The efficacy of phosphodiesterase‐5 inhibitors for erectile dysfunction in patients with post‐traumatic stress disorder and spinal cord injury: A systematic review and meta‐analysis

Erectile dysfunction (ED) is highly prevalent in men with post‐traumatic stress disorder (PTSD) and spinal cord injury (SCI), worsening psychological burden and quality of life. Phosphodiesterase‐5 (PDE‐5) inhibitors are established first‐line therapy for ED, but their efficacy in these specific populations has not been rigorously synthesized. The aim of this systematic review is to evaluate PDE‐5 inhibitor efficacy for PTSD‐ and SCI‐associated ED through a PRISMA 2020‐compliant systematic review and meta‐analysis of randomized controlled trials. PubMed/MEDLINE, Embase, PsycINFO, and CENTRAL were searched from inception to October 2025 using two parallel strategies: PTSD/trauma + ED + PDE‐5 inhibitors, and SCI + ED + PDE‐5 inhibitors. Eligible studies were randomized controlled trials (RCTs) comparing oral PDE‐5 inhibitors with placebo in adult males. The primary outcome was mean difference (MD) in International Index of Erectile Function‐Erectile Function (IIEF‐EF) score. SCI trials were pooled using inverse‐variance random‐effects meta‐analysis; PTSD trials were synthesized narratively because of metric heterogeneity. Risk of bias was assessed using Cochrane RoB 2. Overall, five RCTs ( n = 941) were included. Two SCI parallel‐group trials ( n = 604) were meta‐analyzed. PDE‐5 inhibitors significantly improved IIEF‐EF scores versus placebo (pooled MD = 8.62; 95% CI = 7.65–9.60; p < 0.001; I 2 = 0%; GRADE: moderate certainty). One SCI crossover trial supported these findings qualitatively. In PTSD, the larger parallel‐group RCT showed no significant IIEF‐EF benefit ( p = 0.08), whereas the smaller crossover trial showed improved total IIEF score ( p < 0.001). In conclusion, PDE‐5 inhibitors show robust, clinically meaningful efficacy in SCI‐associated ED. Evidence in PTSD‐associated ED remains inconclusive, requiring adequately powered RCTs with standardized IIEF‐EF reporting to clarify treatment effects and guide population‐specific clinical decision‐making in practice.