{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:54:39Z","timestamp":1792108479771,"version":"4.4.0"},"reference-count":144,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Erectile dysfunction (ED) is a common multifactorial condition with significant physical, psychological and relational consequences. While historically associated with aging, its rising prevalence among younger men underscores the need for updated diagnostic and therapeutic frameworks. This narrative review synthesizes contemporary evidence on the pathophysiology, diagnostic workup and management of ED, with emphasis on guideline-directed care and emerging treatment modalities. A comprehensive literature search was conducted, with evidence synthesized from key clinical guidelines, landmark trials and recent peer-reviewed studies. Lifestyle optimization remains the foundational step, followed by first-line pharmacotherapy with phosphodiesterase type 5 inhibitors (PDE5is), which demonstrate high efficacy and safety across diverse patient populations. For patients with inadequate PDE5is response, second-line options include alprostadil (intracavernosal, with approximately 70% success rates or intraurethral), vacuum erection devices and penile prosthesis surgery, with patient and partner satisfaction exceeding 95% for the latter when performed in experienced centers. Psychosexual therapy is an integral adjunct, particularly in psychogenic or mixed etiologies. Regenerative approaches such as low-intensity extracorporeal shockwave therapy (Li-SWT) and platelet-rich plasma (PRP) injections are under investigation; current evidence supports their use only in experimental settings due to limited long-term data. A multidisciplinary, individualized strategy\u2014incorporating pharmacologic, surgical and psychosocial interventions\u2014remains the cornerstone of modern ED management. This review critically distinguishes well-established evidence from ongoing clinical debates and translates findings into practical guidance for daily practice. Ongoing technological advances may further refine diagnostic accuracy and treatment personalization, but high-quality studies are needed to establish the role of regenerative and digital tools.<\/jats:p>","DOI":"10.3390\/medicina62050854","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T08:46:26Z","timestamp":1777538786000},"page":"854","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Erectile Dysfunction: A Comprehensive Review of Pathophysiology, Diagnosis and Contemporary Management"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4315-7660","authenticated-orcid":false,"given":"Felice","family":"Crocetto","sequence":"first","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"Amicuzi","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1529-982X","authenticated-orcid":false,"given":"Michele","family":"Musone","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Imbimbo","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9000-7534","authenticated-orcid":false,"given":"Simone","family":"Tammaro","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2036-0356","authenticated-orcid":false,"given":"Luigi","family":"Napolitano","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Reccia","sequence":"additional","affiliation":[{"name":"Urology Unit, Azienda Ospedaliera di Rilievo Nazionale Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"De Luca","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgical Multispecialty, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3865-5988","authenticated-orcid":false,"given":"Francesco","family":"Del Giudice","sequence":"additional","affiliation":[{"name":"Department of Urology, University Sapienza, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Stizzo","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelangelo","family":"Olivetta","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgical Sciences, Azienda Ospedaliera di Rilievo Nazionale Sant\u2019Anna e San Sebastiano, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario Di","family":"Lieto","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele Di","family":"Mauro","sequence":"additional","affiliation":[{"name":"U.O.C. Anestesia, Rianimazione e Terapia Intensiva, Azienda Ospedaliera di Rilievo Nazionale Ospedali dei Colli, Cotugno Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennaro","family":"Mattiello","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgical Sciences, Azienda Ospedaliera di Rilievo Nazionale Sant\u2019Anna e San Sebastiano, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Puca","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5070-4968","authenticated-orcid":false,"given":"Giampiero","family":"Della Rosa","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Magliocchetti","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Giugliano","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Capoluongo","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariano","family":"Coppola","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvestro","family":"Imperatore","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Madonna","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Capone","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Del Biondo","sequence":"additional","affiliation":[{"name":"Department of Urology, Ospedale San Paolo, ASL NA1 Centro, 80125 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4884-132X","authenticated-orcid":false,"given":"Biagio","family":"Barone","sequence":"additional","affiliation":[{"name":"Department of Urology, Ospedale San Paolo, ASL NA1 Centro, 80125 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jsxm.2015.12.019","article-title":"Definitions of Sexual Dysfunctions in Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015","volume":"13","author":"McCabe","year":"2016","journal-title":"J. Sex. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1038\/s41443-025-01094-7","article-title":"Global Prevalence of Erectile Dysfunction in 2025: A Call for Updated Epidemiological Data","volume":"38","author":"Chen","year":"2025","journal-title":"Int. J. Impot. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.sxmr.2017.05.004","article-title":"Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors","volume":"5","author":"Nguyen","year":"2017","journal-title":"Sex. Med. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Zang, N., Xiang, Y., Lin, F., Liu, X., and Zhang, J. (2025). A Comprehensive Analysis of Erectile Dysfunction Prevalence and the Impact of Prostate Conditions on ED among US Adults: Evidence from NHANES 2001-2004. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1412369"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s11934-024-01213-9","article-title":"Erectile Dysfunction in Adolescents and Young Adults","volume":"25","author":"Pantazis","year":"2024","journal-title":"Curr. Urol. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.14336\/AD.2019.1028","article-title":"Practical Approaches to Treat ED in PDE5i Nonresponders","volume":"11","author":"Cai","year":"2020","journal-title":"Aging Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"17562872211002059","DOI":"10.1177\/17562872211002059","article-title":"Reviewing the Evidence for Shockwave- and Cell-Based Regenerative Therapies in the Treatment of Erectile Dysfunction","volume":"13","author":"Drury","year":"2021","journal-title":"Ther. Adv. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s13178-021-00668-6","article-title":"Embarrassment, Shame, and Reassurance: Emotion and Young People\u2019s Access to Online Sexual Health Information","volume":"20","author":"Waling","year":"2023","journal-title":"Sex. Res. Soc. Policy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.sxmr.2019.06.008","article-title":"Epidemiology Update of Erectile Dysfunction in Eight Countries with High Burden","volume":"8","author":"Goldstein","year":"2020","journal-title":"Sex. Med. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1111\/jsm.12885","article-title":"The Relationship between Metabolic Syndrome, Its Components, and Erectile Dysfunction: A Systematic Review and a Meta-Analysis of Observational Studies","volume":"12","author":"Besiroglu","year":"2015","journal-title":"J. Sex. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5229702","DOI":"10.1155\/2022\/5229702","article-title":"Prevalence, Comorbidities, and Risk Factors of Erectile Dysfunction: Results from a Prospective Real-World Study in the United Kingdom","volume":"2022","author":"Li","year":"2022","journal-title":"Int. J. Clin. Pract."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Sangiorgi, G., Cereda, A., Benedetto, D., Bonanni, M., Chiricolo, G., Cota, L., Martuscelli, E., and Greco, F. (2021). Anatomy, Pathophysiology, Molecular Mechanisms, and Clinical Management of Erectile Dysfunction in Patients Affected by Coronary Artery Disease: A Review. Biomedicines, 9.","DOI":"10.3390\/biomedicines9040432"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"de Souza, I.L.L., Ferreira, E.d.S., Vasconcelos, L.H.C., Cavalcante, F.d.A., and da Silva, B.A. (2022). Erectile Dysfunction: Key Role of Cavernous Smooth Muscle Cells. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.895044"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"32","DOI":"10.5410\/wjcu.v2.i3.32","article-title":"Neural Regulation of Sexual Function in Men","volume":"2","author":"Azadzoi","year":"2013","journal-title":"World J. Clin. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Melis, M.R., and Argiolas, A. (2021). Erectile Function and Sexual Behavior: A Review of the Role of Nitric Oxide in the Central Nervous System. Biomolecules, 11.","DOI":"10.3390\/biom11121866"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Sa\u011f\u0131r, S., Unsal, V., Oner, E., Y\u0131ld\u0131z, R., and Mert, B.D. (2025). Comparison of PDE-5 Inhibitors Used in Erectile Dysfunction with Some Candidate Molecules: A Study Involving Molecular Docking, ADMET, DFT, Biological Target, and Activity. BMC Urol., 25.","DOI":"10.1186\/s12894-025-01727-5"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"De Leonardis, F., Colalillo, G., Finazzi Agr\u00f2, E., Miano, R., Fuschi, A., and Asimakopoulos, A.D. (2022). Endothelial Dysfunction, Erectile Deficit and Cardiovascular Disease: An Overview of the Pathogenetic Links. Biomedicines, 10.","DOI":"10.3390\/biomedicines10081848"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"18389","DOI":"10.1038\/s41598-021-97230-6","article-title":"A Prospectively Collected Observational Study of Pelvic Floor Muscle Strength and Erectile Function Using a Novel Personalized Extracorporeal Perineometer","volume":"11","author":"Kim","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.2522\/ptj.20130354","article-title":"Pelvic-Floor Muscle Rehabilitation in Erectile Dysfunction and Premature Ejaculation","volume":"94","author":"Lavoisier","year":"2014","journal-title":"Phys. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.physio.2019.01.002","article-title":"Pelvic Floor Muscle Training Improves Erectile Dysfunction and Premature Ejaculation: A Systematic Review","volume":"105","author":"Myers","year":"2019","journal-title":"Physiotherapy"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.sxmr.2021.02.001","article-title":"The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction: A Narrative Review","volume":"10","author":"Yaacov","year":"2022","journal-title":"Sex. Med. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Liu, Y., Hu, X., Xiong, M., Li, J., Jiang, X., Wan, Y., Bai, S., and Zhang, X. (2023). Association of BMI with Erectile Dysfunction: A Cross-Sectional Study of Men from an Andrology Clinic. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1135024"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Banerjee, D., and Mani, A. (2025). Obesity\u2019s Systemic Impact: Exploring Molecular and Physiological Links to Diabetes, Cardiovascular Disease, and Heart Failure. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1681766"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e12997","DOI":"10.1111\/eci.12997","article-title":"Adipokine Dysregulation and Adipose Tissue Inflammation in Human Obesity","volume":"48","author":"Unamuno","year":"2018","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"De Lorenzo, A., Noce, A., Moriconi, E., Rampello, T., Marrone, G., Di Daniele, N., and Rovella, V. (2018). MOSH Syndrome (Male Obesity Secondary Hypogonadism): Clinical Assessment and Possible Therapeutic Approaches. Nutrients, 10.","DOI":"10.20944\/preprints201803.0259.v1"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Huang, L., Liu, H., Li, L., Wang, S., and Sun, G. (2023). Correlation between Visceral Fat Metabolism Score and Erectile Dysfunction: A Cross-Sectional Study from NHANES 2001-2004. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1283545"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"107910","DOI":"10.5662\/wjm.v16.i1.107910","article-title":"Erectile Dysfunction: Proposed Definition and Staging for Early Diagnosis","volume":"16","author":"Raveendran","year":"2026","journal-title":"World J. Methodol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"709","DOI":"10.21037\/tau.2020.03.10","article-title":"Current Approaches to the Diagnosis of Vascular Erectile Dysfunction","volume":"9","author":"Ma","year":"2020","journal-title":"Transl. Androl. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.jsxm.2016.01.007","article-title":"Endocrinologic Control of Men\u2019s Sexual Desire and Arousal\/Erection","volume":"13","author":"Corona","year":"2016","journal-title":"J. Sex. Med."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Thomas, C., and Konstantinidis, C. (2021). Neurogenic Erectile Dysfunction. Where Do We Stand? Medicines, 8.","DOI":"10.3390\/medicines8010003"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e030061","DOI":"10.1136\/bmjopen-2019-030061","article-title":"Neuroimaging Biomarkers of Psychogenic Erectile Dysfunction: Protocol for a Systematic Review","volume":"9","author":"Yin","year":"2019","journal-title":"BMJ Open"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"11","DOI":"10.4103\/1008-682X.139253","article-title":"Evaluation of Young Men with Organic Erectile Dysfunction","volume":"17","author":"Papagiannopoulos","year":"2015","journal-title":"Asian J. Androl."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"100434","DOI":"10.1016\/j.esxm.2021.100434","article-title":"A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM)","volume":"9","author":"Dewitte","year":"2021","journal-title":"Sex. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1007\/s00270-023-03412-2","article-title":"Venous Leak Embolization in Patients with Venogenic Erectile Dysfunction via Deep Dorsal Penile Vein Access: Safety and Early Efficacy","volume":"46","author":"Diehm","year":"2023","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1080\/00015385.2019.1590498","article-title":"The Erectile Dysfunction as a Marker of Cardiovascular Disease: A Review","volume":"75","author":"Diaconu","year":"2020","journal-title":"Acta Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1007\/s11930-014-0023-9","article-title":"Current Diagnosis and Management of Erectile Dysfunction","volume":"6","author":"Pastuszak","year":"2014","journal-title":"Curr. Sex. Health Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"159","DOI":"10.18773\/austprescr.2022.051","article-title":"Erectile Dysfunction: Causes, Assessment and Management Options","volume":"45","author":"Lowy","year":"2022","journal-title":"Aust. Prescr."},{"key":"ref_38","first-page":"142","article-title":"Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction","volume":"14","author":"Christanto","year":"2025","journal-title":"F1000Research"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/S0090-4295(97)00238-0","article-title":"The International Index of Erectile Function (IIEF): A Multidimensional Scale for Assessment of Erectile Dysfunction","volume":"49","author":"Rosen","year":"1997","journal-title":"Urology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1038\/sj.ijir.3900472","article-title":"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","volume":"11","author":"Rosen","year":"1999","journal-title":"Int. J. Impot. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"qfad009","DOI":"10.1093\/sexmed\/qfad009","article-title":"Erection Hardness Score or Penile Doppler Ultrasound: Which Is a Better Predictor of Failure of Nonsurgical Treatment of Erectile Dysfunction?","volume":"11","author":"Silva","year":"2023","journal-title":"Sex. Med."},{"key":"ref_42","first-page":"139","article-title":"Assessing Sexual Health: A Comprehensive Scoping Review of Measurement Questionnaires","volume":"38","author":"Arabkari","year":"2024","journal-title":"Med. J. Islam. Repub. Iran"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Cao, S., Hu, X., Shao, Y., Wang, Y., Tang, Y., Ren, S., and Li, X. (2023). Relationship between Weight-Adjusted-Waist Index and Erectile Dysfunction in the United State: Results from NHANES 2001-2004. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1128076"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/bju.15313","article-title":"Association of Erectile Dysfunction and Cardiovascular Disease: An Umbrella Review of Systematic Reviews and Meta-analyses","volume":"128","author":"Mostafaei","year":"2021","journal-title":"BJU Int."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e14504","DOI":"10.1111\/and.14504","article-title":"The Relationship between Obstructive Sleep Apnoea and Erectile Dysfunction: An Underdiagnosed Link? A Prospective Cross-Sectional Study","volume":"54","author":"Cantone","year":"2022","journal-title":"Andrologia"},{"key":"ref_46","first-page":"e102020","article-title":"Management of Erectile Dysfunction in Middle-Aged Men: A Prospective Evaluation of Lifestyle and Pharmacological Treatments in a Tertiary Care Center","volume":"18","author":"Bokre","year":"2026","journal-title":"Cureus"},{"key":"ref_47","first-page":"1","article-title":"Reviewers of the AACE\/ACE Obesity Clinical Practice Guidelines. American Association Of Clinical Endocrinologists And American College Of Endocrinology Comprehensive Clinical Practice Guidelines For Medical Care Of Patients With Obesity","volume":"22","author":"Garvey","year":"2016","journal-title":"Endocr. Pract. Off. J. Am. Coll. Endocrinol. Am. Assoc. Clin. Endocrinol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2786","DOI":"10.21037\/tau-20-796","article-title":"Diagnosis of Hypogonadism in Patients Treated with Low Energy Shock Wave Therapy for Erectile Dysfunction: A Narrative Review","volume":"9","author":"Biernikiewicz","year":"2020","journal-title":"Transl. Androl. Urol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"621","DOI":"10.12669\/pjms.343.14330","article-title":"The Association between Subclinical Hypothyroidism and Erectile Dysfunction","volume":"34","author":"Chen","year":"2018","journal-title":"Pak. J. Med. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"117532","DOI":"10.1016\/j.taap.2025.117532","article-title":"Prolactin Impairs Erectile Function via eNOS Suppression Independently of Testosterone","volume":"504","author":"Cheng","year":"2025","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1503\/cmaj.150033","article-title":"Diagnosis and Management of Testosterone Deficiency Syndrome in Men: Clinical Practice Guideline","volume":"187","author":"Morales","year":"2015","journal-title":"CMAJ Can. Med. Assoc. J."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Salari, N., Heidarian, P., Jalili, F., Babajani, F., Shohaimi, S., Nasirian, M., and Mohammadi, M. (2024). The Sexual Dysfunction in Women with Thyroid Disorders: A Meta-Analysis. BMC Endocr. Disord., 24.","DOI":"10.1186\/s12902-024-01817-9"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1093\/jsxmed\/qdad163","article-title":"Princeton IV Consensus Guidelines: PDE5 Inhibitors and Cardiac Health","volume":"21","author":"Kloner","year":"2024","journal-title":"J. Sex. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1111\/jsm.12715","article-title":"Changes in Erectile Dysfunction over Time in Relation to Framingham Cardiovascular Risk in the Boston Area Community Health (BACH) Survey","volume":"12","author":"Fang","year":"2015","journal-title":"J. Sex. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1093\/jsxmed\/qdae070","article-title":"Efficient Use of Penile Doppler Ultrasound for Investigating Men with Erectile Dysfunction","volume":"21","author":"Flores","year":"2024","journal-title":"J. Sex. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.2214\/AJR.19.22141","article-title":"Penile Doppler Ultrasound for Erectile Dysfunction: Technique and Interpretation","volume":"214","author":"Varela","year":"2020","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1016\/j.sxmr.2018.10.005","article-title":"The Role of Nocturnal Penile Tumescence and Rigidity (NPTR) Monitoring in the Diagnosis of Psychogenic Erectile Dysfunction: A Review","volume":"7","author":"Zou","year":"2019","journal-title":"Sex. Med. Rev."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1093\/jsxmed\/qdaf173","article-title":"Prevalence of Mental Health Evaluation in Erectile Dysfunction Clinical Trials","volume":"22","author":"Morcos","year":"2025","journal-title":"J. Sex. Med."},{"key":"ref_59","unstructured":"(2025, November 02). Top Researchers in Andrology: A Bibliometric and Demographic Analysis of the Last 7 Years. Available online: https:\/\/www.jomh.org\/articles\/10.22514\/jomh.2024.129."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1111\/andr.70135","article-title":"From Prototype to Clinical Practice: How to Validate Novel Instruments for Non-Invasive Erectile Dysfunction Diagnostics?","volume":"14","author":"Torenvlied","year":"2026","journal-title":"Andrology"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.eururo.2025.04.010","article-title":"European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Hypogonadism, Erectile Dysfunction, Premature Ejaculation, and Peyronie\u2019s Disease","volume":"88","author":"Salonia","year":"2025","journal-title":"Eur. Urol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/j.clinthera.2017.01.001","article-title":"Phosphodiesterase Type 5 Inhibitors for the Treatment of Erectile Dysfunction: Pharmacology and Clinical Impact of the Sildenafil Citrate Orodispersible Tablet Formulation","volume":"39","author":"Scaglione","year":"2017","journal-title":"Clin. Ther."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.juro.2018.05.004","article-title":"Erectile Dysfunction: AUA Guideline","volume":"200","author":"Burnett","year":"2018","journal-title":"J. Urol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1002\/sm2.28","article-title":"An Update of the International Society of Sexual Medicine\u2019s Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE)","volume":"2","author":"Althof","year":"2014","journal-title":"Sex. Med."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Romano, L., Arcaniolo, D., Spirito, L., Quattrone, C., Bottone, F., Pandolfo, S.D., Barone, B., Napolitano, L., Ditonno, F., and Franco, A. (2024). Comparison of Current International Guidelines on Premature Ejaculation: 2024 Update. Diagnostics, 14.","DOI":"10.3390\/diagnostics14161819"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"El-Osta, A., Kerr, G., Alaa, A., El Asmar, M.L., Karki, M., Webber, I., Riboli Sasco, E., Blume, G., Beecken, W.-D., and Mummery, D. (2023). Investigating Self-Reported Efficacy of Lifestyle Medicine Approaches to Tackle Erectile Dysfunction: A Cross-Sectional eSurvey Based Study. BMC Urol., 23.","DOI":"10.1186\/s12894-023-01180-2"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1111\/andr.13791","article-title":"Sexual Dysfunctions in Inflammatory Bowel Disease: Role of Mediterranean Diet and Quality of Life","volume":"13","author":"Romano","year":"2025","journal-title":"Andrology"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Defeudis, G., Mocini, E., Mazzilli, R., Massari, M.C., Minnetti, M., Stojanovic, V., Medenica, S., Poggiogalle, E., Faggiano, A., and Donini, L.M. (2026). The Influence of the Mediterranean Dietary Pattern on Male and Female Sexual Dysfunctions: An Updated Review. Hormones.","DOI":"10.1007\/s42000-025-00756-x"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1016\/j.dld.2022.05.016","article-title":"Sexual Dysfunction in Gastroenterological Patients: Do Gastroenterologists Care Enough? A Nationwide Survey from the Italian Society of Gastroenterology (SIGE)","volume":"54","author":"Romano","year":"2022","journal-title":"Dig. Liver Dis."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.genhosppsych.2017.04.003","article-title":"Lifestyle Interventions for Weight Loss among Overweight and Obese Adults with Serious Mental Illness: A Systematic Review and Meta-Analysis","volume":"47","author":"Naslund","year":"2017","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_71","first-page":"648","article-title":"Improved Erectile Function after Bariatric Surgery: Role of Testosterone and Other Factors-a Cohort Prospective Study","volume":"21","author":"Wysocki","year":"2025","journal-title":"Surg. Obes. Relat. Dis. Off. J. Am. Soc. Bariatr. Surg."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.esxm.2019.06.003","article-title":"Effect of Bariatric Surgery on Male Sexual Function: A Meta-Analysis and Systematic Review","volume":"7","author":"Xu","year":"2019","journal-title":"Sex. Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1159\/000508171","article-title":"A Meta-Analysis of Erectile Dysfunction and Alcohol Consumption","volume":"105","author":"Li","year":"2021","journal-title":"Urol. Int."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1093\/jsxmed\/qdaf045","article-title":"The Relationship between Perceived Stress and Erectile Function in Patients with Psychogenic Erectile Dysfunction: The Mediating Role of Fatigue","volume":"22","author":"Cao","year":"2025","journal-title":"J. Sex. Med."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"187","DOI":"10.21037\/tau.2016.02.05","article-title":"Can Lifestyle Modification Affect Men\u2019s Erectile Function?","volume":"5","author":"Hehemann","year":"2016","journal-title":"Transl. Androl. Urol."},{"key":"ref_76","first-page":"759","article-title":"Water Vapor Thermal Therapy (Rez\u016bm System) in Patients with Large Prostates: Results from a Prospective Comparative Study","volume":"76","author":"Balsamo","year":"2024","journal-title":"Minerva Urol. Nephrol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.esxm.2019.06.006","article-title":"Meta-Analysis of the Long-Term Efficacy and Tolerance of Tadalafil Daily Compared With Tadalafil On-Demand in Treating Men With Erectile Dysfunction","volume":"7","author":"Zhou","year":"2019","journal-title":"Sex. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.jsxm.2020.01.027","article-title":"Phosphodiesterase Type-5 Inhibitor Prescription Patterns in the United States Among Men with Erectile Dysfunction: An Update","volume":"17","author":"Mulhall","year":"2020","journal-title":"J. Sex. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"42","DOI":"10.23736\/S2724-6051.23.05552-0","article-title":"Treatment Preferences of Patients with Erectile Dysfunction: A Systematic Review of Randomized Controlled Trials","volume":"76","author":"Manfredi","year":"2024","journal-title":"Minerva Urol. Nephrol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.eururo.2015.03.031","article-title":"Phosphodiesterase 5 Inhibitors for the Treatment of Erectile Dysfunction: A Trade-off Network Meta-Analysis","volume":"68","author":"Chen","year":"2015","journal-title":"Eur. Urol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.sxmr.2018.03.008","article-title":"Cardiovascular Safety of Phosphodiesterase Type 5 Inhibitors After Nearly 2 Decades on the Market","volume":"6","author":"Kloner","year":"2018","journal-title":"Sex. Med. Rev."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s10557-021-07275-y","article-title":"Cardiac Effects of Phosphodiesterase-5 Inhibitors: Efficacy and Safety","volume":"37","author":"Roy","year":"2023","journal-title":"Cardiovasc. Drugs Ther."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1007\/s00345-020-03233-9","article-title":"Efficacy and Safety of Oral Phosphodiesterase 5 Inhibitors for Erectile Dysfunction: A Network Meta-Analysis and Multicriteria Decision Analysis","volume":"39","author":"Madeira","year":"2021","journal-title":"World J. Urol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/j.jacc.2021.01.045","article-title":"Association of Phosphodiesterase-5 Inhibitors Versus Alprostadil With Survival in Men With Coronary Artery Disease","volume":"77","author":"Andersson","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1016\/j.jsxm.2016.09.008","article-title":"External Mechanical Devices and Vascular Surgery for Erectile Dysfunction","volume":"13","author":"Trost","year":"2016","journal-title":"J. Sex. Med."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"e5721","DOI":"10.1002\/pds.5721","article-title":"Oral Phosphodiesterase Type 5 Inhibitors and Priapism: A VigiBase Analysis","volume":"33","author":"Abbasi","year":"2024","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1080\/13685538.2016.1230601","article-title":"Vacuum Erection Device in Treatment of Organic Erectile Dysfunction and Penile Vascular Differences between Patients with DM Type I and DM Type II","volume":"20","author":"Pajovic","year":"2017","journal-title":"Aging Male Off. J. Int. Soc. Study Aging Male"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Dell\u2019Atti, L., Slyusar, V., Ronchi, P., and Cambise, C. (2024). Vacuum Erection Device Plus Once-Daily Tadalafil Improve Clinical Outcomes after Extracorporeal Shock Wave Therapy in Men Affected by Erectile Dysfunction Associated with Peyronie\u2019s Disease. Life, 14.","DOI":"10.3390\/life14091162"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"65","DOI":"10.5534\/wjmh.2017.35.2.65","article-title":"Testosterone Replacement Therapy: Long-Term Safety and Efficacy","volume":"35","author":"Corona","year":"2017","journal-title":"World J. Men\u2019s Health"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1007\/s11934-019-0908-2","article-title":"Emerging Treatments for Erectile Dysfunction: A Review of Novel, Non-Surgical Options","volume":"20","author":"Patel","year":"2019","journal-title":"Curr. Urol. Rep."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Tao, R., Chen, J., Wang, D., Li, Y., Xiang, J., Xiong, L., Ji, J., Wu, J., Zhou, S., and Jia, C. (2022). The Efficacy of Li-ESWT Combined With VED in Diabetic ED Patients Unresponsive to PDE5is: A Single-Center, Randomized Clinical Trial. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.937958"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.esxm.2019.06.001","article-title":"Interventions to Treat Erectile Dysfunction and Premature Ejaculation: An Overview of Systematic Reviews","volume":"7","author":"Ciocanel","year":"2019","journal-title":"Sex. Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1080\/2090598X.2021.1926763","article-title":"The Effectiveness of Psychological Interventions Alone, or in Combination with Phosphodiesterase-5 Inhibitors, for the Treatment of Erectile Dysfunction: A Systematic Review","volume":"19","author":"Atallah","year":"2021","journal-title":"Arab J. Urol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.sxmr.2018.12.006","article-title":"Platelet-Rich Plasma and Treatment of Erectile Dysfunction: Critical Review of Literature and Global Trends in Platelet-Rich Plasma Clinics","volume":"7","author":"Scott","year":"2019","journal-title":"Sex. Med. Rev."},{"key":"ref_95","first-page":"27","article-title":"Safety and Efficacy of Inflatable Penile Prostheses for the Treatment of Erectile Dysfunction: Evidence to Date","volume":"15","author":"Wang","year":"2022","journal-title":"Med. Devices Auckl. NZ"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1038\/s41443-025-01165-9","article-title":"Removal Rate and Mechanical Failure in Penile Prosthesis Implantation: A Systematic Review","volume":"38","author":"Pezzoli","year":"2026","journal-title":"Int. J. Impot. Res."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"S767","DOI":"10.21037\/tau.2017.04.25","article-title":"30-Day Adverse Event Rates Following Penile Prosthesis Surgery: An American College of Surgeons National Surgical Quality Improvement Program Based Evaluation","volume":"6","author":"Sood","year":"2017","journal-title":"Transl. Androl. Urol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"2472786","DOI":"10.1080\/13685538.2025.2472786","article-title":"The Efficacy of Platelet-Rich Plasma (PRP) Alone or in Combination with Low Intensity Shock Wave Therapy (Li-SWT) in Treating Erectile Dysfunction: A Systematic Review and Meta-Analysis of Seven Randomized Controlled Trials","volume":"28","author":"Zhou","year":"2025","journal-title":"Aging Male Off. J. Int. Soc. Study Aging Male"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"e14197","DOI":"10.1111\/and.14197","article-title":"Comparison of the Efficacy of Low-Intensity Shock Wave Therapy and Its Combination with Platelet-Rich Plasma in Patients with Erectile Dysfunction","volume":"53","author":"Geyik","year":"2021","journal-title":"Andrologia"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"283","DOI":"10.5534\/wjmh.230105","article-title":"Variations in Low Intensity Shockwave Treatment Protocols for Erectile Dysfunction: A Review of the Literature and Guide to Offering Treatment","volume":"42","author":"Hayon","year":"2024","journal-title":"World J. Men\u2019s Health"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1097\/JU.0000000000003481","article-title":"Platelet Rich Plasma for the Treatment of Erectile Dysfunction: A Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial","volume":"210","author":"Masterson","year":"2023","journal-title":"J. Urol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"970","DOI":"10.21037\/tau-24-30","article-title":"Efficacy and Safety of Platelet-Rich Plasma (PRP) in Erectile Dysfunction (ED): A Systematic Review and Meta-Analysis","volume":"13","author":"Huang","year":"2024","journal-title":"Transl. Androl. Urol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"e225","DOI":"10.1016\/j.esxm.2016.06.001","article-title":"Twelve-Month Efficacy and Safety of Low-Intensity Shockwave Therapy for Erectile Dysfunction in Patients Who Do Not Respond to Phosphodiesterase Type 5 Inhibitors","volume":"4","author":"Bechara","year":"2016","journal-title":"Sex. Med."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Napolitano, L., Barone, B., Spirito, L., Trama, F., Pandolfo, S.D., Capece, M., Garc\u00eda-Rojo, E., Fern\u00e1ndez-Pascual, E., Crocetto, F., and Fusco, F. (2023). Voice Assistants as Consultants for Male Patients with Sexual Dysfunction: A Reliable Option?. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20032612"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.sxmr.2018.03.007","article-title":"Comparison of Infrapubic vs Penoscrotal Approaches for 3-Piece Inflatable Penile Prosthesis Placement: Do We Have a Winner?","volume":"6","author":"Palmisano","year":"2018","journal-title":"Sex. Med. Rev."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"qeaf065","DOI":"10.1093\/sxmrev\/qeaf065","article-title":"A Critical Analysis of the Methodological Limitations in Trials of Low-Intensity Shockwave Therapy for Erectile Dysfunction","volume":"14","author":"Salter","year":"2026","journal-title":"Sex. Med. Rev."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.21037\/tau-24-329","article-title":"Is Low-Intensity Shockwave Therapy for Erectile Dysfunction a Durable Treatment Option?\u2014Long-Term Outcomes of a Randomized Sham-Controlled Trial","volume":"13","author":"Lange","year":"2024","journal-title":"Transl. Androl. Urol."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1016\/j.jsxm.2019.08.001","article-title":"Long-Term Follow-Up After Penile Prosthesis Implantation-Survival and Quality of Life Outcomes","volume":"16","author":"Chierigo","year":"2019","journal-title":"J. Sex. Med."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"qdaf325","DOI":"10.1093\/jsxmed\/qdaf325","article-title":"Current Advances in Platelet-Rich Plasma Therapy for Erectile Dysfunction: A Meta-Analysis of Randomized Controlled Trials","volume":"23","author":"Jacob","year":"2026","journal-title":"J. Sex. Med."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s00345-024-05065-3","article-title":"Platelet-Rich Plasma Therapy in Erectile Dysfunction and Peyronie\u2019s Disease: A Systematic Review of the Literature","volume":"42","author":"Asmundo","year":"2024","journal-title":"World J. Urol."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"873","DOI":"10.2471\/BLT.24.291565","article-title":"Associations between Sexual Health and Well-Being: A Systematic Review","volume":"102","author":"Vasconcelos","year":"2024","journal-title":"Bull. World Health Organ."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"271","DOI":"10.2174\/0115748871355207250411202640","article-title":"Sexual Dysfunctions in Chronic Liver Diseases: A Narrative Review on Prevalence and Putative Pathophysiologic Mechanisms","volume":"20","author":"Priadko","year":"2025","journal-title":"Rev. Recent. Clin. Trials"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.sxmr.2020.05.005","article-title":"Effect of Genetic Polymorphism on the Response to PDE5 Inhibitors in Patients With Erectile Dysfunction: A Systematic Review and a Critical Appraisal","volume":"8","author":"Mostafa","year":"2020","journal-title":"Sex. Med. Rev."},{"key":"ref_114","first-page":"e77851","article-title":"Association of Sexual Health and Mental Health in Erectile Dysfunction: Expert Opinion from the Indian Context","volume":"17","author":"Vasan","year":"2025","journal-title":"Cureus"},{"key":"ref_115","first-page":"e36450","article-title":"Is Penile Doppler Ultrasonography Overdiagnosed?","volume":"15","author":"Salman","year":"2023","journal-title":"Cureus"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"qfaf104","DOI":"10.1093\/sexmed\/qfaf104","article-title":"Utilization and Prospects of Artificial Intelligence in the Diagnosis, Prediction, and Treatment of Erectile Dysfunction","volume":"14","author":"Zhang","year":"2026","journal-title":"Sex. Med."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"373","DOI":"10.4081\/aiua.2022.3.373","article-title":"Natural Treatments for Erectile Dysfunction: A Focus on Mobile Health Applications","volume":"94","author":"Napolitano","year":"2022","journal-title":"Arch. Ital. Urol. Androl."},{"key":"ref_118","first-page":"e89918","article-title":"Erectile Dysfunction in Young Adults: A Narrative Review","volume":"17","author":"Safa","year":"2025","journal-title":"Cureus"},{"key":"ref_119","first-page":"1","article-title":"Efficacy and Putative Mechanisms of Action of Nutraceuticals in the Management of Erectile Dysfunction: A Narrative Review","volume":"21","author":"Romano","year":"2025","journal-title":"J. Men\u2019s Health"},{"key":"ref_120","doi-asserted-by":"crossref","unstructured":"Barone, B., Amicuzi, U., Tammaro, S., Olivetta, M., Stizzo, M., Musone, M., Napolitano, L., De Luca, L., Reccia, P., and Capone, F. (2026). Male Infertility: A Comprehensive Review of Urological Causes and Contemporary Management. J. Clin. Med., 15.","DOI":"10.3390\/jcm15010397"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"16003","DOI":"10.1038\/nrdp.2016.3","article-title":"Erectile Dysfunction","volume":"2","author":"Yafi","year":"2016","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1002\/pros.24675","article-title":"Prostate and Gut: Any Relationship? A Narrative Review on the Available Evidence and Putative Mechanisms","volume":"84","author":"Romano","year":"2024","journal-title":"Prostate"},{"key":"ref_123","doi-asserted-by":"crossref","unstructured":"Argiolas, A., Argiolas, F.M., Argiolas, G., and Melis, M.R. (2023). Erectile Dysfunction: Treatments, Advances and New Therapeutic Strategies. Brain Sci., 13.","DOI":"10.3390\/brainsci13050802"},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"200","DOI":"10.4111\/icu.20230114","article-title":"The Future Role of Precision Medicine in Male Sexual Dysfunction","volume":"64","author":"Park","year":"2023","journal-title":"Investig. Clin. Urol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"qfaf025","DOI":"10.1093\/sexmed\/qfaf025","article-title":"Sexual Dysfunctions in Patients with Well-Compensated Chronic Liver Disease: Role of Etiology, Mediterranean Diet and Quality of Life in an Observational Cross-Sectional Study","volume":"13","author":"Romano","year":"2025","journal-title":"Sex. Med."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"5842","DOI":"10.7150\/ijbs.120980","article-title":"Metabolic Syndrome-Associated Erectile Dysfunction: Multiple Vascular Endothelial Dysfunction Mechanisms and Potential Therapeutic Targets","volume":"21","author":"Wang","year":"2025","journal-title":"Int. J. Biol. Sci."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"190","DOI":"10.4103\/singaporemedj.SMJ-2022-101","article-title":"Erectile Dysfunction: Assessment and Management in Primary Care","volume":"65","author":"Ong","year":"2024","journal-title":"Singap. Med. J."},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Wang, W., Zhao, S., Zhou, R., Yu, P.-Z., Pan, S.-Y., Huan, P.-F., Shi, Z.-D., Liu, Y., Hu, X., and Lu, J.-R. (2025). Associations between Metabolic Syndrome and Erectile Dysfunction: Evidence from the NHANES 2001-2004. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1543668"},{"key":"ref_129","first-page":"5","article-title":"Lifestyle Modifications and Erectile Dysfunction: What Can Be Expected?","volume":"17","author":"Maiorino","year":"2014","journal-title":"Asian J. Androl."},{"key":"ref_130","doi-asserted-by":"crossref","unstructured":"Qin, Z., Wu, W., Wei, Y., Xu, H., Liu, B., and Bao, B. (2026). The Impact of Bariatric Surgery on Male Sexual Function: A Systematic Review and Meta-Analysis. Front. Endocrinol., 17.","DOI":"10.3389\/fendo.2026.1798050"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/andr.70108","article-title":"Comparative Efficacy of Combination Therapy Including Regenerative Therapies versus Monotherapy for Erectile Dysfunction: A Systematic Review and Meta-analysis","volume":"14","author":"Quistini","year":"2026","journal-title":"Andrology"},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"118","DOI":"10.4111\/icu.20220327","article-title":"Low-Intensity Extracorporeal Shock Wave Therapy for Erectile Dysfunction: Myths and Realities","volume":"64","author":"Bocchino","year":"2023","journal-title":"Investig. Clin. Urol."},{"key":"ref_133","doi-asserted-by":"crossref","unstructured":"Medrano-S\u00e1nchez, E.M., Pe\u00f1a-Cantonero, B., Cand\u00f3n-Ballester, P., Blanco-D\u00edaz, M., and D\u00edaz-Mohedo, E. (2024). Effectiveness of Low-Intensity Extracorporeal Shock Wave Therapy in Erectile Dysfunction: An Analysis of Sexual Function and Penile Hardness at Erection: An Umbrella Review. J. Pers. Med., 14.","DOI":"10.3390\/jpm14020177"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"501","DOI":"10.3390\/clinpract12040054","article-title":"Psychological Factors Related to Impotence as a Sexual Dysfunction in Young Men: A Literature Scan for Noteworthy Research Frameworks","volume":"12","author":"Ciaccio","year":"2022","journal-title":"Clin. Pract."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.ucl.2021.06.009","article-title":"Physiology of Erection and Pathophysiology of Erectile Dysfunction","volume":"48","author":"MacDonald","year":"2021","journal-title":"Urol. Clin. N. Am."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"102","DOI":"10.12688\/f1000research.16576.1","article-title":"Recent Advances in the Understanding and Management of Erectile Dysfunction","volume":"8","author":"Krzastek","year":"2019","journal-title":"F1000Research"},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"690","DOI":"10.21037\/tau-22-600","article-title":"Comparison of Satisfaction with Penile Prosthesis Implantation in Patients with Prostate Cancer Radiation Therapy versus Radical Prostatectomy","volume":"12","author":"Mehr","year":"2023","journal-title":"Transl. Androl. Urol."},{"key":"ref_138","doi-asserted-by":"crossref","unstructured":"De Rocco Ponce, M., Silva Garret\u00f3n, A., Sousa Iglesias, \u00c1., Dumas Castro, S., Contreras Garcia, R., Malca Caballero, L., Rene Sanchez Curbelo, J., Vantman Luft, D., Casta\u00f1\u00e9, E.R., and Rajmil, O. (2025). Patient Satisfaction and Outcomes of Penile Prosthesis Implantation in Psychogenic and Organic Erectile Dysfunction: A Comparative Study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14145032"},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1093\/jsxmed\/qdad059","article-title":"Multidisciplinary Approach to the Treatment of Sexual Dysfunction in Couples Using a Biopsychosocial Model","volume":"20","author":"Lynn","year":"2023","journal-title":"J. Sex. Med."},{"key":"ref_140","first-page":"e77087","article-title":"Partnering With Patients to Improve a Multidisciplinary Sexual Dysfunction Program: A Survey of Patient Experience at a Single Institution","volume":"17","author":"Iftekhar","year":"2025","journal-title":"Cureus"},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"2106","DOI":"10.21037\/tau-2025-193","article-title":"Advances in Erectile Dysfunction Treatment Research: A Narrative Review","volume":"14","author":"Yao","year":"2025","journal-title":"Transl. Androl. Urol."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"211","DOI":"10.4081\/aiua.2022.2.211","article-title":"Erectile Dysfunction and Mobile Phone Applications: Quality, Content and Adherence to European Association Guidelines on Male Sexual Dysfunction","volume":"94","author":"Napolitano","year":"2022","journal-title":"Arch. Ital. Urol. Androl."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"470","DOI":"10.4081\/aiua.2022.4.470","article-title":"Male Infertility, What Mobile Health Applications \u201cKnow\u201d: Quality Analysis and Adherence to European Association of Urology Guidelines","volume":"94","author":"Fusco","year":"2022","journal-title":"Arch. Ital. Urol. Androl."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"328","DOI":"10.4081\/aiua.2022.3.328","article-title":"Premature Ejaculation in the Era of Mobile Health Application: A Current Analysis and Evaluation of Adherence to EAU Guidelines","volume":"94","author":"Napolitano","year":"2022","journal-title":"Arch. Ital. Urol. 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