Erectile disorder – scales and terminology

If you want to read more generally about ED click here

Historically ED has been classified as either;

  • Primary, meaning lifelong (Master et al 1986), which is relevantly rare (Wylie 2007),
  • Secondary meaning acquired, having developed at some point after a history of successful sexual activity (Master et al 1986). Secondary ED can be initiated and maintained for biological, psychological or mixed reasons.

These terms are used less frequently these days but are still worth knowing, especially if you are going to do some reading around the subject.


Medical classification of ED

There are two main sources of medical classification for ED, these are

  • The Diagnostic and Statistical Manual (DSM) currently on version 5 (DSM-V) which is a guide primarily used in the USA to define when insurance companies will pay for treatment.
  • The International Classification of Disease (ICD) currently on version 10 (ICD-10) which is the World health Organisation’s (WHO) primary source of classification.

DSM-5 requires the presence of 2 or more of the below, in more than 75% of sexual situations for the last 6 months

  1. Difficulty achieving erection.
  2. Difficulty maintain erection
  3. a notable decrease in hardness

(definition from Binik & Hall 2014)

ICD10 – Gives the much broader definition of ‘difficulty in developing or maintaining an erection suitable for satisfactory intercourse’ (ICD-10  2016).

Find out about natural and psychological approaches to ED

Find out about medical approaches to ED


Erection Hardness Scale (EHS )

The EHS is one of the most recently developed scales (Wincze 2004 & Mayor 2008). On this scale an erection is given a rating of 1-4

  1. The penis is larger than normal, but not hard.
  2. The penis is hard, but not hard enough for penetration.
  3. The penis is hard enough for penetration but not completely hard.
  4. The penis is completely hard and fully rigid.

Although simplistic the EHS expresses the nature and degree of the primary characteristic of ED effectively. This particular scale is quick to use and may provide a way to measure improvement.