Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Are questions on both achieving and maintaining an erection needed to define erectile dysfunction?


Our 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 (κ=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 (κ=0.86) when the alternatives ‘never’ and ‘sometimes’ were combined. Consistency was almost perfect (κ=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.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1
Figure 2
Figure 3


  1. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993; 270: 83–90.

  2. Fleiss JL . Statistical Methods for Rates and Proportions 2nd edn. John Wiley: New York, 1981, pp 38–46.

    Google Scholar 

  3. Feldman HA et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.

    Article  CAS  Google Scholar 

  4. Koskimäki J, Hakama M, Huhtala H, Tammela TLJ . Effect of erectile dysfunction on frequency of intercourse: a population-based prevalence study in Finland. J Urol 2000; 164: 367–370.

    Article  Google Scholar 

  5. Landis JR, Koch GG . The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.

    Article  CAS  Google Scholar 

  6. Conte HR . Development and use of self-report techniques for assessing sexual functioning: a review and critique. Arch Sex Behav 1983; 12: 555–576.

    Article  CAS  Google Scholar 

  7. Anderson BL, Broffit B . Is there a reliable and valid self-report measure of sexual function? Arch Sex Behav 1988; 17: 509–525.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to J Koskimäki.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Koskimäki, J., Häkkinen, J., Hakama, M. et al. Are questions on both achieving and maintaining an erection needed to define erectile dysfunction?. Int J Impot Res 17, 335–338 (2005).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • erectile dysfunction
  • consistency
  • impotence
  • population-based


Quick links