Narrative-based sexual medicine. A collection of patients' stories and clinical cases to better understand the management of erectile dysfunction with type 5 phosphodiesterase inhibitors in the real life

INTRODUCTION: Narrative-based medicine (NBM) integrates patient stories with the clinician's perspective and scientific evidence to personalize care. This approach is particularly well suited to sexual medicine. Sexual dysfunctions - especially erectile dysfunction (ED) - are highly multifaceted conditions in which individual histories and couple dynamics substantially influence diagnosis and treatment. Traditional evidence-based tools may fail to capture this complexity, as sexual symptoms emerge from the interplay of several connected systems. . FINDINGS: This narrative review presents a series of realistic clinical vignettes illustrating the challenges of ED management within contemporary Italian sexual medicine, using the multidisciplinary Italian Society of Andrology and Sexual Medicine (SIAMS) guidelines as a normative framework. Each vignette is accompanied by scientific commentary grounded on evidence provided by the SIAMS guidelines. ED is framed as a sentinel symptom of systemic health, as postulated by the Systems Sexology which offer integrative models connecting the prescription of virtuous lifestyles with the type 5 phosphodiesterase inhibitors (PDE5i). CONCLUSION: This perspective underscores the inadequacy of simplistic "symptom-pill" approaches and highlights the need for personalized, multidimensional care, including alternative pharmaceutical formulations of PDE5i, such as the orodispersible film, that may enhance discretion, acceptability, and adherence.