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The erection hardness score and its relationship to successful sexual intercourse.
J Sex Med. 2008 Oct; 5(10):2374-80.JS

Abstract

INTRODUCTION

The Erection Hardness Score (EHS), recently validated, was developed in 1998 as a simple (one-item) method to quantify erection outcome data. Although it is intuitive that erection hardness and successful sexual intercourse (SSI) are related, the link has not been directly established.

OBJECTIVE

To evaluate the relationship between erection hardness (assessed by EHS) and SSI, establishing the EHS as a clinically useful tool.

METHODS

The data set (N = 307) was from a multinational, double-blind, placebo-controlled trial (with open-label extension) of sildenafil citrate in men with erectile dysfunction.

MAIN OUTCOME MEASURES

Event-based modeling used every intercourse attempt and the EHS to estimate the odds ratio of SSI between adjacent EHS categories. Mean-based modeling used mean EHS per patient to determine its relationship to percentage of SSI. Mediation-based modeling used mean EHS and mean percentage of SSI over the double-blind phase to estimate the direct effect of sildenafil treatment on SSI and the indirect effect of sildenafil treatment on SSI via erection hardness.

RESULTS

The odds of SSI for EHS 3 (hard enough for penetration but not completely hard) were 41.9 times (95% confidence interval [CI], 33.0-53.2; P < 0.0001) that for EHS 2 (hard but not hard enough for penetration), and the odds of SSI for EHS 4 (completely hard and fully rigid) were 23.7 times (95% CI, 19.5-28.9; P < 0.0001) that for EHS 3. The percentage of SSI increased approximately curvilinearly with the increase in mean EHS, from almost 60% at EHS 3 to 78.5% at EHS 3.5 and to 93.1% at EHS 4. The indirect effect of sildenafil treatment on SSI via erection hardness accounted for almost 90% of the total effect on SSI (P < 0.0001).

CONCLUSION

The close and direct relationship between erection hardness and SSI supports the broader use of the EHS-a simple, valid, reliable, and responsive measure-in clinical practice.

Authors+Show Affiliations

Sexual Medicine, Alvarado Hospital, University of California, San Diego, CA 92120, USA. irwingoldstein@comcast.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18624971

Citation

Goldstein, Irwin, et al. "The Erection Hardness Score and Its Relationship to Successful Sexual Intercourse." The Journal of Sexual Medicine, vol. 5, no. 10, 2008, pp. 2374-80.
Goldstein I, Mulhall JP, Bushmakin AG, et al. The erection hardness score and its relationship to successful sexual intercourse. J Sex Med. 2008;5(10):2374-80.
Goldstein, I., Mulhall, J. P., Bushmakin, A. G., Cappelleri, J. C., Hvidsten, K., & Symonds, T. (2008). The erection hardness score and its relationship to successful sexual intercourse. The Journal of Sexual Medicine, 5(10), 2374-80. https://doi.org/10.1111/j.1743-6109.2008.00910.x
Goldstein I, et al. The Erection Hardness Score and Its Relationship to Successful Sexual Intercourse. J Sex Med. 2008;5(10):2374-80. PubMed PMID: 18624971.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The erection hardness score and its relationship to successful sexual intercourse. AU - Goldstein,Irwin, AU - Mulhall,John P, AU - Bushmakin,Andrew G, AU - Cappelleri,Joseph C, AU - Hvidsten,Kyle, AU - Symonds,Tara, Y1 - 2008/07/01/ PY - 2008/7/16/pubmed PY - 2009/4/8/medline PY - 2008/7/16/entrez SP - 2374 EP - 80 JF - The journal of sexual medicine JO - J Sex Med VL - 5 IS - 10 N2 - INTRODUCTION: The Erection Hardness Score (EHS), recently validated, was developed in 1998 as a simple (one-item) method to quantify erection outcome data. Although it is intuitive that erection hardness and successful sexual intercourse (SSI) are related, the link has not been directly established. OBJECTIVE: To evaluate the relationship between erection hardness (assessed by EHS) and SSI, establishing the EHS as a clinically useful tool. METHODS: The data set (N = 307) was from a multinational, double-blind, placebo-controlled trial (with open-label extension) of sildenafil citrate in men with erectile dysfunction. MAIN OUTCOME MEASURES: Event-based modeling used every intercourse attempt and the EHS to estimate the odds ratio of SSI between adjacent EHS categories. Mean-based modeling used mean EHS per patient to determine its relationship to percentage of SSI. Mediation-based modeling used mean EHS and mean percentage of SSI over the double-blind phase to estimate the direct effect of sildenafil treatment on SSI and the indirect effect of sildenafil treatment on SSI via erection hardness. RESULTS: The odds of SSI for EHS 3 (hard enough for penetration but not completely hard) were 41.9 times (95% confidence interval [CI], 33.0-53.2; P < 0.0001) that for EHS 2 (hard but not hard enough for penetration), and the odds of SSI for EHS 4 (completely hard and fully rigid) were 23.7 times (95% CI, 19.5-28.9; P < 0.0001) that for EHS 3. The percentage of SSI increased approximately curvilinearly with the increase in mean EHS, from almost 60% at EHS 3 to 78.5% at EHS 3.5 and to 93.1% at EHS 4. The indirect effect of sildenafil treatment on SSI via erection hardness accounted for almost 90% of the total effect on SSI (P < 0.0001). CONCLUSION: The close and direct relationship between erection hardness and SSI supports the broader use of the EHS-a simple, valid, reliable, and responsive measure-in clinical practice. SN - 1743-6109 UR - https://www.unboundmedicine.com/medline/citation/18624971/The_erection_hardness_score_and_its_relationship_to_successful_sexual_intercourse_ DB - PRIME DP - Unbound Medicine ER -