Model of care is a strategy that ensures comprehensive, patient-centered healthcare through coordinated actions across different levels of care.(1) Model of care can be used to mitigate differences in treatment response by improving therapeutic adherence and continuity in multifactorial conditions such as male sexual dysfunction.(1,2) This retrospective study aims to describe the perception of clinical improvement, adherence to follow-up, and the sociodemographic profile of men with erectile dysfunction maneged through a model of care at a referral center

This is a retrospective observational study based on the analysis of 168 electronic medical records of men aged ≥18 years with a clinical complaint of erectile dysfunction, who were treated between March 2022 and April 2025 at a specialized pelvic floor center. Sociodemographic data, lifestyle habits, medical and medication history, number of sessions attended, adherence to follow-up visits, and perceived clinical improvement were collected. The therapeutic protocol included pelvic floor physiotherapy sessions performed two to three times per week, comprising pelvic floor muscle training, non-ablative penile radiofrequency, and low-intensity shockwave therapy. Perception of clinical improvement 
was assessed by self-report using a percentage scale of symptom improvement. Statistical analyses were performed using the independent Student’s t-test, with a significance level set at 5%.

The mean age was 63.6±9.3 years. Participants were predominantly married (39.3%), retired (30.4%), and sedentary (28.0%); walking was the most common physical activity. A history of radical prostatectomy was present in 64.9%, with a mean interval of 23.8±37.5 months between surgery and admission. Radiotherapy was reported by 12.5% and daily tadalafil 5 mg use by 36.9%. Hypertension (57.7%), diabetes mellitus (36.9%), and dyslipidemia (23.2%) were the most prevalent comorbidities. A mean of 15.1±8.2 sessions per patient was performed, and attendance at the first follow-up was 71.4%. Clinical improvement was reported by 53.6% of participants. Mean self-reported improvement was 39.3±22.1% at the first follow-up and 42.8±22.9% at the second. A higher number of sessions was significantly associated with clinical improvement (p<0.001). Prostatectomy history (p=0.023), use of erectile dysfunction medication (p=0.007), and tadalafil use (p=0.003) were also associated with a greater number of sessions. Initiation of treatment within six months after prostatectomy was associated with higher satisfaction after 12 sessions (p=0.022).

Erectile dysfunction is a multifactorial condition, highlighting the importance of a multidisciplinary approach. High levels of perception of clinical improvement and patient satisfaction, including among men with a history of prostatectomy, support the effectiveness of the proposed clinical management pathway. The predominant profile — older, married men with comorbidities — is consistent with the literature linking aging and cardiovascular disease to a higher prevalence of erectile dysfunction. The presence of a partner and early treatment initiation after prostatectomy appear to positively influence outcomes. Adherence to follow-up decreased over time, possibly due to initial symptom improvement. Combined strategies, including pelvic floor physiotherapy and adjunctive therapies, are particularly relevant given the limitations and adverse effects of isolated pharmacological treatment.

A structured clinical management pathway for erectile dysfunction demonstrated good adherence to follow-up and a substantial perception of clinical improvement, particularly among men with a history of prostatectomy and those using adjunctive pharmacological therapy. Improvement was proportional to the number of sessions performed, reinforcing the importance of treatment continuity. The implementation of a multidisciplinary care model, integrating pelvic floor rehabilitation, non-ablative radiofrequency, and low-intensity shockwave therapy, appears to be a promising and accessible strategy within the Unified Health System (SUS). These findings support the expansion of structured care pathways for male sexual health, with the potential to optimize resource allocation, reduce exclusive reliance on pharmacological and surgical interventions, and promote comprehensive and effective care.

Pinto HA. Linhas de cuidado na Bahia: um conceito em viva produção. Revista Baiana de Saúde Pública. 2012 Aug 19;33(1):22
McMahon CG. Current Diagnosis and Management of Erectile Dysfunction. Medical Journal of Australia. 2019 May 17;210(10):469–76