Discrepancy Between Patient vs Provider Assessment of Erection Quality

Objective: To characterize the discrepancy between patients' and providers' assessments of erection rigidity and its association with patient characteristics and penile ultrasound parameters.

Methods: Patients presenting for penile Doppler ultrasound between July 2022 and October 2023 were reviewed retrospectively. After intracavernosal injection, patients and providers independently rated erection rigidity from 1 to 10 prior to ultrasound. We defined discrepancy as a difference of 2 out of 10 or greater between the two assessments. Chi-squared and Mann-Whitney U tests were used for hypothesis testing.

Results: 65/297 (22%) of patients demonstrated a discrepancy in perceived erection quality. 58/65 (89%) of these patients rated their erections lower than their providers. There was a higher incidence of erectile dysfunction as the primary diagnosis in the discrepant group as compared to the concordant group (P = .01). The discrepant group also showed a higher resistive index on penile ultrasound (P = .04), with no difference in peak systolic velocity, end diastolic velocity, or other clinical variables between the two groups.

Conclusion: Discrepancy in perceived erection rigidity was mainly driven by lower patient perception, although these patients had noninferior penile hemodynamics to their peers. These findings underscore the influence of subjective perception of virility on sexual function. It is critical for clinicians to identify patients with poor perception of erectile function out of proportion to physiologic abnormalities. Thoughtful counseling about treatment goals and expectations, emphasizing functional outcomes, and adjunctive treatments such as sex therapy or psychotherapy are critical to therapeutic success in this population.