Erectile dysfunction: Monitoring response to treatment in clinical practice - Recommendations of an international study panel Journal Article


Authors: Mulhall, J.; Althof, S. E.; Brock, G. B.; Goldstein, I.; Jünemann, K. P.; Kirby, M.
Article Title: 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. Conclusions: 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. © 2007 International Society for Sexual Medicine.
Keywords: adult; treatment outcome; patient satisfaction; clinical trial; placebo; outcome assessment; clinical practice; evidence based medicine; evidence-based medicine; quality of life; sexual satisfaction; psychology; patient monitoring; practice guideline; questionnaire; patient care; correlation analysis; systematic review; quantitative analysis; urology; data analysis; scoring system; piperazines; professional-patient relations; erectile dysfunction; primary medical care; penile erection; meta analysis; phosphodiesterase v inhibitor; sildenafil; sexual intercourse; phosphodiesterase inhibitors; vasodilator agents; impotence; sexual behavior; imidazoles; social psychology; medical expert; penis erection; international cooperation; sulfones; self esteem; great britain; coitus; sex education; pde5 inhibitors; ed treatment satisfaction; erection hardness; treatment goals in ed therapy; triazines
Journal Title: Journal of Sexual Medicine
Volume: 4
Issue: 2
ISSN: 1743-6095
Publisher: Elsevier Inc.  
Date Published: 2007-03-01
Start Page: 448
End Page: 464
Language: English
DOI: 10.1111/j.1743-6109.2007.00441.x
PUBMED: 17367440
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 29" - "Export Date: 17 November 2011" - "Source: Scopus"
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  1. John P Mulhall
    603 Mulhall