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International Journal of Impotence Research (2005) 17, 335338
& 2005 Nature Publishing Group All rights reserved 0955-9930/05 $30.00www.nature.com/ijirAre questions on both achieving and maintaining an erection
needed to define erectile dysfunction?J Koskimaki1*, J Hakkinen1, M Hakama1, H Huhtala1, TLJ Tammela1 and R Shiri11Department of Urology, Tampere University Hospital and Medical School and School of Public Health,
University of Tempere, Tempere, FinlandOur aim was to ascertain if the assessment of erectile dysfunction (ED) should include questions on
difficulty in both achieving and maintaining erection. A population-based study of 3143 men in
Tampere region in Finland was conducted by mailed questionnaire. The 1983 men who responded
questions on erectile function were included in the analysis. Different levels in the severity of ED
were used to examine the agreement between the two questions. Consistency was measured by
kappa coefficient. Consistency was fairly high (j 0.71) when the severity of ED was examined in
four groups. In those cases where alternative responses were categorized into three groups,
consistency was best (j 0.86) when the alternatives never and sometimes were combined.
Consistency was almost perfect (j 0.97) when ED dichotomized into two groups and the cutoff was
set between the alternatives quite often and intercourse does succeed. The kappa index was 0.86
with the cutoff level between sometimes and quite often and 0.67 with the cutoff between never
and sometimes. When ED was examined in different age groups, the consistency was the highest
among the oldest respondents. Responses on both symptoms are needed to distinguish between
normal erectile function and minimal ED, and also between minimal and moderate ED, especially
in young men. When the aim is to distinguish between complete ED and a milder form, the
information from one question is the same as that from two questions.International Journal of Impotence Research (2005) 17, 335338. doi:10.1038/sj.ijir.3901328
Published online 21 April 2005Keywords: erectile dysfunction; consistency; impotence; population-basedIntroduction2Erectile dysfunction (ED) is defined as an inability
to achieve or maintain an erection sufficient for
satisfactory sexual function.1 According to this
definition, erectile function is divided into two
components and any difficulties in either may
constitute ED. Such a division may be necessary
given the different etiology and pathophysiology
underlying the two components of ED. However, it
is also conceivable that in...