Erectile Dysfunction: Monitoring Response to Treatment in Clinical Practice—Recommendations of an International Study Panel

Abstract

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.

Characteristics and expectations of patients with erectile dysfunction: results of the SCORED study

“…One particularly difficult factor to address is erection hardness, although it is of critical importance in treatment success. 11 In a study involving 1960 men, insufficient efficacy was the main reason (83%) to switch treatment. Moreover, patients were more satisfied with the new treatment because it yielded stronger erections (73%).…”

“…Moreover, patients were more satisfied with the new treatment because it yielded stronger erections (73%). 12 One simple way of assessing erection hardness is the four-point Erection Hardness Score (EHS), 11,13 and recent studies have shown that even a shift from score 3 (penis hard enough for penetration but not completely hard) to score 4 (penis is completely hard and fully rigid) correlates with statistically significant increases in self-esteem, confidence, sexual relationship and overall relationship (Self-Esteem and Relationship questionnaire) as well as increases in satisfaction, orgasmic function, sexual desire and intercourse satisfaction (International Index of Erectile Function, IIEF).…”

Application of Erection Hardness Score as a Diagnostic Tool to Assess Erectile Function Recovery after Robot-Assisted Radical Prostatectomy

“…The erectile function of the enrolled patients was assessed using a STP [8,9] where the patient responded to the question: "How would you rate the hardness of your erection?" and IIEF-5 [10] initially and on every patient visit at 3, 6 and 12 months after RARP.…”

Sexual Health and Overall Wellness (SHOW) survey in men and women in selected European and Middle Eastern countries

“…The questionnaire was developed by Harris Interactive Inc., in close collaboration with Pfizer Inc. and in consultation with experts in the field. The questionnaire comprised closed-ended questions only, with one validated question (Erection Hardness Scale; EHS 14 ). The questionnaire was designed to evaluate: (i) overall health and wellness; (ii) importance of and satisfaction with various aspects of life, intimate relationship, sexual experience and sexual performance; (iii) general attitudes about sex; (iv) attitudes about men's sexual health; (v) frequency of and satisfaction with sexual intercourse; (vi) attitudes and perceptions of suboptimal erection; (vii) level of interest in improving sexual experience; (viii) usage of and satisfaction with treatments for improving erectile function; (ix) physician-patient dialogue concerning erectile function.…”