Bridging the Gap in Psychogenic Erectile Dysfunction: A Narrative Review of Underexplored Therapeutic Options

Background and Objectives: Psychogenic erectile dysfunction (ED) is a distinct clinical condition characterized by predominant psychological or relational factors. Despite its prevalence, diagnostic criteria remain heterogeneous and are often based on exclusion of organic causes. Current guidelines recommend cognitive behavioral therapy (CBT), eventually combined with medical therapy such as phosphodiesterase type 5 inhibitors (PDE5i), as first-line treatment. However, evidence regarding alternative conservative and surgical therapies remains limited. This narrative review aims to evaluate the available evidence on these treatments in psychogenic ED. Materials and Methods: A comprehensive literature search was conducted in PubMed, Scopus, and MEDLINE using MeSH terms and free-text keywords related to psychogenic ED and therapeutic interventions. Eligible studies included those involving human subjects, published in English, and reporting outcomes specifically for psychogenic or non-organic ED. Reviews, case reports, and non-full-text articles were excluded. Study selection and data extraction were performed independently by two authors. Due to heterogeneity, a narrative synthesis was conducted. Results: Evidence on alternative therapies is limited and heterogeneous, with many studies predating the 2000s. Vacuum erection devices (VEDs) may improve outcomes, particularly when combined with psychotherapy. Constriction rings showed promising preliminary results. Acupuncture demonstrated inconsistent efficacy, although recent randomized trials suggest potential benefits. Intracavernosal injections (ICI) showed favorable outcomes, particularly in patients refractory to first-line therapies, with some reports of restored spontaneous erections. Penile prosthesis (PP) implantation remains underexplored in contemporary literature on psychogenic ED; however, recent evidence reports good satisfaction rates. Conclusions: Beyond CBT and PDE5i, evidence for alternative treatments in psychogenic ED is scarce and methodologically limited. Selected patients may benefit from adjunctive therapies, including VED, ICI, and acupuncture, while PP can be considered a definitive treatment option. Further well-designed studies are needed to clarify their role within a structured, evidence-based management approach.