The ED Treatment Evidence Card

This page exists because we could not find one. If you want to know what the evidence behind a given erectile dysfunction treatment actually is — not whether a clinic says it works, but what the profession’s own guideline grades it — you have to read a 2018 document written for urologists and track each statement down individually. So we coded all 25 of its statements and put them on one page.

How strong is the evidence, really?

Guideline panels grade the evidence behind each statement from A (strong, consistent, from good trials) down to C (low certainty, from few or flawed studies). Some statements get no grade at all, because no body of evidence underlies them — they are labelled Clinical Principle or Expert Opinion.

Sorted that way, the ladder has an empty top rung.

This is not a scandal, and it is not an argument that ED treatment does not work. Grading systems are deliberately conservative, and erectile dysfunction is genuinely hard to study: the main outcome is self-reported, the placebo response is large, and blinding a vacuum pump is not straightforward. But it is the context that every confident sentence about ED treatment is written against, and almost nobody states it.

Every treatment, and what the guideline grades it

All 25 statements, grouped by strength. Wording is our plain-language summary; the grade is the guideline’s own.

Where the internet and the guideline disagree

Three of the treatments above carry an explicit warning label: the guideline calls them investigational or experimental. They are also three of the most heavily marketed treatments in men’s health.

In September 2026 we audited 90 consumer-facing pages and coded 137 separate claims about these three therapies against the guideline. Where a page took a position, this is how often it presented the therapy as effective or established without telling the reader about the designation.

The pattern is what you would predict from incentives, and we would be overstating it if we left it there. Several private clinics in the sample disclosed the status plainly, one citing the guideline by name and year. At least one major academic medical centre’s main ED page listed shockwave therapy among its treatment options with no caveat anywhere. Incentive predicts the tendency. It does not decide the individual page.

How to read a recommendation grade

Two separate things are being graded, and conflating them is the single most common error in health writing.

A statement can be a Strong Recommendation on Grade C evidence — that is exactly what penile prosthesis is. It means the panel is confident about the trade-off even though the trial base is thin. The reverse is rarer but possible. So “strongly recommended” is not a claim about evidence quality, and “Grade C” is not a claim that something does not work. It means we know less than we would like.

<figure>
  <img src="https://bigdickpills.com/wp-content/uploads/2026/09/bdp-ed-evidence-card-share.png"
       alt="Of the 25 numbered statements in the AUA erectile dysfunction guideline, zero rest on Grade A evidence."
       width="1200" height="630">
  <figcaption>Source: <a href="https://bigdickpills.com/erectile-dysfunction/ed-evidence-card/">The ED Treatment Evidence Card</a>,
  Big Dick Pills. CC BY 4.0.</figcaption>
</figure>

This card summarises a clinical guideline for general readers. It is not medical advice and cannot account for your circumstances. Treatment decisions belong with you and your doctor. Guideline wording is summarised in plain language; the grades are quoted as published.