Phytotherapies and complementary therapies for erectile dysfunction: A focused secondary synthesis and critical...

To provide a focused secondary synthesis and critical clinical interpretation of the AFU/SFMS evidence base on phytotherapies and complementary therapies for erectile dysfunction (ED).

The parent AFU/SFMS evidence review used a predefined systematic search and selection process in PubMed/Medline for French- and English-language publications from January 1999 to January 2023, updated to October 2023. Eligible evidence comprised systematic reviews, meta-analyses, randomized trials, and prospective non-randomized studies in adult men with ED. Outcomes included IIEF/IIEF-5, EHS, satisfaction, adverse events, and physiologic measures. No de novo search or risk-of-bias reassessment was performed for this secondary manuscript.

The evidence base was broad but fragmented. The most coherent phytotherapy signal concerned traditional Chinese herbal medicine combined with tadalafil, with a pooled IIEF-5 weighted mean difference of 3.11 points, although comparator structure and non-standardized formulations limit interpretation. Ginseng, L-arginine, and Pycnogenol showed modest low-certainty signals. Other agents and proprietary formulations remained preliminary or inconsistent. Among complementary therapies, pelvic floor muscle training provided the clearest actionable signal; in the pivotal trial, 40% of men regained normal erectile function by 6 months. Acupuncture and electrical or magnetic therapies were hypothesis-generating. Cognitive behavioral therapy appeared clinically discussable as an adjunct.

Evidence does not support routine recommendation of phytotherapies or most complementary therapies for ED. A few coherent but low-certainty signals may inform counseling, but claims remain weakened by heterogeneity, short follow-up, and bias. These interventions should guide shared decision-making and research priorities, not replace validated ED care.