To provide a focused secondary synthesis and critical clinical interpretation of the AFU/SFMS evidence base on phytotherapies and complementary therapies for erectile dysfunction (ED).
The parent AFU/SFMS evidence review used a predefined systematic search and selection process in PubMed/Medline for French- and English-language publications from January 1999 to January 2023, updated to October 2023. Eligible evidence comprised systematic reviews, meta-analyses, randomized trials, and prospective non-randomized studies in adult men with ED. Outcomes included IIEF/IIEF-5, EHS, satisfaction, adverse events, and physiologic measures. No de novo search or risk-of-bias reassessment was performed for this secondary manuscript.
The evidence base was broad but fragmented. The most coherent phytotherapy signal concerned traditional Chinese herbal medicine combined with tadalafil, with a pooled IIEF-5 weighted mean difference of 3.11 points, although comparator structure and non-standardized formulations limit interpretation. Ginseng, L-arginine, and Pycnogenol showed modest low-certainty signals. Other agents and proprietary formulations remained preliminary or inconsistent. Among complementary therapies, pelvic floor muscle training provided the clearest actionable signal; in the pivotal trial, 40% of men regained normal erectile function by 6 months. Acupuncture and electrical or magnetic therapies were hypothesis-generating. Cognitive behavioral therapy appeared clinically discussable as an adjunct.
Evidence does not support routine recommendation of phytotherapies or most complementary therapies for ED. A few coherent but low-certainty signals may inform counseling, but claims remain weakened by heterogeneity, short follow-up, and bias. These interventions should guide shared decision-making and research priorities, not replace validated ED care.
The French journal of urology. 2026 Jun 01 [Epub ahead of print]
Cédric Lebâcle, Diana Kassab, Antoine Faix, Cyrille Guillot-Tantay, Johann Barkatz, Eric Huyghe
Urology Department, University Hospital of Bicêtre-Paris Saclay University, Le Kremlin-Bicêtre, Paris, France. Electronic address: ., Association Française d'Urologie, Paris, France., Clinique Saint-Roch, Montpellier, France., Hôpital Foch, Service d'urologie et de transplantation rénale, Suresnes, France., Department of Urology, Besançon University Hospital, Besançon, France., Department of Urology, Toulouse-Rangueil University Hospital, Toulouse, France; Department of Reproductive Medicine, Toulouse-Paule-de-Viguier University Hospital, Toulouse, France; Research Unit DEFE, Development Embryo Fertility Environment, INSERM 1203, University of Toulouse, University of Montpellier, Toulouse, France.