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We synthesize epidemiologic prevalence and risk data on ED in MS, map mechanistic pathways linking central and spinal lesions, autonomic\u2013endothelial imbalance, and psychosocial modulators to ED phenotypes, and provide a stage-based care algorithm integrating neuro-urological testing and psycho-sexological support. Across more than 30 studies, pooled ED prevalence in men with MS is approximately 50%, with higher odds at greater disability and with co-existing lower urinary tract symptom (LUTS) and depression. Phosphodiesterase-5 inhibitors (PDE5i) are commonly used as first-line pharmacologic therapy, although data specific to MS remain limited and individual response can vary. Device-, injection-, neuromodulation-, and prosthesis-based options offer escalation pathways. Evidence quality varies and residual confounding and detection bias remain possible.<\/jats:p>","DOI":"10.3389\/fcell.2025.1728027","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T07:15:36Z","timestamp":1765350936000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the interconnectedness of multiple sclerosis and erectile dysfunction: mechanisms and management strategies"],"prefix":"10.3389","volume":"13","author":[{"given":"Yongrui","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongliang","family":"Cao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"105531","DOI":"10.1016\/j.msard.2024.105531","article-title":"Characteristics and predictors of sexual dysfunction in men with multiple sclerosis","volume":"85","author":"Adamec","year":"2024","journal-title":"Mult. 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