Linguistic and psychometric validation of the Erection Hardness Score to Spanish

Introduction: The Erection Hardness Score (EHS) is a one-item questionnaire that assesses rigidity on a 4-point scale.

Aim: To perform a validation of a Spanish version of the EHS by comparison with the International Index of Erectile Function (IIEF) questionnaire.

Methods: Validation of the EHS included: (i) professional translation of the scale; (ii) scientific evaluation of the translation from four independent urologists; (iii) assessment on five individuals to test correct comprehension and idiomatic adequacy (iv) validation of the EHS by a cross-sectional, multicenter comparison with the IIEF.

Main outcome methods: Patients were required to respond to a Spanish version of the EHS and IIEF. Statistic correlation was carried out between the EHS score and IIEF-erectile function domain (EF) score.

Results: A total of 125 patients were recruited. Overall prevalence of erectile dysfunction (ED) by the EHS questionnaire was of 80.2% patients (n=97). Mean EHS was 2.74±0.97. Mean IIEF-EF score was 17.4±9.5. The EHS showed good reliability. The rate of missing responses to the EHS questionnaire was 0%. A one-factor analysis of variance was performed between the EHS and EF subdomain of IIEF (P=0.000). Pearson's correlation coefficient between EHS and EF subdomain of IIEF was 0.834, P<0.01.

Conclusions: The EHS is a reliable tool to test ED and its Spanish version was satisfactorily understood by patients and correlated with IIEF-EF.