European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Hypogonadism, Erectile Dysfunction, Premature Ejaculation, and Peyronie’s Disease

Abstract

Objective

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.

Evidence acquisition

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.

Key findings

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.

Conclusions and clinical implications

This overview of the 2025 EAU SRH guidelines offers valuable insights into the diagnosis, treatment, and follow-up of LOH, ED, PE, and PD.