Ira D. Sharlip

INTRODUCTION: Sexual health is an integral part of overall health. Sexual dysfunction can have a major impact on quality of life and psychosocial and emotional well-being. AIM: To provide evidence-based, expert-opinion consensus guidelines for clinical management of sexual dysfunction in men. METHODS: An international consultation collaborating with major urologic and sexual medicine societies convened in Paris, July 2009. More than 190 multidisciplinary experts from 33 countries were assembled into 25 consultation committees. Committee members established scope and objectives for each chapter. Following an exhaustive review of available data and publications, committees developed evidence-based guidelines in each area. Main Outcome Measures. New algorithms and guidelines for assessment and treatment of sexual dysfunctions were developed based on work of previous consultations and evidence from scientific literature published from 2003 to 2009. The Oxford system of evidence-based review was systematically applied. Expert opinion was based on systematic grading of medical literature, and cultural and ethical considerations. RESULTS: Algorithms, recommendations, and guidelines for sexual dysfunction in men are presented. These guidelines were developed in an evidence-based, patient-centered, multidisciplinary manner. It was felt that all sexual dysfunctions should be evaluated and managed following a uniform strategy, thus the International Consultation of Sexual Medicine (ICSM-5) developed a stepwise diagnostic and treatment algorithm for sexual dysfunction. The main goal of ICSM-5 is to unmask the underlying etiology and/or indicate appropriate treatment options according to men's and women's individual needs (patient-centered medicine) using the best available data from population-based research (evidence-based medicine). Specific evaluation, treatment guidelines, and algorithms were developed for every sexual dysfunction in men, including erectile dysfunction; disorders of libido, orgasm, and ejaculation; Peyronie's disease; and priapism. CONCLUSIONS: Sexual dysfunction in men represents a group of common medical conditions that need to be managed from a multidisciplinary perspective.

No AccessJournal of UrologyCLINICAL UROLOGY: Special Communications1 Oct 2003American Urological Association Guideline On The Management of Priapism DROGO K. MONTAGUE, JONATHAN JAROW, GREGORY A. BRODERICK, ROGER R. DMOCHOWSKI, JEREMY P.W. HEATON, TOM F. LUE, AJAY NEHRA, IRA D. SHARLIP, and MEMBERS OF THE ERECTILE DYSFUNCTION GUIDELINE UPDATE PANEL‡‡ DROGO K. MONTAGUEDROGO K. MONTAGUE Financial interests/and or relationship with American Medical Systems, Bayer, Lilly-ICOS and Pfizer. More articles by this author , JONATHAN JAROWJONATHAN JAROW Financial interest and/or other relationship with Pfizer and Bayer. More articles by this author , GREGORY A. BRODERICKGREGORY A. BRODERICK Financial interest and/or other relationship with Bayer, Eli Lilly/ICOS, Mentor Corp. Abbott/Tap and Pfizer. More articles by this author , ROGER R. DMOCHOWSKIROGER R. DMOCHOWSKI Financial interest and/or other relationship with Ortho-McNeil Pharmaceuticals, Watson and Indevus. More articles by this author , JEREMY P.W. HEATONJEREMY P.W. HEATON Financial interests/and or relationship with AGGSH International, Cellegy and TAP. More articles by this author , TOM F. LUETOM F. LUE Financial interest and/or other relationship with Pfizer, Lilly/ICOS, Bayer-GlaxoSmithKline and Tap. More articles by this author , AJAY NEHRAAJAY NEHRA Financial interest and/or other relationship with Bayer and Pfizer. More articles by this author , IRA D. SHARLIPIRA D. SHARLIP Financial interest and/or other relationship with Pfizer, Lilly/ICOS, Bayer, Tap and NexMed. More articles by this author , and MEMBERS OF THE ERECTILE DYSFUNCTION GUIDELINE UPDATE PANEL‡‡ Consultants: Hanan S. Bell, Patrick M. Florer and Charles B. Hathaway. More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000087608.07371.caAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Low-flow priapism: risk factors for erectile dysfunction. BJU Int2002; 89: 285. Google Scholar 2 : The ultrastructure of erectile tissue in priapism. J Urol1986; 135: 142. Link, Google Scholar 3 : Pharmacologic erection: time-dependent changes in the corporal environment. Int J Impot Res1994; 6: 9. Google Scholar 4 : Catecholamines, sympathomimetic drugs, and adrenergic receptor antagonists. In: Goodman and Gilman's The Pharmacological Basis of Therapeutics. Edited by . New York: McGraw-Hill Professional Publishing, chapt. 102001: 215. Google Scholar 5 : Priapism. In: Glenn's Urologic Surgery. Edited by . Philadelphia: Lippincott Williams & Wilkins1998. Google Scholar 6 : Atlas of Urologic Surgery. Philadelphia: W. B. 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Google Scholar © 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byBivalacqua T, Allen B, Brock G, Broderick G, Chou R, Kohler T, Mulhall J, Oristaglio J, Rahimi L, Rogers Z, Terlecki R, Trost L, Yafi F and Bennett N (2022) The Diagnosis and Management of Recurrent Ischemic Priapism, Priapism in Sickle Cell Patients, and Non-Ischemic Priapism: An AUA/SMSNA GuidelineJournal of Urology, VOL. 208, NO. 1, (43-52), Online publication date: 1-Jul-2022.Hou L and Burnett A (2020) Regimented Phosphodiesterase Type 5 Inhibitor Use Reduces Emergency Department Visits for Recurrent Ischemic PriapismJournal of Urology, VOL. 205, NO. 2, (545-553), Online publication date: 1-Feb-2021.Masterson T, Parmar M, Tradewell M, Nackeeran S, Rainer Q, Blachman-Braun R, Heller N, Greer A, Hauser N, Kava B and Ramasamy R (2020) Using Artificial Intelligence to Predict Surgical Shunts in Men with Ischemic PriapismJournal of Urology, VOL. 204, NO. 5, (1033-1038), Online publication date: 1-Nov-2020.Zacharakis E, Raheem A, Freeman A, Skolarikos A, Garaffa G, Christopher A, Muneer A and Ralph D (2013) The Efficacy of the T-Shunt Procedure and Intracavernous Tunneling (Snake Maneuver) for Refractory Ischemic PriapismJournal of Urology, VOL. 191, NO. 1, (164-168), Online publication date: 1-Jan-2014.Roghmann F, Becker A, Sammon J, Ouerghi M, Sun M, Sukumar S, Djahangirian O, Zorn K, Ghani K, Gandaglia G, Menon M, Karakiewicz P, Noldus J and Trinh Q (2013) Incidence of Priapism in Emergency Departments in the United StatesJournal of Urology, VOL. 190, NO. 4, (1275-1280), Online publication date: 1-Oct-2013.Qureshi J, Wood H and Feldman M (2013) High Flow Priapism on Color Doppler UltrasoundJournal of Urology, VOL. 189, NO. 6, (2312-2313), Online publication date: 1-Jun-2013.Segal R, Readal N, Pierorazio P, Burnett A and Bivalacqua T (2012) Corporal Burnett “Snake” Surgical Maneuver for the Treatment of Ischemic Priapism: Long-Term FollowupJournal of Urology, VOL. 189, NO. 3, (1025-1029), Online publication date: 1-Mar-2013.Salem E and El Aasser O (2010) Management of Ischemic Priapism by Penile Prosthesis Insertion: Prevention of Distal ErosionJournal of Urology, VOL. 183, NO. 6, (2300-2303), Online publication date: 1-Jun-2010.Abern M and Levine L (2009) Ketoconazole and Prednisone to Prevent Recurrent Ischemic PriapismJournal of Urology, VOL. 182, NO. 4, (1401-1406), Online publication date: 1-Oct-2009.Brant W, Garcia M, Bella A, Chi T and Lue T (2009) T-Shaped Shunt and Intracavernous Tunneling for Prolonged Ischemic PriapismJournal of Urology, VOL. 181, NO. 4, (1699-1705), Online publication date: 1-Apr-2009.Burnett A (2008) No Surgery for Stuttering PriapismJournal of Urology, VOL. 181, NO. 2, (450-451), Online publication date: 1-Feb-2009.Morey A (2007) Trauma, and Genital and Urethral ReconstructionJournal of Urology, VOL. 178, NO. 1, (174-176), Online publication date: 1-Jul-2007. Volume 170Issue 4 Part 1October 2003Page: 1318-1324 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.MetricsAuthor Information DROGO K. MONTAGUE Financial interests/and or relationship with American Medical Systems, Bayer, Lilly-ICOS and Pfizer. More articles by this author JONATHAN JAROW Financial interest and/or other relationship with Pfizer and Bayer. More articles by this author GREGORY A. BRODERICK Financial interest and/or other relationship with Bayer, Eli Lilly/ICOS, Mentor Corp. Abbott/Tap and Pfizer. More articles by this author ROGER R. DMOCHOWSKI Financial interest and/or other relationship with Ortho-McNeil Pharmaceuticals, Watson and Indevus. More articles by this author JEREMY P.W. HEATON Financial interests/and or relationship with AGGSH International, Cellegy and TAP. More articles by this author TOM F. LUE Financial interest and/or other relationship with Pfizer, Lilly/ICOS, Bayer-GlaxoSmithKline and Tap. More articles by this author AJAY NEHRA Financial interest and/or other relationship with Bayer and Pfizer. More articles by this author IRA D. SHARLIP Financial interest and/or other relationship with Pfizer, Lilly/ICOS, Bayer, Tap and NexMed. More articles by this author MEMBERS OF THE ERECTILE DYSFUNCTION GUIDELINE UPDATE PANEL‡‡ Consultants: Hanan S. Bell, Patrick M. Florer and Charles B. Hathaway. More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION: Definitions of sexual dysfunctions in women and men are critical in facilitating research and enabling clinicians to communicate accurately. AIMS: To present the new set of definitions of all forms of sexual dysfunction in women and men adopted by the Fourth International Consultation on Sexual Medicine (ICSM) held in 2015. METHODS: Classification systems, including the International Classification of Diseases, 10th Edition and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and systems that focus on only specific types of sexual dysfunctions (e.g., the International Society for Sexual Medicine definition for premature ejaculation) were reviewed. MAIN OUTCOME MEASURES: Evidence-based definitions were retained, gaps in definitions were identified, and outdated definitions were updated or discarded. Where evidence was insufficient or absent, expert opinion was used. Some definitions were self-evident and termed clinical principles. RESULTS: The evidence to support the various classification systems was carefully evaluated. A more comprehensive analysis of this evidence can be found in two other articles in this journal that consider the incidence and prevalence and the risk factors for sexual dysfunction in men and women. These data were used to shape the definitions for sexual dysfunction that have been recommended by the 2015 ICSM. CONCLUSION: The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions. As more research and clinical studies are conducted, there likely will be modifications of at least some definitions.

During a 9-year period 1,469 men who underwent microsurgical vasectomy reversal procedures were studied at 5 institutions. Of 1,247 men who had first-time procedures sperm were present in the semen in 865 of 1,012 men (86%) who had postoperative semen analyses, and pregnancy occurred in 421 of 810 couples (52%) for whom information regarding conception was available. Rates of patency (return of sperm to the semen) and pregnancy varied depending on the interval from the vasectomy until its reversal. If the interval had been less than 3 years patency was 97% and pregnancy 76%, 3 to 8 years 88% and 53%, 9 to 14 years 79% and 44% and 15 years or more 71% and 30%. The patency and pregnancy rates were no better after 2-layer microsurgical vasovasostomy than after modified 1-layer microsurgical procedures and they were statistically the same for all patients regardless of the surgeon. When sperm were absent from the intraoperative vas fluid bilaterally and the patient underwent bilateral vasovasostomy rather than vasoepididymostomy, patency occurred in 50 of 83 patients (60%) and pregnancy in 20 of 65 couples (31%). Neither presence nor absence of a sperm granuloma at the vasectomy site nor type of anesthesia affected results. Repeat microsurgical reversal procedures were less successful. A total of 222 repeat operations produced patency in 150 of 199 patients (75%) who had semen analyses and pregnancy was reported in 52 of 120 couples (43%).