Erectile dysfunction (ED) has an increasing worldwide prevalence and is associated with a complex, pathophysiological mechanism.1,2 In patients with primary organic causes, phosphodiesterase type 5 (PDE5) inhibitors are considered the first-line monotherapy because of their safety profile, rapid efficacy, and convenient oral administration.3 Other recommended first-line treatment modalities include intracavernosal injections, topical or intraurethral alprostadil, vacuum erectile device, and low-intensity extracorporeal shockwave therapy (Li-ESWT).4 This evidence concerns the gene PDE5A and erectile dysfunction.