Current treatment for erectile dysfunction: an umbrella review of systematic reviews and meta-analyses

This umbrella review aimed to summarize and provide a general evaluation of the effectiveness of current treatments for erectile dysfunction (ED) and assess the quality of evidence.

This umbrella review available in PubMed, Web of Science, the Cochrane Library, and Embase, covering studies published up to October 2025, was conducted. The International Index of Erectile Function (IIEF) or its simplified version and the erectile hardness score (EHS) were used as endpoints to evaluate the effectiveness of the treatments.

Of 1191 studies, 23 published meta-analyses were extracted, yielding 42 summary effects on IIEF (n = 20), the international index of erectile function-5 (IIEF-5) (n = 9), the international index of erectile function-erectile function (IIEF-EF) (n = 6), and EHS (n = 7) on 36 interventions. All meta-analyses were analyzed via the AMSTAR-2, of which 13 (56.5%) were rated as critically low quality, 7 (30.5%) were rated as low quality, 2 (8.7%) were rated as moderate quality, and 1 (4.3%) was rated as high quality. Of the 42 summary effects, only two studies were rated as high-quality and moderate-quality respectively, whereas 47.6% (n = 20) and 47.6% (n = 20) were rated low and very low, respectively.

The current evidence base for ED treatments is predominantly of low or very low quality. While statistically significant improvements in ED were observed with both pharmacological and nonpharmacological interventions, these findings should be interpreted with caution due to the limited number of patients and the subjective nature of outcome indicators. The treatment landscape for ED is increasingly diverse, yet the reliability of the evidence is poor. Further well-designed studies on single treatments and high-quality meta-analyses of intertreatment comparisons are urgently recommended.