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Linguistic and Psychometric Validation of the Erection Hardness Score to Spanish


Eduard García-Cruz, MD, Hospital Clínic, Department of Urology, Barcelona 08026, Spain. Tel: +34619267020; Fax: +34932275545; E-mail:


Introduction.  The Erection Hardness Score (EHS) is a one-item questionnaire that assesses rigidity on a 4-point scale.

Aim.  To perform a validation of a Spanish version of the EHS by comparison with the International Index of Erectile Function (IIEF) questionnaire.

Methods.  Validation of the EHS included: (i) professional translation of the scale; (ii) scientific evaluation of the translation from four independent urologists; (iii) assessment on five individuals to test correct comprehension and idiomatic adequacy (iv) validation of the EHS by a cross-sectional, multicenter comparison with the IIEF.

Main Outcome Methods.  Patients were required to respond to a Spanish version of the EHS and IIEF. Statistic correlation was carried out between the EHS score and IIEF-erectile function domain (EF) score.

Results.  A total of 125 patients were recruited. Overall prevalence of erectile dysfunction (ED) by the EHS questionnaire was of 80.2% patients (n = 97). Mean EHS was 2.74 ± 0.97. Mean IIEF-EF score was 17.4 ± 9.5. The EHS showed good reliability. The rate of missing responses to the EHS questionnaire was 0%. A one-factor analysis of variance was performed between the EHS and EF subdomain of IIEF (P = 0.000). Pearson's correlation coefficient between EHS and EF subdomain of IIEF was 0.834, P < 0.01.

Conclusions.  The EHS is a reliable tool to test ED and its Spanish version was satisfactorily understood by patients and correlated with IIEF-EF. García-Cruz E, Romero Otero J, Martínez Salamanca JI, Leibar Tamayo A, Rodríguez Antolín A, Astobieta Odriozola A, and Alcaraz A. Linguistic and psychometric validation of erection hardness score to Spanish. J Sex Med 2011;8:470–474.

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