Introduction Clinical practice guidelines for management of erectile dysfunction (ED) provide limited direction in defining appropriate treatment goals with phosphodiesterase type 5 (PDE5) inhibitor therapy. Aim To establish an evidence-based position on treatment goals in ED, including the role of erection hardness, with the potential to improve self-esteem, confidence, and overall sexual and relationship satisfaction. Main Outcome Measure The target of ED therapy is optimization of a rigid erectile response, as assessed by the 4-point Erection Hardness Score (EHS). Methods An international panel of experts in urology, psychology, and primary care convened to evaluate retrospective data from worldwide phase 2, 3, and 4 clinical trials, involving over 10,000 men with ED, as well as data from recent prospective studies, concerning the role of erection hardness in defining the response to treatment with PDE5 therapy. Results Significant positive correlations were found between EHS and the Quality of Erection Questionnaire and the International Index of Erectile Function (IIEF) erectile function domain score and other IIEF measures. Significant positive correlations were also found between erection hardness and psychosocial measures such as self-esteem, confidence, and relationship satisfaction (assessed by the Self-Esteem And Relationship questionnaire), and satisfaction with medical treatment (assessed by the Erectile Dysfunction Inventory of Treatment Satisfaction). A shift in most frequent erection from EHS 3 (hard enough for penetration but not fully hard) at baseline to EHS 4 (completely hard and fully rigid) at the end of treatment was accompanied by significant improvements in intercourse and relationship satisfaction, psychosocial benefits, and satisfaction with ED treatment. Conclusion Support is found for monitoring and treating patients with ED to their full erectile potential. Quantitative assessment of erection hardness in clinical practice will lead to improved outcomes in overall sexual experience and optimal treatment satisfaction.

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Introduction Liquid injectable silicone (LIS) has been used for soft tissue augmentation in excess of 50 years. Until recently, all literature on penile augmentation with LIS consisted of case reports or small cases series, most involving surgical intervention to correct the complications of LIS. New formulations of LIS and new methodologies for injection have renewed interest in this procedure. Aim We reported a case of penile augmentation with LIS and reviewed the pertinent literature. Methods Comprehensive literature review was performed using PubMed. We performed additional searches based on references from relevant review articles. Results Injection of medical grade silicone for soft tissue augmentation has a role in carefully controlled study settings. Historically, the use of LIS for penile augmentation has had poor outcomes and required surgical intervention to correct complications resulting from LIS. Conclusions We currently discourage the use of LIS for penile augmentation until carefully designed and evaluated trials have been completed.

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Most women with HSDD were in long-term partner relationships with high levels of overall relationship satisfaction. Postmenopausal women were more likely to seek help for their disorder, despite similarly high levels of distress associated with HSDD. Further research is needed to examine treatment outcomes.