What is the preferred first-line treatment for erectile dysfunction in men without contraindications to PDE5 inhibitors?

• A. Phosphodiesterase-5 inhibitor therapy (e.g., sildenafil)
• B. Testosterone therapy
• C. Vacuum erection device
• D. Penile implant

Answer: (A)

PDE5 inhibitors are the preferred first-line treatment for erectile dysfunction in men who have no contraindications to these medications. They work by enhancing the nitric oxide–cGMP pathway, which increases blood flow to the penis in response to sexual stimulation, helping to achieve and maintain an erection. They’re noninvasive, convenient (taken orally before sexual activity), and have strong proven effectiveness with a favorable safety profile for most patients. It’s important to note they require sexual arousal to work and must not be used with nitrates due to the risk of dangerous blood pressure drops. Testosterone therapy is reserved for men with documented hypogonadism, not as a routine first-line treatment for ED. Other options like vacuum devices or penile implants exist but are typically considered only if PDE5 inhibitors are ineffective or contraindicated.