Sexual and Reproductive Health


2.1. Methods

For the 2023 Sexual and Reproductive Health Guidelines, new evidence was identified, collated and appraised through a structured assessment of the literature for section 9 - Penile Size Abnormalities and Dysmorphophobia. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A detailed search strategy is available online: In addition, sections 5 - Management of Erectile Dysfunction and 10 - Male Infertility were reviewed by the panel and updated as required.

For each recommendation within the guidelines there is an accompanying online strength rating form which includes an assessment of the benefit to harms ratio and patients’ preferences for each recommendation. The strength rating forms draw on the guiding principles of the GRADE methodology but do not purport to be GRADE [1,2]. Each strength rating form addresses several key elements namely:

  1. the overall quality of the evidence which exists for the recommendation, references used in this text are graded according to a classification system modified from the Oxford Centre for Evidence-Based Medicine Levels of Evidence [3];
  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 of patient values and preferences on the intervention;
  6. the certainty of those patient values and preferences.

These key elements are the basis that panels use to define the strength rating of each recommendation. The strength of each recommendation is represented by the term ‘strong’ or ‘weak’ [4]. 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 nature and variability of patient values and preferences. Additional information can be found in the general Methodology section of this print, and online at the EAU website: 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. For 2023 the newly added section on penile size abnormalities and dysmorphophobia was reviewed prior to publication. The Panel would like to acknowledge the contribution of Dr. Miguel Ricou from the Department of Community Medicine, Information and Health Decision Sciences at the Faculty of Medicine, University of Porto, Portugal, for his expertise and time in reviewing the penile size abnormalities and dysmorphophobia section from a bioethics perspective.

2.3. Future goals

The results of ongoing and new systematic reviews will be included in the 2024 update of the Sexual and Reproductive Health Guidelines. Systematic reviews in progress and planned for inclusion in the 2024 update include:

  • Vasectomy and male contraception.
  • Penile prosthesis implantation peri-operative complications.
  • Sexual function outcomes in men undergoing interventions for prostate cancer.