Male Sexual Dysfunction

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

ISBN 978-94-92671-04-2

K. Hatzimouratidis (Chair), F. Giuliano, I. Moncada, A. Muneer, A. Salonia (Vice-chair), P. Verze
Guideline Associates: A. Parnham, E.C. Serefoglu



These guidelines include four sections. The aim of the first two sections is to present the current evidence for the diagnosis and treatment of patients suffering from erectile dysfunction (ED) and premature ejaculation (PE). Erectile Dysfunction and PE are the two main complaints in male sexual medicine [1,2]. Pharmacological therapies have completely changed the diagnostic and therapeutic approach to ED.

The aim of the third section is to provide the practicing urologist with the most recent evidence on the diagnosis and management of penile curvature in order to assist in their decision-making. Penile curvature is a common urological disorder which can be congenital or acquired. Congenital curvature is briefly discussed in these guidelines as a distinct pathology in the adult population without any other concomitant abnormality present (such as urethral abnormalities). For paediatric congenital penile curvature, please refer to the EAU Guidelines on Paediatric Urology, Chapter on Congenital Penile Curvature [3]. Acquired curvature is mainly due to Peyronie’s disease but can also be due to the development of fibrosis following penile fracture.

The aim of the fourth section is to present the current evidence for the diagnosis and treatment of patients suffering from priapism. Priapism is a pathological condition representing a true disorder of penile erection that persists for more than four hours and beyond, or is unrelated to sexual interest or stimulation [4]. Overall, erections lasting up to four hours are by consensus defined as ‘prolonged’. Priapism may occur at all ages. The incidence rate of priapism in the general population is low (0.5-0.9 cases per 100,000 persons per year) [5,6]. In men with sickle cell disease, the prevalence of priapism is up to 3.6% in men less than eighteen years of age [7] increasing up to 42% in men more than eighteen years of age [8-11].

It must be emphasised that clinical guidelines present the best evidence available to the experts. However, following guidelines recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2.Publication history

The first EAU Guidelines on Erectile Dysfunction were published in 2000 with subsequent updates in 2001, 2002, 2004, 2005, 2009, 2013 and 2014. In particular, the 2009 document presented a significant update of the previous publication with the inclusion of the topic “Premature Ejaculation” and the text was renamed “EAU Guidelines on Male Sexual Dysfunction” [12]. In 2011 the Panel decided to develop new guidelines addressing Penile Curvature, which resulted in a new publication in 2012 [13]. In 2014 a guideline on Priapism was completed [14].

The 2016 edition merged the previous EAU guidelines for ED, PE, penile curvature and priapism into one guideline [15]. In 2017 a scoping search was performed covering all areas of the guideline and it was updated accordingly.

1.3.Available Publications

Alongside several scientific summaries published in the EAU scientific journal, European Urology [16-20], a quick reference document (Pocket Guidelines) is available, both in print and in a number of versions for mobile devices, presenting the main findings of the Male Sexual Dysfunction guidelines. These are abridged versions which may require consultation together with the full text version. All available material can be viewed at the EAU website, which also includes a selection of translations produced by national urological associations:

1.4.Panel composition

The EAU Guidelines Panel on Male Sexual Dysfunction consists of urologists, selected based on their expertise to represent the professionals treating patients suffering from ED, PE, penile curvature and priapism.