Modified calculation of the IIEF6-a more accurate assessment of erectile function in middle-aged men

BACKGROUND: The Erectile Function Domain of the International Index of Erectile Function (IIEF6) is inaccurate in assessing erectile function in men who are not practicing sexual intercourse. Improvement through a modification was recently tested on patients after radical prostatectomy. This study examines the application of this modification in a population-based cohort of middle-aged men. AIM: To assess the feasibility of a modified IIEF6 in a population-based random sample of 50-year old men in Germany. METHODS: 4924 men were included. IIEF6, Erection Hardness Score (EHS), and causes for the absence of sexual intercourse within the previous 4 weeks were assessed. Modified calculation (double weighting of non-intercourse IIEF6 questions) was applied in case of absence due to external circumstances. OUTCOMES: Impact of the modification on erectile dysfunction (ED) prevalence and agreement between IIEF6 and EHS in ED classification. RESULTS: As a result of the modified calculation, ED prevalence in the overall study sample decreased by 6.2% to a rate of 27.2%. Agreement between IIEF6 and EHS was increased from 2.7% to 73.4% in men with no sexual intercourse due to external circumstances. CLINICAL IMPLICATIONS: An additional inquiry into the reason for the absence of sexual intercourse and modified calculation enhances the accuracy of IIEF6 in evaluating erectile function of the individual man. STRENGTHS AND LIMITATIONS: This study comprises a large population-based sample. As the study population was exclusively 50-year-old men, results may not be representative of the population average. CONCLUSION: A more accurate evaluation of an individual man's erectile function may be achieved by using a modified version of the IIEF6.