A Measure Of Things – Part Thirteen
I always find that the pages of that wonderful organ, Case Reports in Urology, have the salutary effect of cheering me up. At first blush, an article entitled Superselective Embolisation with Microcoil and Gelfoam for High-Flow Priapism Secondary to Bilateral Cavernous Fistulae: A Case Study, published a couple of months ago, wouldn’t set the juices to flow. But there are some hidden gems inside, not just for practising urologists.
The case study, reported by Sarah Prattley, Timothy Bryant and Rowland Rees of the University Hospital in Southampton, tells of the misfortune that befell an unnamed 35-year-old man when he fell off his moped. Instead of the usual cuts and grazes, the poor man had bruised his perineum, the area between the anus and the genitals. More concerning, though, was that he had developed an erection that just would not go down, as if he had had an overdose of Viagra. Some reports suggest it lasted as long as nine days. The permanent erection was not painful, just causing him “mild discomfort when walking”.
There are two causes of long-lasting erections, low flow priapism, where the blood doesn’t flow away from the penis as it should, and high-flow priapism, where too much blood rushes into the organ and won’t stop. Our friend had the latter and instead of adopting the usual method to deal with an unwanted erection, ice packs, the medics deployed a catheter to block the arteries feeding the erection and then diverted blood away using a gel-like foam and a microfoil. Happily, after a few weeks of soreness, the man’s organ was performing satisfactorily and his erection lasted just long enough to disappoint his wife.
But the takeaway for me from this story is that there is a medical scale for measuring the hardness of an erection. And not just one, but two. The medics reported that the subject of their case study had an erection that was 4 on the Erection Hardness Score (EHS). I had to find out more.
Well, the EHS is one of these scales where you are asked a question and you have to give a number as a response. An example would be on a scale of 1 to 10, how happy are you? Psychologists call these things Likert scales. The question germane to the EHS is “how would you rate the harness of your erection?” Respondents use a scale running from 0 to 4, 0 being the penis does not enlarge, 1 being the penis is larger, but not hard, 2 being the penis is hard, but not hard enough for penetration, 3 being the penis is hard enough for penetration, but not completely hard while 4 is the penis is completely hard and fully rigid.
The benefit of the EHS, created in 1998, the po-faced description of the scale states, is that men can use it on their own and report back to their doctor with their findings. But the dog’s bollocks of erection scales, or as we like to call it the gold standard, is the International Index of Erectile Function (IIEF). This is a questionnaire consisting of fifteen sections, requiring the respondent to mark their experience over the last four weeks, a score between 0 and five given to each response. The scores are added up to give a cumulative reading across five categories – erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. The results will determine what action is taken.
Comparative tests have shown that there is little variance in outcome and diagnosis whether the EHS or IIEF methodology has been used.
Where would we be without a bit of precision in our lives. I will never look at moped riders in the same way after this.
