) | Yes |
| Acupuncture plus psychological therapy vs psychological therapy (4 weeks)73 | 1 (102) | “Erection sufficient for intercourse” | RR = 1.99 (1.38 to 2.55) | Yes |
| Chinese herb formula plus simvastatin vs simvastatin (unclear)66 | 1 (63) | IIEF-5 | MD = 4.52 (4.08 to 4.96) | Yes |
| Psychological plus PDE5-Is vs PDE5-Is (postintervention)32 | 7 (550) | Erectile dysfunction | d = 0.45 (0.03 to 0.89) | Yes |
| Psychological plus PDE5-Is vs PI (postintervention)32 | 4 (312) | Erectile dysfunction symptoms | d = 0.67 (0.24 to 1.58) | Yes |
| Group therapy plus sildenafil citrate vs sildenafil (26 weeks)63 | 2 (71) | “Persistence of erectile dysfunction” | RR = 0.46 (0.24 to 0.88) | Yes |
d = Cohen’s d, effect size indicating the standardized difference between 2 means; DHEA = Dehydroepiandrosterone; IIFF-EF = International Index of Erectile Function-Erectile Function; IIEF-5 = International Index of Erectile Dysfunction; EFD = erectile function domain; MD = mean difference; OR = odds ratio; PDE5-Is = phosphodiesterase type 5 inhibitors; PI = psychological intervention; RR = risk ratio.
∗
Sexual hormones or neurosteroids.
†
Pine bark extract.
‡
Derived from the bark of a West African evergreen tree.
§
Psychological therapies: sex therapy, marital therapy, educational intervention, other psychotherapy.