The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction

Corona G; Cucinotta D; Di Lorenzo G; Ferlin A; Giagulli VA; Gnessi L; Isidori AM; Maiorino MI; Miserendino P; Murrone A; Pivonello R; Rochira V; Sangiorgi GM; Stagno G; Foresta C; Lenzi A; Maggi M; Jannini EA

doi:10.1007/s40618-023-02015-5

Clinical Guidelines and Standards · Guidelines by Clinical Area

The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction

Corona G, Cucinotta D, Di Lorenzo G, Ferlin A, Giagulli VA, Gnessi L, Isidori AM, Maiorino MI, Miserendino P, Murrone A, Pivonello R, Rochira V, Sangiorgi GM, Stagno G, Foresta C, Lenzi A, Maggi M, Jannini EA

Published June 2023 Journal of endocrinological investigation

DOI 10.1007/s40618-023-02015-5 PMID 36698034 PMC PMC9876440

RRM Academy Synopsis

Erectile dysfunction guideline urges whole-health, couple assessment

An Italian guideline from eleven medical societies finds that erectile dysfunction has many risk factors and calls for checking both partners. The panel graded its advice. It suggests looking for erectile dysfunction when a couple is checked for infertility. The guideline names PDE5 inhibitor pills as first-line treatment, after or with lifestyle change.

Regained erectile function: Mediterranean diet group, 37 in 100; Control group, 7 in 100. Source: Corona G et al., 2023, PMID 36698034.

Key Findings

The guideline strongly recommends investigating erectile dysfunction in men with arterial hypertension, obesity, diabetes mellitus, or dyslipidemia.
Among men in infertile couples, sexual dysfunctions ranged from 6.7 to 75%, and erectile dysfunction affected about one in six infertile men.
A SIAMS survey reported erectile dysfunction in 56.2% of men undergoing assisted reproduction techniques (ART).
In one 2-year trial of men with metabolic syndrome and erectile dysfunction, more men on a Mediterranean diet regained erectile function than controls (37% vs 7%; p = 0.015).
The panel recommends against the term "psychogenic" for non-organic erectile dysfunction (expert opinion) and against diagnosing erectile dysfunction by exclusion (good clinical practice).

Interpretation

The guideline is a consensus document from an expert task force. Most recommendations carry a GRADE or practice-based label. Many rest on observational associations, while some lifestyle advice cites randomized trials. The authors say few studies checked erectile dysfunction in infertile couples with validated tools. Studies of men over 70 and under 40 are limited. The methods describe expert discussion of the best evidence available in PubMed.

RRM Context

Restorative reproductive medicine looks for the cause of infertility in both partners. The guideline adds male-side detail. Its authors say erectile dysfunction may also signal hypogonadism and poor general health in infertile men. They call for assessing the couple as a whole, which matches the restorative goal of evaluating both partners first.

Our editorial summary of this paper, not the article's abstract.

Abstract

Purpose

Erectile dysfunction (ED) is one of the most prevalent male sexual dysfunctions. ED has been in the past mistakenly considered a purely psycho-sexological symptom by patients and doctors. However, an ever-growing body of evidence supporting the role of several organic factors in the pathophysiological mechanisms underlying ED has been recognized.

Methods

The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving several other National Societies to provide an updated guideline on the diagnosis and management of ED. Derived recommendations were based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

Results

Several evidence-based statements were released providing the necessary up-to-date guidance in the context of ED with organic and psychosexual comorbidities. Many of them were related to incorrect lifestyle habits suggesting how to associate pharmacotherapies and counseling, in a couple-centered approach. Having the oral therapy with phosphodiesterase type 5 inhibitors as the gold standard along with several other medical and surgical therapies, new therapeutic or controversial options were also discussed.

Conclusions

These are the first guidelines based on a multidisciplinary approach that involves the most important Societies related to the field of sexual medicine. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving couple sexual satisfaction and overall general health.

Topics

Clinical Guidelines and Standards Guidelines by Clinical Area Bone and Endocrine Guidelines

Clinical Guidelines and Standards › Guidelines by Clinical Area › Bone and Endocrine Guidelines

G Di Lorenzo

PMID 36698034 36698034 DOI 10.1007/s40618-023-02015-5 10.1007/s40618-023-02015-5 Corona et al. 2023, Corona 2023

The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction

Erectile dysfunction guideline urges whole-health, couple assessment

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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