The “DOPE” New ED Guidelines-Disorders of Penile Erections: Where We’ve Been and Where We’re Going

How to cite: Bernie HL. The “DOPE” New ED Guidelines-Disorders of Penile Erections: Where We’ve Been and Where We’re Going. Grand Rounds in Urology. February 2026. Accessed Oct 2026. https://grandroundsinurology.com/the-dope-new-ed-guidelines-disorders-of-penile-erections-where-weve-been-and-where-were-going/

Summary

Helen L. Bernie, DO, MPH, Director of Sexual and Reproductive Medicine, and Assistant Professor of Urology, Indiana University, Carmel, Indiana, reviews the 2018 AUA erectile dysfunction guideline, focusing on what the guideline did well, where evidence limitations constrained its recommendations, and how clinicians can apply it in practice. Dr. Bernie identifies shared decision-making as a central strength of the guideline, emphasizing a shift away from rigid stepwise treatment sequencing toward informing men about all non-contraindicated treatment options.

Dr. Bernie reviews structured sexual and medical history, focused physical examination, selective laboratory testing, and use of validated questionnaires as foundational components of diagnosis and risk stratification. She emphasizes the guideline’s framing of erectile dysfunction as a marker of systemic disease, particularly cardiovascular disease, presenting erectile dysfunction as a broader men’s health opportunity.

She highlights “gray areas” where evidence was not mature enough for stronger recommendations. These include penile rehabilitation, management after properly optimized PDE5 inhibitor non-response, regenerative therapies such as shockwave and stem cell approaches, testosterone nuance in erectile dysfunction management, and limitations in outcome measurement tools. Across these topics, she emphasizes that gaps reflect evidence limitations rather than conceptual failures of the guideline.

Dr. Bernie emphasizes that the guideline’s core principles remain applicable, particularly shared decision-making, appropriate education on PDE5 inhibitors, and treating erectile dysfunction as a gateway to broader men’s health optimization. She also highlights clinician engagement in peer review as part of future guideline evolution.

 

About the 45th Annual Ralph E. Hopkins Urology Seminar

 

The Annual Ralph E. Hopkins Urology Seminar, also known as the Jackson Hole Seminars, brings together distinguished urologists, clinical researchers, and thought leaders to share wisdom and experience that drives meaningful progress in patient care. Changes occur in medicine and urology on an almost daily basis, so it is imperative that the practicing urologist remains on the cutting edge. Urologists need to keep current on assessing, diagnosing, and treating urologic conditions in the clinical setting. The 45th meeting took place in 2026, focusing on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. 2026 also marked the meeting’s first-ever all-female speaker panel.