Evolving medical management of erectile dysfunction: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024)

Treatment of erectile dysfunction is based on pharmacotherapy for most patients. To review the current data on pharmacotherapy for erectile dysfunction based on efficacy, psychosocial outcomes, and safety outcomes. A review of the literature was undertaken by the committee members. All related articles were critically analyzed and discussed, and consensus statements were developed after presentation at the 2024 ICSM. Eight recommendations are provided with the corresponding level of evidence and grade of recommendation. The management of erectile dysfunction should be personalized to address the psychosocial needs and expectations of both the patient and their partner. PDE5 inhibitors remain the first-line treatment for most men, while intracavernosal injections, vacuum erection devices, and penile prostheses serve as second-line options, with treatment decisions guided by patient preferences. Key recommendations are summarized in table 1.