Evidence supports PDE5 inhibitors for improving erectile function in men with spinal cord injury, while evidence for other interventions and sexual health domains remains limited, with most systematic reviews rated critically low or low confidence.
The overall quality of included systematic reviews was frequently limited, with the majority rated critically low or low confidence.
PDE5 inhibitors showed the most coherent evidence for improving erectile function in men with spinal cord injury.
Women were substantially underrepresented in the included systematic reviews, with female sexual function outcomes rarely synthesized.
The literature search was conducted across seven databases from inception to November 2025.
Sexual dysfunction and sexual health problems are described as common after neurological disorders, but interventional evidence is fragmented across conditions and outcomes.
The authors identified critical methodological gaps including lack of inclusive trials, absence of broader standardized outcomes, and insufficient follow-up duration.
This research reviewed the existing scientific evidence on treatments for sexual health problems in people with neurological conditions such as spinal cord injury, stroke, or multiple sclerosis. The researchers gathered and evaluated 26 previous systematic reviews — studies that themselves summarize large bodies of research — covering a wide range of treatments and outcomes. Their goal was to understand what works, for whom, and how strong the evidence is. The most important finding was that drugs called PDE5 inhibitors (such as sildenafil, commonly known as Viagra) have reasonably good evidence for improving erectile function in men with spinal cord injury. For nearly everything else — other treatments, other neurological conditions, and outcomes beyond erectile function — the evidence was rated as low or very low quality. Women were largely left out: half of all reviews only studied men, and only 6 of the 26 reviews actually measured female sexual function using validated tools. Children and adolescents with neurological conditions were completely absent from the evidence base. The overall quality of the reviews themselves was also poor, with most rated as critically low confidence. This research suggests that sexual health after neurological injury or disease is a significantly under-studied area, particularly for women, couples, and younger patients. The gap between how common these problems are and how little high-quality evidence exists to guide treatment is striking. Researchers and clinicians working in neurorehabilitation are encouraged to conduct more rigorous, inclusive clinical trials that measure a broader range of outcomes — including relationship quality and psychological wellbeing — and follow patients over longer periods of time.
Manuli A, Calderone A, Latella D, Quattrini F, Pucciarelli G, Calabrò R. (2026). Sexual Health After Neurological Disorders: A Comprehensive Umbrella Review of Treatment Evidence.. Medical sciences (Basel, Switzerland). https://doi.org/10.3390/medsci14010037