Objective To investigate the potential predictors and treatment for secondary sexual dysfunction following pelvic fracture. Methods 184 patients were included in this study from multiple centers in Guangzhou city, to find the potential predictors for secondary sexual dysfunction following pelvic fracture. 76 patients were identified to be secondary sexual dysfunction, which were randomized into three treatment groups, who were given continuous low dose of tadalafil (5 mg/time)combined with oral sildenafil (50 mg/time), tadalafil (5 mg/time) only and sildenafil (50 mg/time) only respectively, and followed by evaluation of therapeutic effect according to IIEF-5 questionnaire and Sexual Encounter Profile (SEP) diaries to evaluate the effect. Results Risk factors including age and the type of pelvic fractures but not urethral injury was associated with the complication of secondary sexual dysfunction . After treatment for twelve weeks, the IIEF-5 score in A groups (18.1 ± 4.2) was significantly higher than that in B (16.4 ± 3.4) or C (16.6 ± 4.0) group (P<0.05). The positive rate of response to SEP2 and SEP3 in A group were 73.0% and 79.4% respectively, both of which were remarkably higher than those in B or C group (P < 0.05). Conclusion Secondary sexual dysfunction following pelvic fracture is associated with age and type of pelvic fractures. Continuous low dose of tadalafil (5 mg/time) combined with sildenafil (50 mg/time) provides superior effective treatment for secondary sexual dysfunction following pelvic fracture.