Narrative-based sexual medicine. A collection of patients' stories and clinical cases to better understand the management of erectile dysfunction with type 5 phosphodiesterase inhibitors in the real life

Introduction: Narrative-based medicine (NBM) integrates patient stories with the clinician’s perspective and scientific evidence to personalize care. This approach is particularly well suited to sexual medicine. Sexual dysfunctions — especially erectile dysfunction (ED) — are highly multifaceted conditions in which individual histories and couple dynamics substantially influence diagnosis and treatment. Traditional evidence-based tools may fail to capture this complexity, as sexual symptoms emerge from the interplay of several connected systems.  Findings: This narrative review presents a series of realistic clinical vignettes illustrating the challenges of ED management within contemporary Italian sexual medicine, using the multidisciplinary Italian Society of Andrology and Sexual Medicine (SIAMS) guidelines as a normative framework. Each vignette is accompanied by scientific commentary grounded on evidence provided by the SIAMS guidelines. ED is framed as a sentinel symptom of systemic health, as postulated by the Systems Sexology which offer integrative models connecting the prescription of virtuous lifestyles with the type 5 phosphodiesterase inhibitors (PDE5i). Conclusion: This perspective underscores the inadequacy of simplistic “symptom–pill” approaches and highlights the need for personalized, multidimensional care, including alternative pharmaceutical formulations of PDE5i, such as the orodispersible film, that may enhance discretion, acceptability, and adherence.