Abstract Introduction Battlefield pelvic injuries can result in erectile dysfunction (ED) in young soldiers. We investigated whether phosphodiesterase-5-inhibitor (PDE5i), low-energy shock wave (LESWT) and/or mesenchymal stem cell (MSC) therapy could improve erectile function (EF) after pelvic injury. Methods Lewis rats 10–12 weeks old were divided into nine groups (n=6/group) - Sham, Injury (control), PDE5i, LESWT, MSC, LESWT+PDE5i, LESWT+MSC, MSC+PDE5i, and LESWT+PDE5i+MSC. Bilateral cavernous nerve crush injury and internal pudendal bundle ligation were performed. Bone marrow-derived MSCs (2x106cells) were injected in to the corpora cavernosum. Rats received LESWT (1000 pulses at 0.06 mJ/mm2, 3Hz, 3 times/week) or sildenafil (PDE5i) in drinking water (~10 mg/kg/day) for four weeks. At 6th week intracavernous pressure (ICP; mmHg) was recorded as EF outcome measure. Results Pelvic injury (control group) showed decrease (p<0.001) in EF based on maximum ICP (88±16), average ICP (81±11), and change in ICP (81±13) compared to sham (maximum137±25; average 125±13.0; change 55±24). EF was improved (P<0.001) with PDE5i+LESWT therapy, maximum ICP (131±14), average ICP (116±9), and change in ICP (63±15) compared to control. LESWT and MSC alone improved EF (P<0.05). RT-PCR demonstrated lower (21–87%) BCL-2, eNOS, epiregulin and connective tissue growth factor relative gene expression in control group compared to sham. MSC or LESWT+PDE5i treatment showed increased (69–87%) epiregulin (marker for smooth muscle) expression compared to control; eNOS was markedly higher in LESWT+PDE5i group. Histology/Molecular studies are ongoing. Conclusion LESWT, MSC and/or PDE5i combination therapy appears to be promising in EF recovery.