2. METHODOLOGY

2.1. Methods

For the 2025 Sexual and Reproductive Health Guidelines, new and relevant evidence has been identified, collated, and appraised through a structured assessment of the literature for Sections 5 Management of Erectile Dysfunction and 11 Male Infertility. Databases searched included Medline, EMBASE, and the Cochrane Libraries, covering a time frame between the 1^st Jan 2023 and 1^st May 2024. A total of 1,499 and 2,788 unique records were identified, retrieved, and screened for relevance for Sections 5 and 11, respectively. Detailed search strategies are available online: https://uroweb.org/guidelines/sexual-and-reproductive-health/publications-appendices.

Recommendations within the Guidelines are developed by the panels to prioritise clinically important care decisions. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and the nature and variability of patient values and preferences. This decision process, which can be reviewed in the strength rating forms which accompany each guideline statement, addresses a number of key elements:

1. the overall quality of the evidence which exists for the recommendation [1];
2. the magnitude of the effect (individual or combined effects);
3. the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
4. the balance between desirable and undesirable outcomes;
5. the impact and certainty of patient values and preferences on the intervention.

Strong recommendations typically indicate a high degree of evidence quality and / or a favourable balance of benefit to harm and patient preference. Weak recommendations typically indicate availability of lower quality evidence, and/or equivocal balance between benefit and harm, and uncertainty or variability of patient preference [2].

Additional information can be found online at the EAU website: http://www.uroweb.org/guideline/. A list of associations endorsing the EAU Guidelines can also be viewed online at this address.

2.2. Review

The EAU Sexual and Reproductive Health Guidelines were peer reviewed prior to publication in 2020. The new priapism section was reviewed prior to publication in 2021. In 2023 the newly added section on penile size abnormalities and dysmorphophobia was reviewed prior to publication.