It has been suggested that for maximum benefit, milk infusions and decoctions ofEriosema kraussianum roots are to be taken two to four hoursbefore any anticipated sexual intercourse, and the effects (achievement andmaintenance of penile erection sufficient for satisfactory sexual intercourse afterpenetration) of the plant extracts have been reported to last for four to six hoursfollowing oral dosing of the milk infusion or decoction of the rootstock extracts(Drewes, pers commun). For example, the Zulu peopleof South Africa have, for centuries, used the roots of Eriosema species as a remedyfor the treatment of erectile dysfunction and/or impotence. The availability of these PDE-5 inhibitors has provided effective and well-toleratedoral treatments for ED.5,7,15,16 Moreover, these drugs havebeen reported to improve endothelial function, 10,14 and are speculated to havevascular and myocardial protective properties.10,17 As a class, the three drugsare indicated for the treatment of erectile dysfunction only. Recent clinical studies have shown that the three PDE-5 inhibitors areeffective and relatively safe, and that they do not increase cardiovascular risk inpatients with CAD.12-14 Clinically known aetiologies of ED include organic, psychogenic and combinedorigins.1 Cardiovascular disorders anddiabetes mellitus are known to contribute significantly to erectile dysfunction oforganic origin.6,8 Organic causes of erectile dysfunction are found in 80–90% of ED patients,and these include vasculogenic (ie, arterial, cavernosal and mixed), neurogenic,anatomical and endocrine causes.4 Psychogenic forms of ED are usually due to sexualperformance anxiety, depression and inhibited sexual drive.4 Still, further studies producing evidence on the optimal treatment formulation are warranted to establish combination therapy as first-line treatment for ED. Moreover, combination therapy with PDE5 inhibitors plus other effective agents has emerged as a promising treatment modality in patients with refractory, complex or difficult-to-treat ED. Due to the plethora of primary studies and due to the complexity of some meta-analytic effects, we did not review the primary studies included in each systematic review and did not consider further primary studies published after these systematic reviews. Consequently, studies comparing the efficacy and safety of such treatment strategies in the form of monotherapy or combination therapy with PDE5 inhibitors are mandatory. 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