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Treatment of male sexual dysfunction

Glenn R Cunningham, MD
Mohit Khera, MD, MBA, MPH
Section Editors
Peter J Snyder, MD
Michael P O'Leary, MD, MPH
Deputy Editor
Kathryn A Martin, MD


The three most common male sexual dysfunctions are decreased libido, erectile dysfunction (ED), and ejaculatory dysfunction (including premature ejaculation [PE] in men ages 18 to 59 years). One or more conditions can co-exist in an individual. The inability to achieve and/or maintain an erection sufficient for satisfactory sexual intercourse is a distressing and common symptom, affecting up to one-third of adult men.

ED is common in men with systemic disorders such as hypertension, ischemic heart disease, and diabetes mellitus, and its prevalence increases with age (figure 1). Although sexual dysfunction is more common in older men, it also affects younger men (ages 18 to 25 years) [1]. Health professionals should therefore ask men of all ages about sexual dysfunction as part of their routine psychosocial assessment. ED can also be seen commonly in men who undergo radical prostatectomy for prostate cancer.

The nonsurgical management of male sexual dysfunction is reviewed here. The etiology and evaluation of sexual dysfunction, the surgical management of ED, and the management in men with cardiovascular disease are discussed in detail separately.

(See "Overview of male sexual dysfunction" and "Evaluation of male sexual dysfunction".)

(See "Surgical treatment of erectile dysfunction".)

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Literature review current through: Dec 2017. | This topic last updated: Aug 16, 2017.
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  1. Akre C, Berchtold A, Gmel G, Suris JC. The evolution of sexual dysfunction in young men aged 18-25 years. J Adolesc Health 2014; 55:736.
  2. Montague DK, Jarow JP, Broderick GA, et al. Chapter 1: The management of erectile dysfunction: an AUA update. J Urol 2005; 174:230.
  3. Montague DK, Jarow J, Broderick GA, et al. AUA guideline on the pharmacologic management of premature ejaculation. J Urol 2004; 172:290.
  4. Qaseem A, Snow V, Denberg TD, et al. Hormonal testing and pharmacologic treatment of erectile dysfunction: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2009; 151:639.
  5. Guay AT, Spark RF, Bansal S, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple's problem--2003 update. Endocr Pract 2003; 9:77.
  6. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010; 95:2536.
  7. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281:537.
  8. Safarinejad MR. The effects of the adjunctive bupropion on male sexual dysfunction induced by a selective serotonin reuptake inhibitor: a double-blind placebo-controlled and randomized study. BJU Int 2010; 106:840.
  9. Sayuk GS, Gott BM, Nix BD, Lustman PJ. Improvement in sexual functioning in patients with type 2 diabetes and depression treated with bupropion. Diabetes Care 2011; 34:332.
  10. Yee A, Loh HS, Hisham Hashim HM, Ng CG. Clinical factors associated with sexual dysfunction among men in methadone maintenance treatment and buprenorphine maintenance treatment: a meta-analysis study. Int J Impot Res 2014; 26:161.
  11. Traish AM, Hassani J, Guay AT, et al. Adverse side effects of 5α-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and depression in a subset of patients. J Sex Med 2011; 8:872.
  12. Ali AK, Heran BS, Etminan M. Persistent Sexual Dysfunction and Suicidal Ideation in Young Men Treated with Low-Dose Finasteride: A Pharmacovigilance Study. Pharmacotherapy 2015; 35:687.
  13. Tsertsvadze A, Fink HA, Yazdi F, et al. Oral phosphodiesterase-5 inhibitors and hormonal treatments for erectile dysfunction: a systematic review and meta-analysis. Ann Intern Med 2009; 151:650.
  14. Burke RM, Evans JD. Avanafil for treatment of erectile dysfunction: review of its potential. Vasc Health Risk Manag 2012; 8:517.
  15. Levine GN, Steinke EE, Bakaeen FG, et al. Sexual activity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2012; 125:1058.
  16. Nehra A, Jackson G, Miner M, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2012; 87:766.
  17. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004; 291:2978.
  18. Gupta BP, Murad MH, Clifton MM, et al. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med 2011; 171:1797.
  19. Simon RM, Howard L, Zapata D, et al. The association of exercise with both erectile and sexual function in black and white men. J Sex Med 2015; 12:1202.
  20. Reis LO, Favaro WJ, Barreiro GC, et al. Erectile dysfunction and hormonal imbalance in morbidly obese male is reversed after gastric bypass surgery: a prospective randomized controlled trial. Int J Androl 2010; 33:736.
  21. Taskin U, Yigit O, Acioglu E, et al. Erectile dysfunction in severe sleep apnea patients and response to CPAP. Int J Impot Res 2010; 22:134.
  22. Budweiser S, Luigart R, Jörres RA, et al. Long-term changes of sexual function in men with obstructive sleep apnea after initiation of continuous positive airway pressure. J Sex Med 2013; 10:524.
  23. Hoekema A, Stel AL, Stegenga B, et al. Sexual function and obstructive sleep apnea-hypopnea: a randomized clinical trial evaluating the effects of oral-appliance and continuous positive airway pressure therapy. J Sex Med 2007; 4:1153.
  24. Knapp A, Myhill PC, Davis WA, et al. Effect of continuous positive airway pressure therapy on sexual function and serum testosterone in males with type 2 diabetes and obstructive sleep apnoea. Clin Endocrinol (Oxf) 2014; 81:254.
  25. Wu C, Zhang H, Gao Y, et al. The association of smoking and erectile dysfunction: results from the Fangchenggang Area Male Health and Examination Survey (FAMHES). J Androl 2012; 33:59.
  26. Pourmand G, Alidaee MR, Rasuli S, et al. Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study. BJU Int 2004; 94:1310.
  27. Boolell M, Gepi-Attee S, Gingell JC, Allen MJ. Sildenafil, a novel effective oral therapy for male erectile dysfunction. Br J Urol 1996; 78:257.
  28. Dinsmore WW, Hodges M, Hargreaves C, et al. Sildenafil citrate (Viagra) in erectile dysfunction: near normalization in men with broad-spectrum erectile dysfunction compared with age-matched healthy control subjects. Urology 1999; 53:800.
  29. Rosen RC, Allen KR, Ni X, Araujo AB. Minimal clinically important differences in the erectile function domain of the International Index of Erectile Function scale. Eur Urol 2011; 60:1010.
  30. Hatzimouratidis K, Moysidis K, Bekos A, et al. Treatment strategy for "non-responders" to tadalafil and vardenafil: a real-life study. Eur Urol 2006; 50:126.
  31. Gruenwald I, Shenfeld O, Chen J, et al. Positive effect of counseling and dose adjustment in patients with erectile dysfunction who failed treatment with sildenafil. Eur Urol 2006; 50:134.
  32. Fink HA, Mac Donald R, Rutks IR, et al. Sildenafil for male erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med 2002; 162:1349.
  33. Rendell MS, Rajfer J, Wicker PA, Smith MD. Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. Sildenafil Diabetes Study Group. JAMA 1999; 281:421.
  34. Schover LR, Fouladi RT, Warneke CL, et al. The use of treatments for erectile dysfunction among survivors of prostate carcinoma. Cancer 2002; 95:2397.
  35. Zippe CD, Kedia AW, Kedia K, et al. Treatment of erectile dysfunction after radical prostatectomy with sildenafil citrate (Viagra). Urology 1998; 52:963.
  36. Bénard F, Carrier S, Lee JC, et al. Men with mild erectile dysfunction benefit from sildenafil treatment. J Sex Med 2010; 7:3725.
  37. Shabsigh R, Kaufman J, Magee M, et al. A multicenter, double-blind, placebo-controlled trial to assess the efficacy of sildenafil citrate in men with unrecognized erectile dysfunction. Urology 2010; 76:373.
  38. Moncada I, Martínez-Jabaloyas JM, Rodriguez-Vela L, et al. Emotional changes in men treated with sildenafil citrate for erectile dysfunction: a double-blind, placebo-controlled clinical trial. J Sex Med 2009; 6:3469.
  39. Vardenafil (levitra) for erectile dysfunction. Med Lett Drugs Ther 2003; 45:77.
  40. Porst H, Rosen R, Padma-Nathan H, et al. The efficacy and tolerability of vardenafil, a new, oral, selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at-home clinical trial. Int J Impot Res 2001; 13:192.
  41. Klotz T, Sachse R, Heidrich A, et al. Vardenafil increases penile rigidity and tumescence in erectile dysfunction patients: a RigiScan and pharmacokinetic study. World J Urol 2001; 19:32.
  42. Hellstrom WJ, Gittelman M, Karlin G, et al. Sustained efficacy and tolerability of vardenafil, a highly potent selective phosphodiesterase type 5 inhibitor, in men with erectile dysfunction: results of a randomized, double-blind, 26-week placebo-controlled pivotal trial. Urology 2003; 61:8.
  43. Goldstein I, Young JM, Fischer J, et al. Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study. Diabetes Care 2003; 26:777.
  44. Brock G, Nehra A, Lipshultz LI, et al. Safety and efficacy of vardenafil for the treatment of men with erectile dysfunction after radical retropubic prostatectomy. J Urol 2003; 170:1278.
  45. Debruyne FM, Gittelman M, Sperling H, et al. Time to onset of action of vardenafil: a retrospective analysis of the pivotal trials for the orodispersible and film-coated tablet formulations. J Sex Med 2011; 8:2912.
  46. Sanford M. Vardenafil orodispersible tablet. Drugs 2012; 72:87.
  47. Rajagopalan P, Mazzu A, Xia C, et al. Effect of high-fat breakfast and moderate-fat evening meal on the pharmacokinetics of vardenafil, an oral phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction. J Clin Pharmacol 2003; 43:260.
  48. Corbin JD, Francis SH. Pharmacology of phosphodiesterase-5 inhibitors. Int J Clin Pract 2002; 56:453.
  49. Porst H, Padma-Nathan H, Giuliano F, et al. Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after dosing: a randomized controlled trial. Urology 2003; 62:121.
  50. Porst H. IC351 (tadalafil, Cialis): update on clinical experience. Int J Impot Res 2002; 14 Suppl 1:S57.
  51. "The Pink Sheet". 2003; 65:23.
  52. Hatzichristou D, d'Anzeo G, Porst H, et al. Tadalafil 5 mg once daily for the treatment of erectile dysfunction during a 6-month observational study (EDATE): impact of patient characteristics and comorbidities. BMC Urol 2015; 15:111.
  53. Tadalafil (Cialis) once a day for erectile dysfunction. Med Lett Drugs Ther 2008; 50:27.
  54. Porst H, Giuliano F, Glina S, et al. Evaluation of the efficacy and safety of once-a-day dosing of tadalafil 5mg and 10mg in the treatment of erectile dysfunction: results of a multicenter, randomized, double-blind, placebo-controlled trial. Eur Urol 2006; 50:351.
  55. Shabsigh R, Seftel AD, Kim ED, et al. Efficacy and safety of once-daily tadalafil in men with erectile dysfunction who reported no successful intercourse attempts at baseline. J Sex Med 2013; 10:844.
  56. Hellstrom WJ, Freier MT, Serefoglu EC, et al. A phase II, single-blind, randomized, crossover evaluation of the safety and efficacy of avanafil using visual sexual stimulation in patients with mild to moderate erectile dysfunction. BJU Int 2013; 111:137.
  57. Kedia GT, Uckert S, Assadi-Pour F, et al. Avanafil for the treatment of erectile dysfunction: initial data and clinical key properties. Ther Adv Urol 2013; 5:35.
  58. Limin M, Johnsen N, Hellstrom WJ. Avanafil, a new rapid-onset phosphodiesterase 5 inhibitor for the treatment of erectile dysfunction. Expert Opin Investig Drugs 2010; 19:1427.
  59. http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/202276s005lbl.pdf (Accessed on September 22, 2014).
  60. McCullough AR, Steidle CP, Klee B, Tseng LJ. Randomized, double-blind, crossover trial of sildenafil in men with mild to moderate erectile dysfunction: efficacy at 8 and 12 hours postdose. Urology 2008; 71:686.
  61. Bella AJ, Brock GB. Tadalafil in the treatment of erectile dysfunction. Curr Urol Rep 2003; 4:472.
  62. Govier F, Potempa AJ, Kaufman J, et al. A multicenter, randomized, double-blind, crossover study of patient preference for tadalafil 20 mg or sildenafil citrate 50 mg during initiation of treatment for erectile dysfunction. Clin Ther 2003; 25:2709.
  63. Tsertsvadze A, Yazdi F, Fink HA, et al. Oral sildenafil citrate (viagra) for erectile dysfunction: a systematic review and meta-analysis of harms. Urology 2009; 74:831.
  64. Brock GB, McMahon CG, Chen KK, et al. Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol 2002; 168:1332.
  65. The Medical Letter 2005; 47:49.
  66. http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/20895s039s042lbl.pdf (Accessed on March 17, 2014).
  67. Zrenner E. No cause for alarm over retinal side-effects of sildenafil. Lancet 1999; 353:340.
  68. Thakur JS, Thakur S, Sharma DR, et al. Hearing loss with phosphodiesterase-5 inhibitors: a prospective and objective analysis with tadalafil. Laryngoscope 2013; 123:1527.
  69. Khan AS, Sheikh Z, Khan S, et al. Viagra deafness--sensorineural hearing loss and phosphodiesterase-5 inhibitors. Laryngoscope 2011; 121:1049.
  70. Maddox PT, Saunders J, Chandrasekhar SS. Sudden hearing loss from PDE-5 inhibitors: A possible cellular stress etiology. Laryngoscope 2009; 119:1586.
  71. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124841.htm (Accessed on March 25, 2014).
  72. Zhang X, Yan G, Ji J, et al. PDE5 inhibitor promotes melanin synthesis through the PKG pathway in B16 melanoma cells. J Cell Biochem 2012; 113:2738.
  73. Loeb S, Folkvaljon Y, Lambe M, et al. Use of Phosphodiesterase Type 5 Inhibitors for Erectile Dysfunction and Risk of Malignant Melanoma. JAMA 2015; 313:2449.
  74. Li WQ, Qureshi AA, Robinson KC, Han J. Sildenafil use and increased risk of incident melanoma in US men: a prospective cohort study. JAMA Intern Med 2014; 174:964.
  75. Matthews A, Langan SM, Douglas IJ, et al. Phosphodiesterase Type 5 Inhibitors and Risk of Malignant Melanoma: Matched Cohort Study Using Primary Care Data from the UK Clinical Practice Research Datalink. PLoS Med 2016; 13:e1002037.
  76. Kloner RA, Hutter AM, Emmick JT, et al. Time course of the interaction between tadalafil and nitrates. J Am Coll Cardiol 2003; 42:1855.
  77. Pharmaceutical Approvals Monthly April 2004; 9:21.
  78. Pomara G, Morelli G, Pomara S, et al. Cardiovascular parameter changes in patients with erectile dysfunction using pde-5 inhibitors: a study with sildenafil and vardenafil. J Androl 2004; 25:625.
  79. MacDiarmid SA, Hill LA, Volinn W, Hoel G. Lack of pharmacodynamic interaction of silodosin, a highly selective alpha1a-adrenoceptor antagonist, with the phosphodiesterase-5 inhibitors sildenafil and tadalafil in healthy men. Urology 2010; 75:520.
  80. Tadalafil (cialis) for erectile dysfunction. Med Lett Drugs Ther 2003; 45:101.
  81. Kloner RA, Jackson G, Emmick JT, et al. Interaction between the phosphodiesterase 5 inhibitor, tadalafil and 2 alpha-blockers, doxazosin and tamsulosin in healthy normotensive men. J Urol 2004; 172:1935.
  82. Bozkurt O, Demir O, Sen V, Esen A. Silodosin causes impaired ejaculation and enlargement of seminal vesicles in sexually active men treated for lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Urology 2015; 85:1085.
  83. Buvat J, Montorsi F, Maggi M, et al. Hypogonadal men nonresponders to the PDE5 inhibitor tadalafil benefit from normalization of testosterone levels with a 1% hydroalcoholic testosterone gel in the treatment of erectile dysfunction (TADTEST study). J Sex Med 2011; 8:284.
  84. Kim JW, Oh MM, Park MG, et al. Combination therapy of testosterone enanthate and tadalafil on PDE5 inhibitor non-reponders with severe and intermediate testosterone deficiency. Int J Impot Res 2013; 25:29.
  85. Boloña ER, Uraga MV, Haddad RM, et al. Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc 2007; 82:20.
  86. Spitzer M, Basaria S, Travison TG, et al. Effect of testosterone replacement on response to sildenafil citrate in men with erectile dysfunction: a parallel, randomized trial. Ann Intern Med 2012; 157:681.
  87. Wessells H, Penson DF, Cleary P, et al. Effect of intensive glycemic therapy on erectile function in men with type 1 diabetes. J Urol 2011; 185:1828.
  88. Derosa G, Romano D, Tinelli C, et al. Prevalence and associations of erectile dysfunction in a sample of Italian males with type 2 diabetes. Diabetes Res Clin Pract 2015; 108:329.
  89. Aversa A, Mazzilli F, Rossi T, et al. Effects of sildenafil (Viagra) administration on seminal parameters and post-ejaculatory refractory time in normal males. Hum Reprod 2000; 15:131.
  90. Kim KK, Kim DG, Ku YH, et al. Bilateral cerebral hemispheric infarction associated with sildenafil citrate (Viagra) use. Eur J Neurol 2008; 15:306.
  91. Alpsan MH, Bebek N, Ciftci FD, et al. Intracerebral hemorrhage associated with sildenafil use: a case report. J Neurol 2008; 255:932.
  92. Swearingen SG, Klausner JD. Sildenafil use, sexual risk behavior, and risk for sexually transmitted diseases, including HIV infection. Am J Med 2005; 118:571.
  93. www.fda.gov/bbs/topics/ANSWERS/2003/ANS01235.html (Accessed on March 07, 2005).
  94. Mitka M. FDA issues warning on "all-natural" herbal product found to contain viagra. JAMA 2003; 289:2786.
  95. Venhuis BJ, Blok-Tip L, de Kaste D. Designer drugs in herbal aphrodisiacs. Forensic Sci Int 2008; 177:e25.
  96. Savaliya AA, Shah RP, Prasad B, Singh S. Screening of Indian aphrodisiac ayurvedic/herbal healthcare products for adulteration with sildenafil, tadalafil and/or vardenafil using LC/PDA and extracted ion LC-MS/TOF. J Pharm Biomed Anal 2010; 52:406.
  97. ElAmrawy F, ElAgouri G, Elnoweam O, et al. Adulterated and Counterfeit Male Enhancement Nutraceuticals and Dietary Supplements Pose a Real Threat to the Management of Erectile Dysfunction: A Global Perspective. J Diet Suppl 2016; 13:660.
  98. Kotirum S, Ismail SB, Chaiyakunapruk N. Efficacy of Tongkat Ali (Eurycoma longifolia) on erectile function improvement: systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2015; 23:693.
  99. healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2016/58816a-eng.php (Accessed on June 13, 2016).
  100. Counterfeit drugs kill! Last updated May 2008. World Health Organization. Available at: apps.who.int/impact/FinalBrochureWHA2008a.pdf?ua=1 (Accessed on June 15, 2016).
  101. Hellstrom WJ. The growing concerns regarding counterfeit medications. J Sex Med 2011; 8:1.
  102. Jackson G, Arver S, Banks I, Stecher VJ. Counterfeit phosphodiesterase type 5 inhibitors pose significant safety risks. Int J Clin Pract 2010; 64:497.
  103. Derouet H, Caspari D, Rohde V, et al. Treatment of erectile dysfunction with external vacuum devices. Andrologia 1999; 31 Suppl 1:89.
  104. Canguven O, Bailen J, Fredriksson W, et al. Combination of vacuum erection device and PDE5 inhibitors as salvage therapy in PDE5 inhibitor nonresponders with erectile dysfunction. J Sex Med 2009; 6:2561.
  105. Vrijhof HJ, Delaere KP. Vacuum constriction devices in erectile dysfunction: acceptance and effectiveness in patients with impotence of organic or mixed aetiology. Br J Urol 1994; 74:102.
  106. Tay KP, Lim PH. A prospective trial with vacuum-assisted erection devices. Ann Acad Med Singapore 1995; 24:705.
  107. Govier FE, McClure RD, Weissman RM, et al. Experience with triple-drug therapy in a pharmacological erection program. J Urol 1993; 150:1822.
  108. Shenfeld O, Hanani J, Shalhav A, et al. Papaverine-phentolamine and prostaglandin E1 versus papaverine-phentolamine alone for intracorporeal injection therapy: a clinical double-blind study. J Urol 1995; 154:1017.
  109. Linet OI, Ogrinc FG. Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. The Alprostadil Study Group. N Engl J Med 1996; 334:873.
  110. Carson CC 3rd, Mino RD. Priapism associated with trazodone therapy. J Urol 1988; 139:369.
  111. Kulmala RV, Tamella TL. Effects of priapism lasting 24 hours or longer caused by intracavernosal injection of vasoactive drugs. Int J Impot Res 1995; 7:131.
  112. Padma-Nathan H, Hellstrom WJ, Kaiser FE, et al. Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group. N Engl J Med 1997; 336:1.
  113. Urciuoli R, Cantisani TA, Carlini M, et al. Prostaglandin E1 for treatment of erectile dysfunction. Cochrane Database Syst Rev 2004; :CD001784.
  114. Lansdell MI, Hepworth D, Calabrese A, et al. Discovery of a selective small-molecule melanocortin-4 receptor agonist with efficacy in a pilot study of sexual dysfunction in humans. J Med Chem 2010; 53:3183.
  115. Afif-Abdo J, Teloken C, Damião R, et al. Comparative cross-over study of sildenafil and apomorphine for treating erectile dysfunction. BJU Int 2008; 102:829.
  116. Maclennan KM, Boshier A, Wilton LV, Shakir SA. Examination of the safety and use of apomorphine prescribed in general practice in England as a treatment for erectile dysfunction. BJU Int 2006; 98:125.
  117. Herman JB, Brotman AW, Pollack MH, et al. Fluoxetine-induced sexual dysfunction. J Clin Psychiatry 1990; 51:25.
  118. Melnik T, Soares BG, Nasselo AG. Psychosocial interventions for erectile dysfunction. Cochrane Database Syst Rev 2007; :CD004825.
  119. Riley AJ, Goodman RE, Kellett JM, et al. Double blind trial of yohimbine hydrochloride in erection inadequacy. J Sexual Marital Therapy 1989; 4:17.
  120. Montorsi F, Strambi LF, Guazzoni G, et al. Effect of yohimbine-trazodone on psychogenic impotence: a randomized, double-blind, placebo-controlled study. Urology 1994; 44:732.
  121. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trials. J Urol 1998; 159:433.
  122. Rowland DL, Kolba TN. Understanding the effects of establishing various cutoff criteria in the definition of men with premature ejaculation. J Sex Med 2015; 12:1175.
  123. McMahon CG, Jannini E, Waldinger M, Rowland D. Standard operating procedures in the disorders of orgasm and ejaculation. J Sex Med 2013; 10:204.
  124. McMahon CG, Porst H. Oral agents for the treatment of premature ejaculation: review of efficacy and safety in the context of the recent International Society for Sexual Medicine criteria for lifelong premature ejaculation. J Sex Med 2011; 8:2707.
  125. Pu C, Yang L, Liu L, et al. Topical anesthetic agents for premature ejaculation: a systematic review and meta-analysis. Urology 2013; 81:799.
  126. Melnik T, Althof S, Atallah AN, et al. Psychosocial interventions for premature ejaculation. Cochrane Database Syst Rev 2011; :CD008195.
  127. Althof SE, Abdo CH, Dean J, et al. International Society for Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation. J Sex Med 2010; 7:2947.
  128. Waldinger MD, Zwinderman AH, Schweitzer DH, Olivier B. Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis. Int J Impot Res 2004; 16:369.
  129. McMahon CG, Althof SE, Kaufman JM, et al. Efficacy and safety of dapoxetine for the treatment of premature ejaculation: integrated analysis of results from five phase 3 trials. J Sex Med 2011; 8:524.
  130. Asimakopoulos AD, Miano R, Finazzi Agrò E, et al. Does current scientific and clinical evidence support the use of phosphodiesterase type 5 inhibitors for the treatment of premature ejaculation? a systematic review and meta-analysis. J Sex Med 2012; 9:2404.
  131. Wu T, Yue X, Duan X, et al. Efficacy and safety of tramadol for premature ejaculation: a systematic review and meta-analysis. Urology 2012; 80:618.
  132. Martyn-St James M, Cooper K, Kaltenthaler E, et al. Tramadol for premature ejaculation: a systematic review and meta-analysis. BMC Urol 2015; 15:6.
  133. Dinsmore WW, Wyllie MG. PSD502 improves ejaculatory latency, control and sexual satisfaction when applied topically 5 min before intercourse in men with premature ejaculation: results of a phase III, multicentre, double-blind, placebo-controlled study. BJU Int 2009; 103:940.
  134. Carson C, Wyllie M. Improved ejaculatory latency, control and sexual satisfaction when PSD502 is applied topically in men with premature ejaculation: results of a phase III, double-blind, placebo-controlled study. J Sex Med 2010; 7:3179.
  135. Rooney M, Pfister W, Mahoney M, et al. Long-term, multicenter study of the safety and efficacy of topical alprostadil cream in male patients with erectile dysfunction. J Sex Med 2009; 6:520.
  136. Rosen RC, Wei JT, Althof SE, et al. Association of sexual dysfunction with lower urinary tract symptoms of BPH and BPH medical therapies: results from the BPH Registry. Urology 2009; 73:562.
  137. Rosen RC, Fitzpatrick JM, ALF-LIFE Study Group. Ejaculatory dysfunction in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. BJU Int 2009; 104:974.
  138. Paduch DA, Polzer PK, Ni X, Basaria S. Testosterone Replacement in Androgen-Deficient Men With Ejaculatory Dysfunction: A Randomized Controlled Trial. J Clin Endocrinol Metab 2015; 100:2956.