Goldstein Irwin, Mulhall John P, Bushmakin Andrew G, Cappelleri Joseph C, Hvidsten Kyle, Symonds Tara
Sexual Medicine, Alvarado Hospital, University of California, San Diego, CA 92120, USA.
J Sex Med. 2008 Oct;5(10):2374-80. doi: 10.1111/j.1743-6109.2008.00910.x. Epub 2008 Jul 1.
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.
To evaluate the relationship between erection hardness (assessed by EHS) and SSI, establishing the EHS as a clinically useful tool.
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.
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.
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).
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.
勃起硬度评分（EHS）于1998年开发，是一种用于量化勃起结果数据的简单（单项）方法，最近已得到验证。虽然直观上勃起硬度与成功性交（SSI）相关，但这种联系尚未直接确立。
评估勃起硬度（通过EHS评估）与SSI之间的关系，将EHS确立为一种临床有用的工具。
数据集（N = 307）来自一项关于枸橼酸西地那非治疗勃起功能障碍男性的多国、双盲、安慰剂对照试验（有开放标签扩展）。
基于事件的模型使用每次性交尝试和EHS来估计相邻EHS类别之间SSI的优势比。基于均值的模型使用每位患者的平均EHS来确定其与SSI百分比的关系。基于中介的模型使用双盲阶段的平均EHS和平均SSI百分比来估计西地那非治疗对SSI的直接效应以及西地那非治疗通过勃起硬度对SSI的间接效应。
EHS为3（硬到足以插入但不完全坚硬）时SSI的几率是EHS为2（硬但不足以插入）时的41.9倍（95%置信区间[CI]，33.0 - 53.2；P < 0.0001），EHS为4（完全坚硬且完全勃起）时SSI的几率是EHS为3时的23.7倍（95% CI，19.5 - 28.9；P < 0.0001）。SSI百分比随平均EHS的增加大致呈曲线增加，从EHS为3时的近60%增加到EHS为3.5时的78.5%，再到EHS为4时的93.1%。西地那非治疗通过勃起硬度对SSI的间接效应占对SSI总效应的近90%（P < 0.0001）。
勃起硬度与SSI之间密切且直接关系支持在临床实践中更广泛使用EHS——一种简单、有效、可靠且灵敏的测量方法。
