Is Erectile Dysfunction a Reliable Proxy of General Male Health Status? The Case for the International Index of Erectile Function—Erectile Function Domain


Andrea Salonia, MD, Department of Urology, University Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy. Tel. +39-02-2643-7286; Fax: +39-02-2643-7298; E-mail:


Introduction.  Erectile dysfunction (ED) has emerged progressively as a sentinel marker of cardiovascular disease (CVD). The correlation between ED and the burden arising from multiple comorbid conditions has been incompletely analyzed.

Aim.  Assess whether erectile function, defined with the International Index of Erectile Function–Erectile Function (IIEF-EF) domain score, is associated with health-significant comorbidities scored with the Charlson comorbidity index (CCI).

Methods.  Clinical and hemodynamic variables of the last 140 consecutive patients who underwent penile color Doppler ultrasonography for new-onset ED were considered. Patients were assessed with a thorough medical and sexual history. Health-significant comorbidities were scored with the CCI.

Main Outcome Measure.  Descriptive statistics and either linear or logistic regression models tested the association among IIEF-EF, hemodynamic parameters, and CCI, which was included in the model both as continuous and categorized variable (0 vs. ≥1).

Results.  Complete data were available for 138 patients (98.6%) (mean age 46.6 years [standard deviation 13.0]; range 21–75 years). CCI was 0, 1, and ≥2 in 94 (68.1%), 23 (16.7%), and 21 (15.25%) patients, respectively. Of all, 35 patients (79.5%) did not have a CVD comorbidity. Mean IIEF-EF was 13.7 (9.3). ED severity was no ED, mild, mild to moderate, moderate, and severe in 12 (9.1%), 28 (20.2%), 12 (9.1%), 23 (16.2%), and 63 (45.5%) patients, respectively. At multivariable linear regression analysis, CCI significantly worsened with increased age (β = 0.33; P = 0.001) and decreased IIEF-EF values (β = −0.25; P = 0.01). At logistic regression analysis, age (odds ratio [OR]: 1.05; P = 0.004) and IIEF-EF (OR: 0.95; P = 0.04) emerged as significant predictors of categorized CCI.

Conclusions.  Severity of ED, as objectively interpreted with IIEF-EF, accounts for a higher CCI, which may be considered a reliable proxy of a lower general male health status regardless of the etiology of ED. Salonia A, Castagna G, Saccà A, Ferrari M, Capitanio U, Castiglione F, Rocchini L, Briganti A, Rigatti P, and Montorsi F. Is erectile dysfunction a reliable proxy of general male health status? The case for the International Index of Erectile Function—Erectile function domain. J Sex Med **;**:**–**.