Erectile Dysfunction (ED) Assessment

WHAT IS ERECTILE DYSFUNCTION?

Erectile dysfunction (ED) is the inability to initiate and maintain an erection satisfactory for sexual intercourse.

 

Assessment

The assessment of ED is based on history and examination, as well as the use of ED questionnaires to determine the severity of ED.

 

Diagnosis and evaluation

ED is diagnosed based on the history of the patient based on the inability to initiate and maintain an erection satisfactory for sexual intercourse.

Further evaluation include evaluation of underlying medical diseases, lifestyle habits, underlying neurological problems, psychological issues, injuries, previous radiotherapy and current medications among others.

Important points in the evaluation include a detailed medical, sexual and social history; a focused physical examination, and laboratory tests for any unrecognized medical diseases and hormonal tests.

Sexual Function and Related History

They include description of erectile dysfunction
 

Age at onset and duration
 

Association with specific event
 

Progression (rapid vs. gradual) of dysfunction
 

Quality of erections
   

Partial, unable to sustain
 

Frequency of dysfunction
   

Mild (occasional), moderate (often), complete absence
 

Setting of erectile dysfunction
   

Presence or absence of nocturnal erections
   

Presence or absence of dysfunction with different partners
   

Presence or absence of dysfunction with self pleasuring
 

Other sexual problems (loss of libido, ejaculation problems)
Presence of chronic disease
Use of prescription, over-the-counter, or recreational drugs
Cigarette smoking
Social issues
 

Relationships
 

Life stressors

  
Expectations of patient and partner
Knowledge of sexual function

 

ED Questionnaires

Various questionnaires are available to assess the severity of ED.

The International Index of Erectile Function (IIEF-5) Questionnaire:

An IEEF-5 questionnaire is available to help patients and doctors to determine if ED is present and how severe it is.

This IIEF-5 questionnaire helps in assessing the severity of ED and a score of 21 or less indicates the patient has a problem with his erection.

Over the past 6 months:

1. How do you rate your confidence that you could get and keep an erection?

Very low

1

Low

2

Moderate

3

High

4

Very high

5

2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration?

Almost never/never 1

A few times (much less than half the time)

2

Sometimes (about half the time)

3

Most times (much more than half the time)

4

Almost always/always

5

3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

Almost never/never

1

A few times (much less than half the time)

2

Sometimes (about half the time)

3

Most times (much more than half the time)

4

Almost always/always

5

4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

Extremely difficult

1

Very difficult

2

Difficult

3

Slightly difficult

4

Not difficult

5

5. When you attempted sexual intercourse, how often was it satisfactory for you?

Almost never/never

1

A few times (much less than half the time)

2

Sometimes (about half the time)

3

Most times (much more than half the time)

4

Almost always/always

5

IIEF-5 scoring:
The IIEF-5 score is the sum of the ordinal responses to the 5 items.
22-25: No erectile dysfunction
17-21: Mild erectile dysfunction
12-16: Mild to moderate erectile dysfunction
8-11: Moderate erectile dysfunction
5-7: Severe erectile dysfunction

 

The Erection Hardness scale:

The Erection Hardness Scale (EHS) involves a 1–4 response to a single question to assess firmness of erection, where 3 is sufficient for penetration and 4 is a rigid erection.

The tool asks men to consider the question ‘How would you rate the hardness of your erection?’ and select one of the following options:

0

Penis does not enlarge

1

Penis is larger, but not hard

2

Penis is hard, but not hard enough

for penetration

 

3

Penis is hard enough for penetration,

but not completely hard

 

4

Penis is completely hard and fully rigid