The European Society for Sexual Medicine (ESSM) virtual congress, helded last February, represented another great success of our society. The COVID-19 situation forced a rapid re-organization of the congress content from a face to face meeting to a virtual event. Nevertheless, the scientific committee worked very hard and, along with the support of MCI and the ESSM Executive Council, we were able to organize a well balance congress including the most updated available evidence.

For the first time all the most important Societies involved in the field, including the International Society for Sexual Medicine (ISSM), the Asian Pacific Society of Reconstructive urology and Andrologic Surgeons (APSARUS), the Asian Pacific Society for Sexual Medicine(APSSM), the South Asian Society for Sexual Medicine (SASSM), the European Federation of Sexology (EFS), the European Association of Urology (EAU) Section of Genito-Urinary Reconstructive Surgeons (ESGURS) and Section of Andrological Urology (ESAU), the Sexual Medicine Society of North America. (SMNA), the Latin American Society for Sexual Medicine (SLAMS), the Middle East Society for Sexual Medicine (MESSM), the International Society for the Study of Women Sexual Health (ISSWSH), the European Professional Association for Transgender Health (EPATH) and the World Association for Sexual Health (WAS) were present at ESSM congress with their own specific session.

The final congress included 671 participants from 63 countries and 42 Scientific Sessions.

The role of testosterone (T) treatment (TRT) in subjects with late onset hypogonadism (LOH) still represents a conflicting issue. Sexual symptoms are the most specific determinants of age related decline of T. Availabe evidence indicates that TRT can ameliorate all the aspects of sexual function in hypogonadal men (total T < 12 nM), although its role in more complicated patients such as those with diabetes mellitus is more limited. Similarly, the role of TRT on other aspects of LOH, including metabolic profile, and mood disturbances as well as on cardiovascular risk is more debatable.

Emerging evidence, mainly derived from pre-clinical studies, has raised the possibility that platelet-rich plasma (PRP), a high concentrations of growth factors contained within platelets, including platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), fibroblast growth factor (FGF), insulin-like growth factor (IGF) can be successfully used as a regenerative approach for the treatment of erectile dysfunction (ED). Similar results were derived from the use of stem cells and gene therapy. However, the limited data obtained in clinical settings still limit the use of these approaches.

Penile prosthesis (PP) represents the 3^rd line therapy for the treatment of ED. When the candidate patients are adequately selected and prepared the overall outcomes are very good and satisfaction higher than 90%. Comorbidities including diabetes mellitus as well as associated vascular diseases arterial hypertension and risk factors such as smoking, if not adequately managed and optimized can all increase the risk of PP complications and infections.

Hypospadias represents one of the most common congenital anomalies in men characterized by proximal displacement of the urethral opening, penile curvature, and a ventrally deficient hooded foreskin. Hypospadias surgery, if not performed in a well centers with sufficient expertise can result in severe functional problems. Conversely, when the condition is adequately addressed, the overall, cosmetic outcomes and sexual function are considered satisfactory in more than 70% and 80%, respectively. As expected, worse results are observed in patients treated for proximal and more complex hypospadias.

Peronie’s Disease (PD) is an acquired connective tissue disorder associated with the formation of fibrous/calcified inelastic plaques at the level of the tunica albuginea (TA) of the penis. The exact etiology of PD is still unknown but putative risk factors include diabetes mellitus, arterial hypertension, dyslipidemia, ED, smoking and alcohol abuse. Specific sessions were focused on update in Surgical and medical treatment of PD. In addition, the possible role of mechanical therapy through the use of low-intensity extracorporeal shock wave therapy, penile traction devices and vacuum pump was also discussed.

Benign prostatic hyperplasia (BPH) is an extremely prevalent clinical condition affecting the aging male population, which prevalence increases from 42% in men in the fifth decade to almost 90% in men older than 80 years. BPH per se’ and lower urinary tract symptoms (LUTS) are frequently associated with ED and overall worse sexual functioning. In addition, medical therapy as well as surgical approach can further complicate the situation by inducing ejaculatory dysfunction and retrograde ejaculation. The available strategies to minimize retrograde ejaculation and sexual dysfunction were discussed in another specific round table.

Other important topics covered during the congress included the management of priapism and as well as the complications in female-to-male transgender surgery. In addition, some interesting new data regarding the role microbiome through life in female genitourinary health have been also discussed. Finally, other specific issues include the short and long-term sexual consequences of COVID-19 infections as well as the sexological aspects of women who have sex with women and sexual distress related to maladaptive cognitive styles and performance anxiety

Despite the COVID-19 situation, ESSM did a marvelous job producing a fantastic congress with the contribution of all the most important societies related to Sexual Medicine. This was my last congress as a Chair of the ESSM Scientific committee. It was a long trip started a long time ago first as a member, then as a sub-chair, and finally and as chair. During this period, I met several friends and great scientists, which have contributed to make Our Society one of the most important of the field.

I am sure that the terrible situation, we are facing off, will eventually finish and that we will have the possibility to meet each other together in a new fantastic ESSM congress. In the last sentence of this summary, let me thank from the bottom of my heart all the people who give me the support, the help and the friendship during all these years. Now it is time to follow the example of all our great Presidents and to continue working for hard ESSM, our great family.