There are many versions of the definition of erectile dysfunction (ED), which are similar but with some differences and are constantly changing, adversely affecting clinical work and experimental research. A clear distinction between normal sexual functioning and those patients with ED who require medical help is essential, and therefore a precise definition of ED should be provided. The current commonly accepted concept is that ED is the inability to achieve and/or maintain a sufficient penile erection to accomplish satisfactory sexual intercourse. The concept is incomplete because it does not clearly define the frequency and duration of erectile dysfunction. Therefore, it has been suggested that ED should be defined as “the inability to achieve and maintain an erection sufficient to complete sexual intercourse, or a decrease in the degree of erection during 75% of sexual intercourse that has lasted for at least 6 months”. ED treatment should be pursued to get rid of the root cause of ED The treatment of ED is widely carried out at home and abroad, and the purpose of ED treatment is generally set on the basis of accomplishing a satisfactory sex life, and at the same time, a new goal of ED treatment has been put forward, i.e., ED is a disease that can be treated, or even can be cured, and the treatment of ED should include three kinds of endings, namely, cured, improved, and ineffective. For young men with ED who do not have other serious health hazards, most of them can realize the goal of complete cure; for many elderly men with ED, especially those who are also combined with some chronic diseases, it is not realistic to expect complete freedom from ED, and it is not difficult to choose the best drug treatment strategy and other methods to help them solve the problem of sexual life temporarily; for a few men who are combined with serious cardiovascular, endocrine and other systemic diseases, it is not difficult to realize the goal of complete cure. For a small number of ED patients with severe cardiovascular, endocrine and other systemic diseases, the current treatment is difficult to meet the requirements of the patients, and it is necessary to explore more targeted and effective treatment methods. For the majority of ED patients, restoration of spontaneous erection and sexual life without relying on the duration of drug action are the ideal goals, and the organic integration of treating the symptoms and treating the root cause can be expected to achieve satisfactory results. We encourage physicians to pursue curative treatment for ED. Clinical and basic research has confirmed that long-term low-dose PDE5 (phosphodiesterase type 5) inhibitor treatment has certain advantages, which can improve the oxygen supply and blood supply of penile cavernous smooth muscle, improve the vascular endothelial function, reduce the fibrosis and apoptosis of cavernous smooth muscle cells, and increase the nocturnal erection, which is expected to cure the psychological ED and restore the patient’s autonomy of erection, and has been recommended by the 2010 guidelines of the European Society of Urology. guidelines of the European Society of Urology in 2010. Long-term, low-dose PDE5 inhibitor therapy may also be tried in patients with refractory ED who have not responded to on-demand treatment with PDE5 inhibitors. Oral medications are still the preferred option What is more important in improving sexual performance with PDE5 inhibitor therapy, maintaining an erection or increasing the hardness of an erection? This has been debated. It has been demonstrated that sildenafil’s effect on improving sexual life is mainly due to its erectile hardness, and at least half of its maintenance effect on erection is driven by erectile hardness, thus obtaining appropriate early erectile hardness is an important goal in the treatment of ED. In recent years, intracavernous vasoactive drug injections and surgical procedures in the penile corpus cavernosum have opened up new avenues for the treatment of ED, but oral medications are still widely used in the treatment of ED and are the preferred method for patients with ED. Based on previous relevant literature and the consensus of experts on the use of drugs to treat ED, Eardley et al. analyzed the effectiveness, tolerability and safety of drug treatment for ED. The results found that all three PDE5 inhibitors are first-line drugs for ED treatment as long as there are no contraindications. It was concluded that PDE5 inhibitors are effective, well-tolerated and safe in the treatment of ED; the treatments of apomorphine, intracorporeal injection of prostaglandin E1 and intraurethral administration of prostaglandin E1 are also effective and well-tolerated. Vascular reconstruction for arterial ED is safe and effective Vascular reconstruction of the inferior abdominal wall artery – deep dorsal penile artery is currently the highest treatment success rate, as long as you choose the right surgical treatment target, vascular reconstruction for arterial ED is still safe and effective. The purpose of penile vein blockage is to reduce the venous return flow when the penis is in erectile state, but there is not an ideal surgical method for treating venous leakage, except for simple and severe venous leakage that can be treated surgically, patients with venous leakage usually take other methods to solve the problem of sexual function rather than surgical treatment. In recent years, expandable penile prosthesis (IPP) implantation technology has been greatly improved, and a wide range of prostheses are available, mainly depending on the patient’s willingness and economic status, which can enable almost all patients with severe ED to achieve satisfactory sexual intercourse. Some scholars have summarized the decision-making consensus on IPP, mechanical devices, and vascular surgical treatments for ED, concluding that IPP is indicated for patients with organic ED who have failed other therapies or are not receptive to other therapies, and that IPP treatment is superior to other therapies; patients with organic ED respond well to noninvasive negative-pressure erection devices (VEDs), which are particularly suitable for those who have had a poor response to intracorporeal vasoactive medications patients; VED combined with PDE5 inhibitors can improve sexual satisfaction in patients with poor efficacy of VED alone after radical prostate cancer surgery; penile vascular surgery can achieve satisfactory results in young patients with internal pubic artery stenosis induced solely by factors such as pelvic trauma, while surgical treatment of venous leakage is ineffective, and vascular surgery needs to be investigated in depth, especially for venous leakage. Surgical treatment of patients with simple venous leaks is not recommended at present.