Summary of the Recommendations on Sexual Dysfunctions in Men

Abstract

Introduction There are few published guidelines for the management of sexual dysfunctions in men and women, despite the prevalence and lack of attention to these problems. Disorders of sexual function in men include erectile dysfunction, orgasm/ejaculation disorders, priapism, and Peyronie's disease. Aim To provide evidence-based and expert-opinion consensus guidelines for the clinical management of men's sexual dysfunctions. Methods An International Consultation in collaboration with major urological and sexual medicine societies assembled over 200 multidisciplinary experts from 60 countries into 17 consultation committees. Committee members established the scope and objectives for each chapter. Following intensive review of available data and publications, committees developed evidence-based guidelines in each area. Main Outcome Measure New algorithms and guidelines for assessment and treatment of men's sexual dysfunction were developed. The Oxford system of evidence-based review was systematically applied. Expert opinion was based on systematic grading of the medical literature, in addition to cultural and ethical considerations. Results Recommendations and guidelines for men's sexual dysfunction are presented. These guidelines were developed as evidence-based, patient-centered, and multidisciplinary in focus. For the clinical assessment and diagnosis of ED, a basic evaluation was recommended for all patients, with optional and specialized testing reserved for special cases. A new treatment algorithm is proposed. This algorithm provides a clinically relevant guideline for managing ED in the large majority of men. New treatment guidelines and algorithms are provided for men's orgasm and ejaculation disorders, including premature ejaculation, retrograde and delayed ejaculation. Finally, expert opinion-based guidelines for the clinical management of priapism and Peyronie's disease are provided. Conclusions Additional research is needed to validate and extend these guidelines. Nonetheless, this summary encompasses the recommendations concerning men's sexual dysfunctions presented at the 2nd International Consultation on Sexual Medicine in Paris, France, June 28–July 1, 2003.

Testosterone and Erectile Function: From Basic Research to a New Clinical Paradigm for Managing Men with Androgen Insufficiency and Erectile Dysfunction

“…Presenting symptoms exist in several other syndromes and vary widely among individuals. Thus, a detailed medical workup is required [4].…”

“…Sexual, psychosocial, and medication history-The sexual symptoms of androgen insufficiency are varied and include decreased sexual interest; diminished erectile quality, particularly of nocturnal erections; muted, delayed or absent orgasms; decreased genital sensation; and reduced sexual pleasure [82,83,86,[88][89][90]. In addition, sexual dysfunction may affect the patient's self-esteem, coping ability, and occupational and social roles [4]. Androgen insufficiency is associated with changes in mood, diminished well-being, blunted motivation, changes in spatial orientation, reduced intellectual ability, fatigue, depression, and anger/irritability [82,83,86,[88][89][90].…”

“…Similarly, ANDROTEST is a structured interview for the screening of androgen insufficiency in men with sexual dysfunction [99]. However, it should be noted that validated questionnaires cannot replace a detailed history and physical examination [4,82,83]. Questionnaires are separate and unique aspects of the "identification" aspect of the new clinical paradigm.…”

“…Thus, an essential component in the management of androgen insufficiency and ED is patient and partner education that is uniquely matched to individual needs [4]. Educational subjects include an overview of pertinent anatomy and physiology, relevant pathophysiology, full disclosure of risks and benefits, and appropriate discussion of expectations with treatment.…”

“…The health of the penile vascular tissues and the perineal and ischiocavernosus muscles that support the proximal penis is essential for normal erectile function [1][2][3][4]. The role of androgens in regulating erectile physiology in humans is of considerable importance and merits continued investigation.…”