1. INTRODUCTION
1.1. Aims and Objectives
The European Association of Urology (EAU) Sexual and Reproductive Health Guidelines aim to provide a comprehensive overview of the medical aspects relating to sexual and reproductive health in adult men.
It must be emphasised that 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, while 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. Panel Composition
The EAU Sexual and Reproductive Health Guidelines Panel consists of an international multidisciplinary group of urologists and endocrinologists. All experts involved in the production of this document have submitted potential conflict of interest statements which can be viewed on the EAU website: http://www.uroweb.org/guidelines/sexual-and-reproductive-health/.
1.3. Available publications
A quick reference document, the Pocket Guidelines, is available. This is an abridged versions that may require consultation together with the full text version. A number of scientific publications are also available. All documents can be viewed on the EAU website: https://uroweb.org/guidelines/sexual-and-reproductive-health.
An EAU Guidelines App for iOS and Android devices is also available containing the Pocket Guidelines, interactive algorithms and calculators, clinical decision support tools, Guidelines cheat sheets, and links to the extended Guidelines.
Reference to tables contained in the online supplementary evidence appendices are made throughout these Guidelines. All tables are available on the EAU website: https://uroweb.org/guidelines/sexual-and-reproductive-health/publications-appendices.
1.4. Publication history
The EAU Sexual and Reproductive Health Guidelines were first published in 2020. This 2026 document presents a limited update of the 2025 publication.
1.5. Summary of changes
For the 2026 Sexual and Reproductive Health Guidelines new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for the Hypogonadism, Disorders of Ejaculation, Penile Curvature and Priapism sections of the Guidelines. This resulted in the inclusion of 116 updated studies across the Guidelines. Key changes include:
- Significant changes to the supporting text throughout Section 3. Hypogonadism.
- Significant revision of 3.5.4 Prostate cancer (PCa).
- The relocation of two recommendations to section 3.5.4 addressing Prostate Cancer (PCa) topics because their conceptual framework and clinical implications were more directly aligned with PCa-related management strategies and outcomes.
- The reorganisation of the recommendations in section 5.6.12 Summary of evidence and recommendations for treatment of erectile dysfunction (ED), so that they flow in a more logical manner.
- Full update and revision of the supporting text and references throughout Section 6 Disorders of Ejaculation.
- Significant revision of 8.2.1 Epidemiology in the Penile Curvature section.
- Significant revision of 8.2.3.a Conservative treatment in the Penile Curvature section.
- Significant revision of 8.2.3.a.1 Oral treatment in the Penile Curvature section.
- Significant revision of 8.2.3.a.4 Other treatments in the Penile Curvature section.
- Significant revision of 8.2.3.b Surgical treatment in the Penile Curvature section.
- Significant revision of section 10.1 Ischaemic (Low-Flow or Veno-Occlusive) Priapism
- Significant revision of 10.1.3.b Surgical management- second-line treatments in the Priapism section.
- Significant revision of 10.2 Priapism in Special Situations
- Updates/modifications to the following recommendations:
3.3.5 Summary of evidence and recommendations for the diagnostic evaluation and screening of LOH
| Recommendation | Strength rating |
| Diagnostic evaluation | |
| Measure total testosterone in the morning (07.00 and 10.00 hours) and in the fasting state, with a reliable laboratory assay. | Strong |
3.4.2.f Summary of evidence and recommendations for testosterone therapy outcome
| Recommendation | Strength rating |
| Do not use testosterone therapy for the treatment of male infertility and in men wishing to be fathers. | Strong |
3.5.9 Summary of evidence and recommendations on safety and monitoring in testosterone therapy
| Recommendations | Strength rating |
| Restrict treatment to patients with a low risk of recurrent PCa after surgery*. Treatment should start after at least one year follow-up with prostate-specific antigen (PSA) level < 0.01 ng/mL and no evidence of recurrence. | Weak |
| Advise patients on active surveillance or treated with non-surgical curative intent that safety data on the use of testosterone therapy are unclear. | Weak |
| Consider further diagnostic testing in prostate cancer naïve patients if there is a significant rise or increase in PSA velocity or total PSA. | Strong |
8.2.3.a.4 Summary of evidence and recommendations for conservative treatment of Peyronie’s disease
| Recommendation | Strength rating |
| Fully counsel patients that data on the use of intralesional platelet-rich plasma either alone or in combination with oral treatment to reduce pain or penile curvature, are still limited. | Strong |
8.2.3.b.4 Summary of evidence and recommendations for surgical treatment of Peyronie’s disease
| Recommendation | Strength rating |
| Perform surgery only when Peyronie’s disease (PD) is stable and sexual intercourse is compromised due to the deformity. | Strong |
10.1.2.e Summary of evidence and recommendations for the diagnosis of ischaemic priapism
| Recommendation | Strength rating |
| In the emergency setting, analysis of blood gas parameters from aspirated corporal blood is essential to distinguish between ischemic and non-ischemic priapism. | Strong |
10.1.4 Summary of evidence and recommendations for treatment of ischaemic priapism
| Recommendation | Strength rating |
| Alternatively, peno-scrotal decompression may be used as a first-line option instead of distal shunting (with or without tunnelling). | Weak |