To evaluate the effects of three different medications with tadalafil on erectile dysfunction (ED) in young men with primary sexual failure.This study included 76 male ED patients aged 21－35 years who had primary sexual failure but normal nocturnal penile tumescence and rigidity and failed to respond to psychotherapy. We randomly assigned them to receive oral tadalafil once daily, on demand, or once-daily + on-demand. After 2－3 months of treatment, we evaluated the effects based on the scores of the patients in the five domains of the International Index of Erectile Function (IIEF-5).After medication, all the patients showed significantly increased scores in the four domains of IIEF-5, namely, erectile function, orgasmic function, intercourse satisfaction, and overall satisfaction. The on-demand group achieved even higher scores in erectile and orgasmic functions but a lower score in sexual desire than the once-daily group. However, the patients in the once-daily + on-demand group exhibited more significant improvement than those in the other two in all the five domains.Once-daily + on-demand medication with tadalafil can significantly enhance the therapeutic effect on psychogenic ED in young men with primary sexual failure.目的： 评估他达拉非3种不同给药方案对初次性生活失败的年轻男性勃起功能障碍（ED）患者疗效。方法： 将夜间阴茎勃起硬度检查正常、心理治疗无效的初次性生活失败的年轻男性ED患者分为他达拉非每日小剂量口服组（每日夜间睡前1~2 h口服他达拉非5 mg）、按需治疗组（性生活前1~2 h口服他达拉非10~20 mg，根据勃起硬度调整剂量）、每日小剂量与按需治疗联合组（无性生活时每日夜间口服他达拉非5 mg，性生活当日于性生活前1~2 h一次性服用他达拉非10~20 mg、其剂量根据勃起硬度确定）共3组，分别给予相应治疗2~3个月。以国际勃起功能指数（IIEF）5个专项评分分别评估疗效。结果： 3组IIEF勃起功能、性高潮、插入满意度、总体满意度专项评分较治疗前均显著提高（P均0.05 或0.01）；按需治疗较每日小剂量治疗显著提高勃起功能和性高潮专项评分(P0.05)，但在性欲专项评分方面，其效果低于每日小剂量治疗；当给予联合治疗时，5个专项评分均得到了最佳改善(P均0.05)。结论： 由于缺乏专业的性心理治疗机构和医生，单纯心理治疗对心理性ED患者疗效较差，以每日小剂量口服联合按需服用他达拉非可明显提高初次性生活失败的年轻男性ED患者疗效。.
