Background: Sonographic studies in the arena of erectile dysfunction had reduced in significance in the last 10 years with the introduction of the latest actual therapies and the acknowledgment that surgical of the penile arterial and venous inefficiency had poor long-term clinical results. The praise of phosphodiesterase type 5 inhibitor developed the therapeutics of erectile dysfunction and completely reformed the method in which men erectile dysfunction are evaluated and examined. Objective: The objective of our study was to assess the sonographic findings of erectile dysfunction and the role of phosphodiesterase-5 inhibitor. Methods: A systematic search was achieved of MEDICINE and EMBASE research databases such as Google Scholar, PubMed, and Crossref databases from 2000 to 2021. The keywords are including, Doppler erectile dysfunction, assessment of sonographic findings of erectile dysfunction, the role of phosphodiesterase-5 inhibitor, and penile color Doppler sonography. Results: A total of 193 studies were documented through the database search. Also, 05 studies were recognized through additional bases. Then, the selection was achieved and 43 records were removed due to repetition. More selection was performed for 150 articles and 62 studies were excluded due to lack of evidence. There were 48 studies excluded due to research conducted on animals because this study was only determined on human studies. Conclusions: Soon, color Doppler sonography might be used in favor of patients because it can detect even small vessels in the tissue and study their blood flow. Duplex sonography of the penile arteries must be performed to deliver a good selection of therapeutic options.