madman
Super Moderator
European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction
Abstract
Context: The present summary of the European Association of Urology (EAU) guidelines is based on the latest guidelines on male sexual health published in March 2021, with a last comprehensive update in January 2021.
Objective: To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health.
Evidence acquisition: A literature review was performed up to January 2021. The guidelines were updated, and a strength rating for each recommendation was included based on either a systematic review of the evidence or a consensus opinion from the expert panel.
Evidence synthesis: Late-onset hypogonadism is a clinical condition in the aging male combining low levels of circulating testosterone and specific symptoms associated with impaired hormone production and/or action. A comprehensive diagnostic and therapeutic workup, along with screening recommendations and contraindications, is provided. Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Along with a detailed basic and advanced diagnostic approach, a novel decision-making algorithm for treating ED, in order to better tailor therapy to individual patients, is provided. The EAU Guidelines have adopted the definition of premature ejaculation (PE), which has been developed by the International Society for Sexual Medicine. After the subtype of PE has been defined, the patient’s expectations should be discussed thoroughly and pharmacotherapy must be considered as the first-line treatment for patients with lifelong PE, whereas treating the underlying cause must be the initial goal for patients with acquired PE. Haemospermia is defined as the appearance of blood in the ejaculate. Several reasons for haemospermia have been acknowledged; the primary goal over the management work-up is to exclude malignant conditions and treat any other underlying cause.
Conclusions: The 2021 guidelines on sexual and reproductive health summarise the most recent findings, and advise in terms of diagnosis and treatment of male hypogonadism and sexual dysfunction for their use in clinical practice. These guidelines reflect the multidisciplinary nature of their management.
Patient summary: Updated European Association of Urology guidelines on sexual and reproductive health are presented, addressing the diagnosis and treatment of the most prevalent conditions in men. Patients must be fully informed of all relevant diagnostic and therapeutic options and, together with their treating physicians, decide on optimal personalized management strategies.
1. Introduction
The most recent summary of the European Association of Urology (EAU) guidelines on male sexual health was published in 2010 [1] and 2012 [2]. The present summary is based on the latest guidelines published in March 2021 [3], with the last comprehensive update in January 2021. The 2021 version of the EAU guideline document is a further comprehensive update of the 2020 guidelines, which already includes an update of the 2018 versions of male sexual dysfunction, male infertility, and male hypogonadism, along with several new topics. It must be emphasized that guidelines present the best evidence available to the experts, who have participated fully in the evaluation of all the material revised systematically for individual chapters.
This article summarises the EAU guideline recommendations on male sexual health management (namely, late-onset hypogonadism [LOH], erectile dysfunction [ED], premature ejaculation [PE], and recurrent haemospermia). The panel presents a summary of these latter conditions because of their epidemiological importance, and a number of innovative updates in terms of their management and their relevance to men's health. Moreover, the full text on male sexual health management can be found in the EAU guideline textbook and at uroweb.org [3].
2. Evidence acquisition
3. Evidence synthesis
3.1. Male hypogonadism
3.1.1. Definition and epidemiology
3.1.2. Classification and causes of male hypogonadism
3.1.3. Diagnostic evaluation of male hypogonadism
3.1.4. Treatment of LOH
3.1.4.1. Testosterone therapy outcomes
3.1.4.1.1. Sexual dysfunction
3.1.4.1.2. Body composition and metabolic profile
3.1.4.1.3. MetS and T2DM
3.1.4.1.4. Mood and cognition
3.1.4.1.5. Bone
3.1.4.1.6. Vitality and physical strength
3.1.4.2. Testosterone therapy—medical preparations
3.1.4.3. Testosterone therapy—safety and follow-up in hypogonadism management
3.2. Erectile dysfunction
3.2.1. Definition and epidemiology of ED
3.2.2. Risk factors for ED
3.2.3. Diagnostic evaluation (basic work-up)
3.2.3.1. Medical and sexual history
3.2.3.2. Physical examination
3.2.3.3. Laboratory testing
3.2.4. Diagnostic evaluation (advanced work-up)
3.2.4.1. Nocturnal penile tumescence and rigidity test
3.2.4.2. Intracavernous injection test
3.2.4.3. Dynamic duplex US of the penis
3.2.4.4. Arteriography and dynamic infusion cavernosometry or cavernosography
3.2.4.5. Psychiatric and psychosocial assessment
3.2.5. Treatment of ED
3.2.5.1. Oral pharmacotherapy for ED
3.2.5.1.1. CV safety
3.2.5.2. Topical/intraurethral alprostadil
3.2.5.3. Intracavernous injection therapy
3.2.5.4. Low-intensity shockwave therapy
3.2.5.5. Vacuum erection devices
3.2.5.6. Hormonal treatment
3.2.5.7. Psychosexual counseling and therapy
3.2.5.8. Vascular surgery for ED
3.2.5.9. Penile prostheses
3.2.6. Follow-up in patients with ED
3.3. Disorders of ejaculation
3.3.1. Premature ejaculation
3.3.1.1. Definition and epidemiology of PE
3.3.1.2. Diagnostic evaluation of PE
3.3.1.3. Therapeutic management of PE
3.3.2. Haemospermia
3.3.2.1. Definition, classification, and epidemiology of haemospermia
3.3.2.2. Investigations for haemospermia
3.3.2.3. Disease management
4. Conclusions
The present text represents a summary of the 2021 EAU guidelines on sexual and reproductive health, dealing with male sexual dysfunction. A summary of recommendations is presented for the following disorders: male hypogonadism, ED, PE, and recurrent haemospermia. For more detailed information and a full list of references, refer to the full-text version available at the EAU website (Uroweb - European Association of Urology (EAU) guideline/sexual-and-reproductive-health/).
Abstract
Context: The present summary of the European Association of Urology (EAU) guidelines is based on the latest guidelines on male sexual health published in March 2021, with a last comprehensive update in January 2021.
Objective: To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health.
Evidence acquisition: A literature review was performed up to January 2021. The guidelines were updated, and a strength rating for each recommendation was included based on either a systematic review of the evidence or a consensus opinion from the expert panel.
Evidence synthesis: Late-onset hypogonadism is a clinical condition in the aging male combining low levels of circulating testosterone and specific symptoms associated with impaired hormone production and/or action. A comprehensive diagnostic and therapeutic workup, along with screening recommendations and contraindications, is provided. Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Along with a detailed basic and advanced diagnostic approach, a novel decision-making algorithm for treating ED, in order to better tailor therapy to individual patients, is provided. The EAU Guidelines have adopted the definition of premature ejaculation (PE), which has been developed by the International Society for Sexual Medicine. After the subtype of PE has been defined, the patient’s expectations should be discussed thoroughly and pharmacotherapy must be considered as the first-line treatment for patients with lifelong PE, whereas treating the underlying cause must be the initial goal for patients with acquired PE. Haemospermia is defined as the appearance of blood in the ejaculate. Several reasons for haemospermia have been acknowledged; the primary goal over the management work-up is to exclude malignant conditions and treat any other underlying cause.
Conclusions: The 2021 guidelines on sexual and reproductive health summarise the most recent findings, and advise in terms of diagnosis and treatment of male hypogonadism and sexual dysfunction for their use in clinical practice. These guidelines reflect the multidisciplinary nature of their management.
Patient summary: Updated European Association of Urology guidelines on sexual and reproductive health are presented, addressing the diagnosis and treatment of the most prevalent conditions in men. Patients must be fully informed of all relevant diagnostic and therapeutic options and, together with their treating physicians, decide on optimal personalized management strategies.
1. Introduction
The most recent summary of the European Association of Urology (EAU) guidelines on male sexual health was published in 2010 [1] and 2012 [2]. The present summary is based on the latest guidelines published in March 2021 [3], with the last comprehensive update in January 2021. The 2021 version of the EAU guideline document is a further comprehensive update of the 2020 guidelines, which already includes an update of the 2018 versions of male sexual dysfunction, male infertility, and male hypogonadism, along with several new topics. It must be emphasized that guidelines present the best evidence available to the experts, who have participated fully in the evaluation of all the material revised systematically for individual chapters.
This article summarises the EAU guideline recommendations on male sexual health management (namely, late-onset hypogonadism [LOH], erectile dysfunction [ED], premature ejaculation [PE], and recurrent haemospermia). The panel presents a summary of these latter conditions because of their epidemiological importance, and a number of innovative updates in terms of their management and their relevance to men's health. Moreover, the full text on male sexual health management can be found in the EAU guideline textbook and at uroweb.org [3].
2. Evidence acquisition
3. Evidence synthesis
3.1. Male hypogonadism
3.1.1. Definition and epidemiology
3.1.2. Classification and causes of male hypogonadism
3.1.3. Diagnostic evaluation of male hypogonadism
3.1.4. Treatment of LOH
3.1.4.1. Testosterone therapy outcomes
3.1.4.1.1. Sexual dysfunction
3.1.4.1.2. Body composition and metabolic profile
3.1.4.1.3. MetS and T2DM
3.1.4.1.4. Mood and cognition
3.1.4.1.5. Bone
3.1.4.1.6. Vitality and physical strength
3.1.4.2. Testosterone therapy—medical preparations
3.1.4.3. Testosterone therapy—safety and follow-up in hypogonadism management
3.2. Erectile dysfunction
3.2.1. Definition and epidemiology of ED
3.2.2. Risk factors for ED
3.2.3. Diagnostic evaluation (basic work-up)
3.2.3.1. Medical and sexual history
3.2.3.2. Physical examination
3.2.3.3. Laboratory testing
3.2.4. Diagnostic evaluation (advanced work-up)
3.2.4.1. Nocturnal penile tumescence and rigidity test
3.2.4.2. Intracavernous injection test
3.2.4.3. Dynamic duplex US of the penis
3.2.4.4. Arteriography and dynamic infusion cavernosometry or cavernosography
3.2.4.5. Psychiatric and psychosocial assessment
3.2.5. Treatment of ED
3.2.5.1. Oral pharmacotherapy for ED
3.2.5.1.1. CV safety
3.2.5.2. Topical/intraurethral alprostadil
3.2.5.3. Intracavernous injection therapy
3.2.5.4. Low-intensity shockwave therapy
3.2.5.5. Vacuum erection devices
3.2.5.6. Hormonal treatment
3.2.5.7. Psychosexual counseling and therapy
3.2.5.8. Vascular surgery for ED
3.2.5.9. Penile prostheses
3.2.6. Follow-up in patients with ED
3.3. Disorders of ejaculation
3.3.1. Premature ejaculation
3.3.1.1. Definition and epidemiology of PE
3.3.1.2. Diagnostic evaluation of PE
3.3.1.3. Therapeutic management of PE
3.3.2. Haemospermia
3.3.2.1. Definition, classification, and epidemiology of haemospermia
3.3.2.2. Investigations for haemospermia
3.3.2.3. Disease management
4. Conclusions
The present text represents a summary of the 2021 EAU guidelines on sexual and reproductive health, dealing with male sexual dysfunction. A summary of recommendations is presented for the following disorders: male hypogonadism, ED, PE, and recurrent haemospermia. For more detailed information and a full list of references, refer to the full-text version available at the EAU website (Uroweb - European Association of Urology (EAU) guideline/sexual-and-reproductive-health/).
