• Neurological aspects. In: Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, Messelink EJ, Oberpenning F, Williams AC. Guidelines on chronic pelvic pain. Arnhem, The Netherlands: European Association of Urology (EAU); 2008 Mar. p. 65-73. [46 references]

This is the current release of the guideline.

• Neurological causes of sexual dysfunction, including cortical disease, spinal cord trauma, stroke, epilepsy, multiple sclerosis, and radical pelvic surgery
• Sexual dysfunction, including hypoactive sexual desire, or disorders of sexual desire, sexual arousal, orgasms or sexual pain

Diagnosis
Evaluation
Management
Treatment

Obstetrics and Gynecology
Urology

Physicians

• To help urologists in the clinical decisions they make every day
• To provide access to the best contemporaneous consensus view on the most appropriate management currently available

Europeans with neurological causes of sexual dysfunction

Diagnosis/Evaluation

1. Identification of neurological causes of sexual dysfunction, including general medical conditions
2. Evaluation of the female within the context of the couple in a sexual medicine clinic

Management/Treatment

1. Treatment of underlying medical conditions
2. Pelvic floor exercises
3. Electrical stimulation feedback with cognitive therapy
4. Hormone replacement therapy in women
5. Testosterone in women
6. Phosphodiesterase-5 inhibitors (considered but not recommended in women)

• Prevalence of female sexual dysfunction
• Prevalence of erectile dysfunction

Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

A structured literature search was performed but this search was limited to randomized controlled trials and meta-analyses, covering at least the past three years, or up until the date of the latest text update if this exceeds the three-year period. Other excellent sources to include were other high-level evidence, Cochrane review and available high-quality guidelines produced by other expert groups or organizations. If there were no high-level data available, the only option was to include lower-level data. The choice of literature was guided by the expertise and knowledge of the Guidelines Working Group.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

1a Evidence obtained from meta-analysis of randomized trials

1b Evidence obtained from at least one randomized trial

2a Evidence obtained from one well-designed controlled study without randomization

2b Evidence obtained from at least one other type of well-designed quasi-experimental study

3 Evidence obtained from well-designed non-experimental studies, such as comparative studies, correlation studies and case reports

4 Evidence obtained from expert committee reports or opinions or clinical experience of respected authorities

Systematic Review

Not stated

Expert Consensus

• The first step in the European Association of Urology (EAU) guidelines procedure is to define the main topic.
• The second step is to establish a working group. The working groups comprise about 4 to 8 members, from several countries. Most of the working group members are academic urologists with a special interest in the topic. Specialists from other medical fields (pain medicine, psychology, radiotherapy, oncology, gynaecology, anaesthesiology, etc.) are included as full members of the working groups as needed. In general, general practitioners or patient representatives are not part of the working groups. Each member is appointed for a four-year period, renewable once. A chairman leads each group.
• The third step is to collect and evaluate the underlying evidence from the published literature.
• The fourth step is to structure and present the information. All main recommendations are summarized in boxes and the strength of the recommendation is clearly marked in three grades (A-C), depending on the evidence source upon which the recommendation is based. Every possible effort is made to make the linkage between the level of evidence and grade of recommendation as transparent as possible.

Grades of Recommendation

1. Based on clinical studies of good quality and consistency addressing the specific recommendations and including at least one randomized trial
2. Based on well-conducted clinical studies, but without randomized clinical studies
3. Made despite the absence of directly applicable clinical studies of good quality

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

Sexual Dysfunction in Men and Women

Neurological causes of sexual dysfunction include cortical disease, spinal cord trauma, stroke, epilepsy, multiple sclerosis, radical pelvic surgery and many more conditions. As the aetiology is diverse, so is the pathophysiology with damage to the thoracolumbar outflow in men during extensive surgery affecting ejaculation to damage of the hypothalamus and pituitary, following head injury, resulting in hypopituitarism and a concomitant desensitisation of the genital region.

The treatment in men and women with neurological or non-neurological disease includes pelvic floor exercises and electrical stimulation feedback with cognitive therapy.

Female sexual dysfunction is less easy to treat, but is affected by problems in the male, and it is now recommended that evaluation of the female should be addressed within the context of the couple in a sexual medicine clinic. Identifying and treating general medical conditions is vital to the effective management of both men and women. In addition to neurological related dysfunction in young women, pelvic floor dysfunction, as a consequence of childbirth, must be taken into account as the importance of the menopause in the older woman. Despite the fact that hormone replacement therapy has been used extensively and effectively, there is still a small sub-set of women in whom this is not enough. In this group the libido is affected greatly and the use of testosterone products have been found to be important. Pharmacotherapy, like the phosphodiesterase (PDE)-5 inhibitors in men, has not been found to be useful in women.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

• Accurate diagnosis and evaluation of neurological causes of sexual dysfunction
• Appropriate management and treatment of neurological causes of sexual dysfunction

Not stated

• The European Association of Urology (EAU) believes that producing validated best practice in the field of urology is a very powerful and efficient tool in improving patient care. It is, however, the expertise of the clinician which should determine the needs of their patients. Individual patients may require individualized approaches which take into account all circumstances and treatment decisions often have to be made on a case-by-case basis.
• There are some very clear limitations on the use of the EAU Guidelines. These guidelines are specifically aimed at helping the practising urologist and will thus be of limited use to other health care providers or third party payers. These are limitations which we have accepted, given that the aim is to cover all of Europe and that such non-clinical questions are best covered locally. Another limitation is that the texts have no medico-legal status, nor are they intended to be used as such.
• The purpose of this text is not to be proscriptive in the way a clinician should treat a patient but rather to provide access to the best contemporaneous consensus view on the most appropriate management currently available. EAU guidelines are not meant to be legal documents but are produced with the ultimate aim to help urologists with their day-to-day practice.

Living with Illness

Effectiveness
Patient-centeredness

• Neurological aspects. In: Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, Messelink EJ, Oberpenning F, Williams AC. Guidelines on chronic pelvic pain. Arnhem, The Netherlands: European Association of Urology (EAU); 2008 Mar. p. 65-73. [46 references]

Not applicable: The guideline was not adapted from another source.

2008 Mar

European Association of Urology - Medical Specialty Society

European Association of Urology

Not stated

Primary Authors: M. Fall (Chair); A.P. Baranowski; S. Elneil; D. Engeler; J. Hughes; E.J. Messelink; F. Oberpenning; A.C. de C. Williams

All members of the Chronic Pelvic Pain guidelines writing panel have provided disclosure statements on all relationships that they have and that might be perceived as a potential source of conflict of interest. This information is kept on file in the European Association of Urology Central Office database. This guideline document was developed with the financial support of the European Association of Urology (EAU). No external sources of funding and support have been involved. The EAU is a non-profit organisation and funding is limited to administrative assistance, travel, and meeting expenses. No honoraria or other reimbursements have been provided.

This is the current release of the guideline.

The following are available:

• EAU guidelines office template. Arnhem, The Netherlands: European Association of Urology (EAU); 2007. 4 p.
• The European Association of Urology (EAU) guidelines methodology: a critical evaluation. Arnhem, The Netherlands: European Association of Urology (EAU); 18 p.

The following is also available:

• Guidelines on chronic pelvic pain. 2005, Ultra short pocket guidelines. Arnhem, The Netherlands: European Association of Urology (EAU); 2008 Mar. 18 p.

Print copies: Available from the European Association of Urology, PO Box 30016, NL-6803, AA ARNHEM, The Netherlands.

None available

This NGC summary was completed by ECRI Institute on December 29, 2008. The information was verified by the guideline developer on February 27, 2009.

This summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

Downloads are restricted to one download and print per user, no commercial usage or dissemination by third parties is allowed.