European Association of Urology Guidelines on Sexual and Reproductive Health-2021 Update: Male Sexual Dysfunction

Eur Urol. 2021 Sep;80(3):333-357. doi: 10.1016/j.eururo.2021.06.007. Epub 2021 Jun 26.


Context: The present summary of the European Association of Urology (EAU) guidelines is based on the latest guidelines on male sexual health published in March 2021, with a last comprehensive update in January 2021.

Objective: To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health.

Evidence acquisition: A literature review was performed up to January 2021. The guidelines were updated, and a strength rating for each recommendation was included based on either a systematic review of the evidence or a consensus opinion from the expert panel.

Evidence synthesis: Late-onset hypogonadism is a clinical condition in the ageing male combining low levels of circulating testosterone and specific symptoms associated with impaired hormone production and/or action. A comprehensive diagnostic and therapeutic work-up, along with screening recommendations and contraindications, is provided. Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Along with a detailed basic and advanced diagnostic approach, a novel decision-making algorithm for treating ED in order to better tailor therapy to individual patients is provided. The EAU guidelines have adopted the definition of premature ejaculation (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. Haemospermia is defined as the appearance of blood in the ejaculate. Several reasons of haemospermia have been acknowledged; the primary goal over the management work-up is to exclude malignant conditions and treat any other underlying cause.

Conclusions: The 2021 guidelines on sexual and reproductive health summarise the most recent findings, and advise in terms of diagnosis and treatment of male hypogonadism and sexual dysfunction for their use in clinical practice. These guidelines reflect the multidisciplinary nature of their management.

Patient summary: Updated European Association of Urology guidelines on sexual and reproductive health are presented, addressing the diagnosis and treatment of the most prevalent conditions in men. Patients must be fully informed of all relevant diagnostic and therapeutic options and, together with their treating physicians, decide on optimal personalised management strategies.

Keywords: Ejaculatory disorders; Erectile dysfunction; Guidelines; Haemospermia; Hypogonadism; Male; Premature ejaculation; Sexual dysfunction; Testosterone.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Erectile Dysfunction* / diagnosis
  • Erectile Dysfunction* / etiology
  • Erectile Dysfunction* / therapy
  • Europe
  • Hemospermia* / diagnosis
  • Hemospermia* / etiology
  • Hemospermia* / therapy
  • Humans
  • Hypogonadism* / diagnosis
  • Hypogonadism* / drug therapy
  • Hypogonadism* / etiology
  • Male
  • Practice Guidelines as Topic
  • Premature Ejaculation* / diagnosis
  • Premature Ejaculation* / etiology
  • Premature Ejaculation* / therapy