The objective of this study is to present a summary of the updated 2025 European Association of Urology (EAU) guidelines on sexual and reproductive health (SRH), focusing on hypogonadism, erectile dysfunction (ED), premature ejaculation (PE), and Peyronie's disease (PD), providing practical recommendations on the clinical workup, with a focus on diagnosis, treatment, and follow-up.
The panel conducted an updated systematic review of new research published in 2021-2024 in Medline, EMBASE, and Cochrane Libraries. The guidelines' recommendations focused on key clinical decisions that would impact patient care most. Each recommendation's strength was evaluated based on three factors: the trade-offs between benefits and drawbacks of different treatment approaches, the quality and reliability of the available evidence, and the diverse preferences and values of patients.
Along with a detailed basic and advanced diagnostic approach for every condition, key recommendations emphasise the importance of appropriate indications and subsequent follow-up for testosterone therapy in patients with late-onset hypogonadism (LOH), a clinical condition in the ageing male combining low levels of circulating testosterone and specific symptoms associated with impaired hormone production and/or action. The decision-making algorithm for treating ED-defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance-aims to support personalised treatment tailored to individual patients, according to the invasiveness, tolerability, and effectiveness of the different therapeutic options and patients' expectations. Hence, patients should be fully counselled with respect to all available treatment modalities. The EAU guidelines adopted the definition of PE, which has been developed by the International Society for Sexual Medicine. After the subtype of PE has been defined, 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. An accurate baseline assessment of patients with PD should differentiate between acute and stable phases of the disorder. Surgical treatment for PD should be offered to patients having a penile deformity with a negative impact on sexual function: patients with concomitant ED should be offered penile prosthesis implantation.
This overview of the 2025 EAU SRH guidelines offers valuable insights into the diagnosis, treatment, and follow-up of LOH, ED, PE, and PD.
European urology. 2025 May 07 [Epub ahead of print]
Andrea Salonia, Paolo Capogrosso, Luca Boeri, Andrea Cocci, Giovanni Corona, Marij Dinkelman-Smit, Marco Falcone, Christian Fuglesang Jensen, Murat Gül, Arif Kalkanli, Ates Kadioğlu, Juan I Martinez-Salamanca, L Afonso Morgado, Giorgio I Russo, Ege Can Serefoğlu, Paolo Verze, Suks Minhas
Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: ., Department of Medicine and Technological Innovations (DIMIT)/Unit of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy., Department of Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy., Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy., Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy., Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands., Urology Clinic, A.O.U. "Città della Salute e della Scienza", Molinette Hospital, University of Turin, Turin, Italy; Neurourology Clinic, A.O.U. "Città della Salute e della Scienza", Unità Spinale Unipolare, Turin, Italy., Department of Urology, Herlev and Gentofte Hospital, Herlev, Denmark., Department of Urology, School of Medicine, Selcuk University, Konya, Turkey., Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey., Department of Urology, İstanbul University School of Medicine, İstanbul, Turkey., Department of Urology, Hospital Universitario Puerta del Hierro Majadahonda, Madrid, Spain., Urology Service, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Biomedicine, Faculty of Medicine, Porto University, Porto, Portugal., Urology Section, Department of Surgery, University of Catania, Catania, Italy., Department of Urology, Biruni University School of Medicine, Istanbul, Turkey., Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy., Department of Urology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK.