Erectile dysfunction (ED) is a major health problem worldwide, and pharmacological treatment relies heavily on phosphodiesterase 5 inhibitors (PDE5I). Avanafil, roldenafil, milonafil, sildenafil, tadanafil, udenafil, and vardenafil are the seven PDE5Is that are currently in common use and have proven efficacy. However, the best PDE5I for ED treatment is still inconclusive. Efficacy evaluation in the study was based on the International Index of Erectile Function (IIEF-EF) >26, the Global Assessment Questionnaire (GAQ-1), successful penile penetration (SEP2) and successful completion of intercourse (SEP3). The side effect assessment then included all side effects or adverse events reported in the study, with the most common side effects being headache, flushing, dyspepsia, and nasal congestion. In a trade-off analysis of the recommended initial dose, sildenafil 50 mg was found to be the most effective but also had the highest overall adverse event rate. Tadanafil 10 mg had moderate efficacy, although the lowest rate of adverse events. Vardenafil 10mg and avanafil 100mg had similar rates of adverse events compared to sildenafil 50mg, but had significantly lower overall efficacy than sildenafil. The efficacy of vardenafil 100 mg was similar to that of tadanafil 10 mg, but the incidence of adverse events was higher with vardenafil. Overall, all PDE5Is in the study were efficacious relative to placebo. Sildenafil 50 mg treatment was preferred for patients seeking high efficacy. Patients expecting optimal tolerability may choose tadanafil 10 mg, and may switch to udenafil 100 mg when efficacy is poor. through this study, clinicians can visualize the efficacy and side effects of various PDE5Is for erectile dysfunction, and can also make timely and accurate dosing adjustments according to patients’ different needs.