The landscape of erectile dysfunction: insights into diagnosis, management, and emerging interventions
https://doi.org/10.21886/2308-6424-2026-14-2-77-89
Abstract
Erectile dysfunction is aprevalent condition affecting millions of men worldwide, with significant implications for physical health, psychological well-being, and quality of life. This systematic literature review aims to provide a comprehensive overview of the current landscape of ED, focusing on its diagnosis, management, and emerging interventions. A structured search of peer-reviewed literature was conducted across multiple databases, including PubMed and Cochrane Library, using predefined inclusion and exclusion criteria. The review highlights the multifactorial nature of erectile dysfunction, emphasizing the importance of accurate diagnosis through tools such as the International Index of Erectile Function, penile Doppler ultrasound, and nocturnal penile tumescence testing. Pharmacological treatments, particularly phosphodiesterase type 5 inhibitors, remain the cornerstone of management, while nonpharmacological options like vacuum erection devices and psychotherapy play complementary roles. Emerging therapies, including stem cell therapy, platelet-rich plasma therapy, and low-intensity extracorporeal shockwave therapy, offer promising avenues for refractory cases. Despite advancements, challenges such as stigma, cost, and limited access to innovative treatments persist. This review underscores the need for a multidisciplinary approach to erectile dysfunction care and calls for further research to refine diagnostic tools, optimize treatment strategies, and enhance accessibility to cutting-edge interventions. By addressing these gaps, we can improve outcomes for men with erectile dysfunction and promote holistic sexual health.
Keywords
About the Authors
S. A. AbbosovUzbekistan
Shukhrat A. Abbosov — Сand.Sc.(Med)
Tashkent
Competing Interests:
Farkhad A. Akilov, author of this article, are member of the Editorial Council of Urology Herald. The manuscript underwent the journal’s standard external peer‑review process by independent experts. The authors declare no other conflicts of interest
A. T. Makhmudov
Uzbekistan
Azamjon T. Makhmudov — Dr.Sc.(Med)
Tashkent
Competing Interests:
Farkhad A. Akilov, author of this article, are member of the Editorial Council of Urology Herald. The manuscript underwent the journal’s standard external peer‑review process by independent experts. The authors declare no other conflicts of interest
A. K. Tulaboev
Uzbekistan
Azamjon K. Tulaboev — Dr.Sc.(Econ)
Tashkent
Competing Interests:
Farkhad A. Akilov, author of this article, are member of the Editorial Council of Urology Herald. The manuscript underwent the journal’s standard external peer‑review process by independent experts. The authors declare no other conflicts of interest
S. U. Aliev
Uzbekistan
Sarvar U. Aliev — Сand.Sc.(Pharm)
Tashkent
Competing Interests:
Farkhad A. Akilov, author of this article, are member of the Editorial Council of Urology Herald. The manuscript underwent the journal’s standard external peer‑review process by independent experts. The authors declare no other conflicts of interest
A. B. Shomarufov
Uzbekistan
Azizbek B. Shomarufov — Сand.Sc.(Med)
Tashkent
Competing Interests:
Farkhad A. Akilov, author of this article, are member of the Editorial Council of Urology Herald. The manuscript underwent the journal’s standard external peer‑review process by independent experts. The authors declare no other conflicts of interest
S. Sh. Shavakhabov
Uzbekistan
Shavkat Sh. Shavakhabov — Сand.Sc.(Med)
Tashkent
Competing Interests:
Farkhad A. Akilov, author of this article, are member of the Editorial Council of Urology Herald. The manuscript underwent the journal’s standard external peer‑review process by independent experts. The authors declare no other conflicts of interest
F. A. Akilov
Uzbekistan
Farkhad A. Akilov — M.D., Dr.Sc.(Med)
Tashkent
Competing Interests:
Farkhad A. Akilov, author of this article, are member of the Editorial Council of Urology Herald. The manuscript underwent the journal’s standard external peer‑review process by independent experts. The authors declare no other conflicts of interest
References
1. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA. 1993;270(1):83-90. PMID: 8510302
2. McKinlay JB. The worldwide prevalence and epidemiology of erectile dysfunction. Int J Impot Res. 2000;12 Suppl 4:S6-S11. DOI: 10.1038/sj.ijir.3900567
3. Wright LN, Moghalu OI, Das R, Horns J, Campbell A, Hotaling J, Pastuszak AW. Erectile Dysfunction and Treatment: An Analysis of Associated Chronic Health Conditions. Urology. 2021;157:148-154. DOI: 10.1016/j.urology.2021.08.009
4. EAU Guidelines. Urological Infections. Edn. presented at the EAU Annual Congress London 2026. EAU Guidelines Office, Arnhem, The Netherlands; 2026.
5. Vasiliev A.O., Astakhov N.V., Arutyunyan P.A., Aliev O.R., Khodyreva L.A., Pushkar D.Yu. Psychogenic Erectile Dysfunction: A Multidisciplinary Problem. City Healthcare. 2023;4(3):87-94. (In Russian). DOI: 10.47619/2713-2617.zm.2023.v.4i3;87-94
6. Gratzke C, Angulo J, Chitaley K, Dai YT, Kim NN, Paick JS, Simonsen U, Uckert S, Wespes E, Andersson KE, Lue TF, Stief CG. Anatomy, physiology, and pathophysiology of erectile dysfunction. J Sex Med. 2010;7(1 Pt 2):445-475. Erratum in: J Sex Med. 2010;7(3):1316. DOI: 10.1111/j.1743-6109.2009.01624.x
7. Fode M, Wiborg MH, Fojecki G, Joensen UN, Jensen CFS. [Organic erectile dysfunction]. Ugeskr Laeger. 2020;182(4):V09190546. (In Danish). Accessed on 01.04.2026. URL: https://ugeskriftet.dk/videnskab/organisk-rejsningsbesvaer
8. Althof SE, Berner MM, Goldstein I, Claes HI, Cappelleri JC, Bushmakin AG, Symonds T, Schnetzler G. Interrelationship of sildenafil treatment effects on the physiological and psychosocial aspects of erectile dysfunction of mixed or organic etiology. J Sex Med. 2010;7(9):3170- 3178. DOI: 10.1111/j.1743-6109.2010.01882.x
9. Pozzi E, Fallara G, Capogrosso P, Boeri L, Belladelli F, Corsini C, Costa A, Candela L, Cignoli D, Cazzaniga W, Schifano N, Ventimiglia E, d’Arma A, Montorsi F, Salonia A. Primary organic versus primary psychogenic erectile dysfunction: Findings from a real-life cross-sectional study. Andrology. 2022;10(7):1302-1309. DOI: 10.1111/andr.13212
10. Assar ME, Angulo J, García-Rojo E, Sevilleja-Ortiz A, García-Gómez B, Fernández A, Sánchez-Ferrer A, La Fuente JM, Romero-Otero J, Rodríguez-Mañas L. Early manifestation of aging-related vascular dysfunction in human penile vasculature-A potential explanation for the role of erectile dysfunction as a harbinger of systemic vascular disease. Geroscience. 2022;44(1):485-501. DOI: 10.1007/s11357-021-00507-x
11. De Leonardis F, Colalillo G, Finazzi Agrò E, Miano R, Fuschi A, Asimakopoulos AD. Endothelial Dysfunction, Erectile Deficit and Cardiovascular Disease: An Overview of the Pathogenetic Links. Biomedicines. 2022;10(8):1848. DOI: 10.3390/biomedicines10081848
12. Rosen RC, Fisher WA, Eardley I, Niederberger C, Nadel A, Sand M; Men’s Attitudes to Life Events and Sexuality (MALES) Study. The multinational Men’s Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin. 2004;20(5):607-617. DOI: 10.1185/030079904125003467
13. Goldstein I, Goren A, Li VW, Tang WY, Hassan TA. Epidemiology Update of Erectile Dysfunction in Eight Countries with High Burden. Sex Med Rev. 2020;8(1):48-58. DOI: 10.1016/j.sxmr.2019.06.008
14. Ayta IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int. 1999;84(1):50-56. DOI: 10.1046/j.1464-410x.1999.00142.x
15. Özkent MS, Hamarat MB, Taşkapu HH, Kılınç MT, Göger YE, Sönmez MG. Is erectile dysfunction related to self-esteem and depression? A prospective case-control study. Andrologia. 2021;53(1):e13910. DOI: 10.1111/and.13910
16. Liu Q, Zhang Y, Wang J, Li S, Cheng Y, Guo J, Tang Y, Zeng H, Zhu Z. Erectile Dysfunction and Depression: A Systematic Review and MetaAnalysis. J Sex Med. 2018;15(8):1073-1082. DOI: 10.1016/j.jsxm.2018.05.016
17. Velurajah R, Brunckhorst O, Waqar M, McMullen I, Ahmed K. Erectile dysfunction in patients with anxiety disorders: a systematic review. Int J Impot Res. 2022;34(2):177-186. DOI: 10.1038/s41443-020-00405-4
18. Al-Shaiji TF. Breaking the Ice of Erectile Dysfunction Taboo: A Focus on Clinician-Patient Communication. J Patient Exp. 2022;9:23743735221077512. DOI: 10.1177/23743735221077512
19. Yuan J, Zhang R, Yang Z, Lee J, Liu Y, Tian J, Qin X, Ren Z, Ding H, Chen Q, Mao C, Tang J. Comparative effectiveness and safety of oral phosphodiesterase type 5 inhibitors for erectile dysfunction: a systematic review and network meta-analysis. Eur Urol. 2013;63(5):902-912. DOI: 10.1016/j.eururo.2013.01.012
20. Pajovic B, Dimitrovski A, Fatic N, Malidzan M, Vukovic M. Vacuum erection device in treatment of organic erectile dysfunction and penile vascular differences between patients with DM type I and DM type II. Aging Male. 2017;20(1):49-53. DOI: 10.1080/13685538.2016.1230601
21. Capogrosso P, Frey A, Jensen CFS, Rastrelli G, Russo GI, Torremade J, Albersen M, Gruenwald I, Reisman Y, Corona G. Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations from the European Society of Sexual Medicine (ESSM). J Sex Med. 2019;16(10):1490- 1505. DOI: 10.1016/j.jsxm.2019.07.016
22. Epifanova MV, Gvasalia BR, Durashov MA, Artemenko SA. Platelet-Rich Plasma Therapy for Male Sexual Dysfunction: Myth or Reality? Sex Med Rev. 2020;8(1):106-113. DOI: 10.1016/j.sxmr.2019.02.002
23. Gülpinar O, Haliloğlu AH, Abdulmajed MI, Bogga MS, Yaman O. Helpseeking interval in erectile dysfunction: analysis of attitudes, beliefs, and factors affecting treatment-seeking interval in Turkish men with previously untreated erectile dysfunction. J Androl. 2012;33(4):624-628. DOI: 10.2164/jandrol.111.013946
24. Cochrane Handbook for Systematic Reviews of Interventions. Higgins J.P.T., Thomas J., Chandler J., Cumpston M., Li T., Page M.J., Welch V.A., eds. 2019. DOI: 10.1002/9781119536604
25. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. DOI: 10.1136/bmj.n71
26. Carra MC, Romandini P, Romandini M. Risk of Bias Evaluation of CrossSectional Studies: Adaptation of the Newcastle-Ottawa Scale. J Periodontal Res. 2025. Epub ahead of print. DOI: 10.1111/jre.13405
27. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, Henry DA. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. DOI: 10.1136/bmj.j4008
28. Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, Hartmann-Boyce J, Ryan R, Shepperd S, Thomas J, Welch V, Thomson H. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;368:l6890. DOI: 10.1136/bmj.l6890
29. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822-830. DOI: 10.1016/s0090-4295(97)00238-0
30. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319-326. DOI: 10.1038/sj.ijir.3900472
31. Neijenhuijs KI, Holtmaat K, Aaronson NK, Holzner B, Terwee CB, Cuijpers P, Verdonck-de Leeuw IM. The International Index of Erectile Function (IIEF)-A Systematic Review of Measurement Properties. J Sex Med. 2019;16(7):1078-1091. DOI: 10.1016/j.jsxm.2019.04.010
32. Parisot J, Yiou R, Salomon L, de la Taille A, Lingombet O, Audureau E. Erection hardness score for the evaluation of erectile dysfunction: further psychometric assessment in patients treated by intracavernous prostaglandins injections after radical prostatectomy. J Sex Med. 2014;11(8):2109-2018. DOI: 10.1111/jsm.12584
33. Ghanem HM, Salonia A, Martin-Morales A. SOP: physical examination and laboratory testing for men with erectile dysfunction. J Sex Med. 2013;10(1):108-110. DOI: 10.1111/j.1743-6109.2012.02734.x
34. Morgado A, Silva AC, Diniz P, Silva CM. Can we rely on total testosterone measurement to exclude hypogonadism in erectile dysfunction? Int J Impot Res. 2023;35(5):454-459.
Review
For citations:
Abbosov S.A., Makhmudov A.T., Tulaboev A.K., Aliev S.U., Shomarufov A.B., Shavakhabov S.Sh., Akilov F.A. The landscape of erectile dysfunction: insights into diagnosis, management, and emerging interventions. Urology Herald. 2026;14(2):77-89. https://doi.org/10.21886/2308-6424-2026-14-2-77-89
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