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Guidelines – Sexual Medicine

Guidelines on Male Sexual Dysfunction: Erectile Dysfunction and Premature Ejaculation

By: Konstantinos Hatzimouratidisa lowast , Edouard Amarb, Ian Eardleyc, Francois Giulianod, Dimitrios Hatzichristoua, Francesco Montorsie, Yoram Vardif and Eric Wespesg

European Urology, Volume 57 Issue 5, May 2010, Pages 804-814

Published online: 01 May 2010

Keywords: Erectile dysfunction, Male sexual dysfunction, Premature ejaculation, EAU Guidelines

Abstract Full Text Full Text PDF (559 KB)

Abstract

Context

Erectile dysfunction (ED) and premature ejaculation (PE) are the two most prevalent male sexual dysfunctions.

Objective

To present the updated version of 2009 European Association of Urology (EAU) guidelines on ED and PE.

Evidence acquisition

A systematic review of the recent literature on the epidemiology, diagnosis, and treatment of ED and PE was performed. Levels of evidence and grades of recommendation were assigned.

Evidence synthesis

ED is highly prevalent, and 5–20% of men have moderate to severe ED. ED shares common risk factors with cardiovascular disease. Diagnosis is based on medical and sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to the patient’s complaints and risk factors. Treatment is based on phosphodiesterase type 5 inhibitors (PDE5-Is), including sildenafil, tadalafil, and vardenafil. PDE5-Is have high efficacy and safety rates, even in difficult-to-treat populations such as patients with diabetes mellitus. Treatment options for patients who do not respond to PDE5-Is or for whom PDE5-Is are contraindicated include intracavernous injections, intraurethral alprostadil, vacuum constriction devices, or implantation of a penile prosthesis.

PE has prevalence rates of 20–30%. PE may be classified as lifelong (primary) or acquired (secondary). Diagnosis is based on medical and sexual history assessing intravaginal ejaculatory latency time, perceived control, distress, and interpersonal difficulty related to the ejaculatory dysfunction. Physical examination and laboratory testing may be needed in selected patients only.

Pharmacotherapy is the basis of treatment in lifelong PE, including daily dosing of selective serotonin reuptake inhibitors and topical anaesthetics. Dapoxetine is the only drug approved for the on-demand treatment of PE in Europe. Behavioural techniques may be efficacious as a monotherapy or in combination with pharmacotherapy. Recurrence is likely to occur after treatment withdrawal.

Conclusions

These EAU guidelines summarise the present information on ED and PE. The extended version of the guidelines is available at the EAU Web site (http://www.uroweb.org/nc/professional-resources/guidelines/online/).

Take Home Message

The 2009 version of the European Association of Urology guidelines on the diagnosis and management of erectile dysfunction and premature ejaculation are presented, summarising the most recent scientific information, current research, and clinical practice.

Keywords: Erectile dysfunction, Male sexual dysfunction, Premature ejaculation, EAU Guidelines.

Footnotes

a 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece

b Hôpital Bichat, Paris, France

c Pyrah Department of Urology, St. James University Hospital, Leeds, UK

d AP-HP, Neuro-Urology-Andrology, Raymond Poincaré Hospital, Garches, France

e Department of Urology, University Vita-Salute San Raffaele, Scientific Institute H. San Raffaele, Milan, Italy

f Department of Neuro-Urology, Rambam Medical Centre and Technion Faculty of Medicine, Haifa, Israel

g Hôpital Civil de Charleroi, Hôpital Erasme, Urology Department, Brussels, Belgium

Corresponding author. 2nd Department of Urology, Aristotle University of Thessaloniki, 54006, Thessaloniki, Greece. Tel. +302310991543; Fax: +302310676092.

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