Advances in Erectile Dysfunction Management: What Does Work

ABSTRACT Erectile dysfunction (ED) is a prevalent and multifactorial disorder that substantially affects quality of life. Pathophysiology includes vascular, neurogenic, drug‐induced, and psychogenic causes, and frequently coexists with cardiometabolic disease. This review synthesizes contemporary evidence on ED diagnosis and management, spanning lifestyle optimization, pharmacologic therapy, device‐based approaches, regenerative modalities, and unique considerations in men treated for prostate cancer. A comprehensive, narrative literature review was conducted using PubMed and Embase to identify peer‐reviewed original studies and review articles published through September 2025. Relevant findings were synthesized to provide an updated overview of current diagnostic and therapeutic approaches and to highlight ongoing challenges and unmet clinical needs. We summarize the full range of contemporary therapies for erectile dysfunction, including lifestyle modification, comorbidity management, pharmacologic therapy, intraurethral agents, intracavernosal injections, vacuum erection devices (VED), penile prosthesis surgery, and postprostatectomy rehabilitation. Lifestyle optimization—particularly increased physical activity, smoking cessation, and glycemic control—remains foundational to both prevention and treatment. Phosphodiesterase type 5 inhibitors (PDE‐5i) continue to serve as first‐line therapy, with high efficacy, favorable safety, and emerging evidence of cardioprotective and renoprotective benefits. For men who do not respond to or cannot use PDE‐5i, effective alternatives include intracavernosal injections, VED, and penile prosthesis implantation. Regenerative therapies—such as low‐intensity extracorporeal shockwave therapy (LI‐ESWT), platelet‐rich plasma (PRP), and stem‐cell–based approaches—aim to restore endothelial and smooth muscle integrity, though evidence remains heterogeneous and long‐term randomized trials are needed. Combination strategies, including daily PDE‐5i therapy with testosterone replacement (in hypogonadal men), antioxidants, VED use, or LI‐ESWT, yield additive improvements without increased adverse events. Among prostate cancer survivors, ED remains common after radical prostatectomy and radiotherapy; early “prehabilitation” and structured rehabilitation with exercise, daily PDE‐5i, and VED use may enhance erectile recovery. ED management has evolved toward a comprehensive yet highly individualized model integrating lifestyle optimization, pharmacotherapy, and multimodal rehabilitation. Despite therapeutic advances, postprostate cancer ED remains a major unmet need. Future research should refine predictive models, optimize timing and combination of interventions, and explore regenerative and vascular restoration therapies to further enhance functional recovery and long‐term outcomes.