As a summary of current Uptodate recommendations for treatment o erectile dysfunction: " Therapy of men with sexual dysfunction is aimed at improving libido and addressing the two vital sexual functions: the capacity to acquire and sustain penile erections and treating premature ejaculation (PE). Optimal treatment varies, depending upon the factor(s) that have reduced libido or caused erectile or ejaculatory dysfunction.
●For men with erectile dysfunction (ED), initial steps include:
•Identifying the underlying etiology, including drugs such as antidepressants or antihypertensive agents that may be causing or contributing to the ED.
•Identifying and treating cardiovascular risk factors, such as smoking, obesity, hypertension, and dyslipidemia, as both lifestyle measures and pharmacotherapy for risk factor reduction may be effective for prevention and treatment of ED.
●For first-line medical therapy of ED, we recommend the phosphodiesterase-5 (PDE-5) inhibitors because of their efficacy, ease of use, and favorable side effect profile. Sildenafil, vardenafil, tadalafil, and avanafil appear to be equally effective, but tadalafil has a longer duration of action. Current practice guidelines suggest that the choice of PDE-5 inhibitor should be based upon on the patient's preferences, including cost, ease of use, and adverse effects."