# Simplified Assessment of Erectile Dysfunction in Adult Men With Sickle Cell Disease: A Cross-Sectional Validation Study

## TL;DR

This study validates simplified tools for assessing erectile dysfunction in men with sickle cell disease, showing they perform well compared to a standard test.

## Contribution

The study validates simplified ED screening tools for use in men with sickle cell disease in a Brazilian setting.

## Key findings

- 45.5% of men with sickle cell disease had moderate-severe erectile dysfunction.
- The Erection Hardness Score, MMAS single-item, and Erectometer showed strong diagnostic accuracy against IIEF-5.
- All tools had high sensitivity and specificity, suggesting suitability for routine screening.

## Abstract

Objective: To estimate the prevalence of erectile dysfunction (ED) and assess the diagnostic performance of simplified tools - the Erection Hardness Score (EHS), the Massachusetts Male Aging Study (MMAS) single-item scale, and a visual analog “Erectometer” - against the International Index of Erectile Function-5 (IIEF-5) among adult men with sickle cell disease (SCD).

Methods: Cross-sectional validation study including 33 adult men with confirmed SCD followed at a regional reference center in Bahia, Brazil (July-December 2021). Sociodemographic, clinical, and laboratory data (total and free testosterone, luteinising hormone (LH), follicle stimulating hormone (FSH), estradiol, ferritin) were collected. Erectile function was assessed using IIEF-5 (reference standard), EHS, MMAS single-item, and the Erectometer. Receiver operating characteristic (ROC) curves and area under the curve (AUC) quantified diagnostic accuracy.

Results: Median age was 35 [IQR 28-48] years; 33% reported prior ischemic priapism. By IIEF-5, 15/33 (45.5%) had moderate-severe ED (≤16). AUCs against IIEF-5 were 0.85 for EHS, 0.82 for MMAS, and 0.90 for the Erectometer (all p<0.001), with sensitivities ≥ 81% and specificities ≥ 79%.

Conclusion: ED is frequent in Brazilian adults with SCD. Brief instruments (EHS, MMAS single-item, Erectometer) show excellent agreement with IIEF-5 and appear suitable for routine screening, potentially enabling earlier multidisciplinary care.