title: Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: a narrative review and meta-analysis.
abstract: BACKGROUND
  Erectile dysfunction (ED) is an increasing health problem that demands 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Primary outcome was ED symptoms, and secondary outcome was sexual satisfaction of the patient.
  
  
  METHODS
  A systematic literature search was conducted in order to identify relevant articles published between 1998 and 2012. We included randomized controlled trials and controlled trials comparing PI with PDE5-I treatment or one of them against a combination of both.
  
  
  RESULTS
  Eight studies with a total number of 562 patients were included in the meta-analysis. 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 stand-alone treatments. None of the moderators (treatment duration, methodological quality, or researcher allegiance) altered the effects.
  
  
  CONCLUSIONS
  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. Stronger RCTs are required to confirm this initial finding.
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Hannah M
authors.initials: HM
authors.lastname: Schmidt
authors.forename: Thomas
authors.initials: T
authors.lastname: Munder
authors.forename: Heike
authors.initials: H
authors.lastname: Gerger
authors.forename: Sarah
authors.initials: S
authors.lastname: Frühauf
authors.forename: Jürgen
authors.initials: J
authors.lastname: Barth
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D007172:Erectile Dysfunction / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012731:Sex Counseling / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058986:Phosphodiesterase 5 Inhibitors
keywords: Erectile Dysfunction Therapy; Health Services Research; Impotence; Intervention; Male; Meta-Analysis; Patient Satisfaction; Phosphodiesterase Inhibitor; Randomized Controlled Trial; Sex Counseling; Sexual Dysfunction; Systematic Review