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 st and -alone treatments .
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 .
INTRODUCTION Erectile dysfunction ( ED ) is an increasing health problem that dem and s 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 .
Sexual satisfaction among patients with erectile dysfunction treated with counseling, sildenafil, or both.
INTRODUCTION Sexual satisfaction is linked to life satisfaction , and erectile dysfunction ( ED ) may lead to an impaired quality of life ( QOL ) . AIM Our goal was to evaluate the QOL among Brazilian patients with ED , before and after three kinds of treatment . METHODS Men aged 25 - 55 years , with a diagnosis of psychogenic or mixed ED , according to the Classification of Mental and Behavioral Disorders of the International Classification of Diseases , 10th edition , and the St and ard Practice in Sexual Medicine , were r and omly assigned to three treatment groups : counseling , sildenafil , and sildenafil plus counseling . At baseline each group had 40 patients .  Sildenafil was provided in 50 mg that could be adjusted to 100 mg . The patients could initially take one to two tablets per week and the entire treatment lasted for 3 months . Counseling was provided in group sessions that took place once a week . They were evaluated at baseline and after 3 months of treatment with the Male Sexual Quotient ( MSQ ) and the Sexual Health Inventory for Men ( SHIM ) . MAIN OUTCOME MEASURES The correlation between the patients ' MSQ score and scores on the SHIM . RESULTS One hundred seventeen patients were enrolled . The three groups were similar according to age , marital status , mean time of ED , and ED severity and etiology . At baseline , MSQ and SHIM total scores were not different among the three groups . MSQ scores increased from 41.2 + /- 15.3 , 38.7 + /- 18.0 , and 46.8 + /- 17.0 to 48.5 + /- 15.3 , 63.8 + /- 21.6 , and 70.0 + /- 17.3 after counseling , sildenafil , and sildenafil plus counseling , respectively ( P < 0.05 ) . SHIM scores also increased significantly ( 9.6 + /- 4.1 , 9.7 + /- 4.1 , and 10.2 + /- 3.9 to 12.1 + /- 3.9 , 16.7 + /- 5.6 , and 17.7 + /- 4.5 after counseling , sildenafil , and sildenafil plus counseling , respectively ) ( P < 0.05 ) . There were no serious adverse events related to sildenafil , and no patient was withdrawn from the study because of an adverse event . CONCLUSIONS The three treatments were significantly efficient , and the best treatment was sildenafil associated with counseling
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 st and -alone treatments .
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 .
INTRODUCTION Erectile dysfunction ( ED ) is an increasing health problem that dem and s 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 .