Clinical performance of a novel brief erectile dysfunction scale and comparison with the international index of erectile function-5

Objective This study aimed to develop a novel brief erectile dysfunction (ED) scale to serve as a rapid clinical tool for grading ED severity, thereby providing a more concise and efficient diagnostic instrument for routine practice. Methods A total of 528 eligible patients were enrolled in this study. Each participant independently completed both the novel brief scale and the International Index of Erectile Function-5 (IIEF-5), and subsequently underwent RigiScan monitoring for nocturnal penile tumescence and rigidity (NPTR), intracavernosal injection (ICI) of vasoactive agents, a comprehensive battery of psychological assessments—including the Symptom Checklist-90 (SCL-90), the Eysenck Personality Questionnaire (EPQ), the Hamilton Depression Rating Scale (HAMD), the Hamilton Anxiety Rating Scale (HAMA), and the State-Trait Anxiety Inventory (STAI)—as well as a panel of laboratory tests. The results from all these examinations were compared with the scores obtained from both the brief scale and the IIEF-5 to evaluate the diagnostic performance of the novel instrument. Weighted Cohen's kappa coefficients were calculated to assess the concordance between the two scales in terms of severity classification, and receiver operating characteristic (ROC) curve analysis was performed using RigiScan grading as the reference standard, with the area under the curve (AUC), sensitivity, specificity, and other diagnostic metrics being computed. Results The brief scale exhibited a strong correlation with the IIEF-5 (Spearman's * r * = 0.77), with a weighted Cohen's kappa of 0.773 (95% CI: 0.725–0.817). Both scales showed highly consistent associations with RigiScan parameters, ICI outcomes, scores on the various psychological inventories, and laboratory measurements. Moreover, the two instruments demonstrated comparable consistency in capturing treatment-related changes in erectile function. Using RigiScan grading as the reference standard, the brief scale yielded an area under the curve (AUC) of 0.77 (95% CI: 0.71–0.83) for the diagnosis of ED, with a sensitivity of 77.8%, a specificity of 78.1%, a false-positive rate of 21.9%, and a false-negative rate of 22.2%. Conclusions The novel brief scale may be clinically applicable for assessing ED across a spectrum of severity. It affords the advantages of greater speed and convenience and holds promise as a complementary rapid screening tool for the preliminary assessment of ED.