Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction

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Diagnosing ED is challenging, and tools like the International Index of Erectile Function (IIEF) and its shorter version, the IIEF-5, are commonly used to assess its severity. Although nocturnal penile tumescence and rigidity (NPTR) monitoring, as an objective test, can help diagnose ED, it is complex and not economical. Therefore, this study aimed to compare NPTR with the IIEF to assess the IIEF’s potential as a cost-effective diagnostic tool for ED. Methods A correlation analysis study was performed on 139 men with ED between August 2017 and March 2023 who had undergone NPTR assessment in Jakarta, Indonesia. ED was assessed using detailed evaluations and IIEF-5 questionnaires. NPTR data was collected using a Rigiscan® device. Serum testosterone, total cholesterol, HbA1c, and vitamin D-25(OH) from blood samples were also evaluated. Bivariate analysis was used to explore the correlations between IIEF-5 scores, NPTR measurements, and blood parameters. Results In total, 139 men with ED (median age: 42 years) were included. The median IIEF-5 score was 11, and comorbidities included dyslipidemia (20%) and diabetes (12%). There are significant correlations between IIEF scores and NPTR variables (number of erections recorded, base tumescence increment, average base tumescence, and duration of base erection with ˃ 60% rigidity). Additionally, significant negative correlations were observed between HbA1c levels and several NPTR variables, including the number and quality of nocturnal erections. Significant correlations were also found between HbA1c and various NPTR variables. Conclusion This study underscores the value of subjective questionnaires such as the IIEF-5 in diagnosing ED, especially in the absence of advanced tests like the NPTR assessment. We found correlations between IIEF scores and nocturnal erection frequency, as well as specific erection characteristics. Our findings highlight the importance of a personalized approach to ED diagnosis. We also observed that higher HbA1c levels were associated with reduced nocturnal erection quality, highlighting the metabolic influence on erectile function. Although IIEF aids in cost-effective assessments, it should not replace objective testing. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-142/v2", "name": "Primary Research on Correlation between Erectile Function Assessment..." } } ] } Home Browse Primary Research on Correlation between Erectile Function Assessment... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Christanto RBI, Wijaya C, Birowo P et al. Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.12688/f1000research.149499.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] Previously titled: Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction Roberto Bagaskara Indy Christanto https://orcid.org/0000-0002-5980-0657 1 , Cindy Wijaya https://orcid.org/0009-0002-1510-1915 1 , Ponco Birowo https://orcid.org/0000-0003-2934-6753 1 , [...] Widi Atmoko https://orcid.org/0000-0002-7793-7083 1 , Gerhard Reinaldi Situmorang 1 , Ashok Agarwal 2 , Rupin Shah 3 Roberto Bagaskara Indy Christanto https://orcid.org/0000-0002-5980-0657 1 , Cindy Wijaya https://orcid.org/0009-0002-1510-1915 1 , [...] Ponco Birowo https://orcid.org/0000-0003-2934-6753 1 , Widi Atmoko https://orcid.org/0000-0002-7793-7083 1 , Gerhard Reinaldi Situmorang 1 , Ashok Agarwal 2 , Rupin Shah 3 PUBLISHED 30 Jul 2025 Author details Author details 1 Department of Urology, Rumah Sakit Dr Cipto Mangunkusumo, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Jakarta, 10430, Indonesia 2 Cleveland Clinic, Cleveland, Ohio, USA 3 Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India Roberto Bagaskara Indy Christanto Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing Cindy Wijaya Roles: Data Curation, Formal Analysis, Investigation, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Ponco Birowo Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Supervision, Validation, Visualization, Writing – Review & Editing Widi Atmoko Roles: Formal Analysis, Investigation, Methodology, Supervision, Validation Gerhard Reinaldi Situmorang Roles: Supervision, Validation, Writing – Review & Editing Ashok Agarwal Roles: Supervision, Validation, Writing – Review & Editing Rupin Shah Roles: Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Global Public Health gateway. Abstract Introduction Erectile dysfunction (ED) affects approximately 40% of men; however, the true prevalence remains uncertain owing to various factors. Diagnosing ED is challenging, and tools like the International Index of Erectile Function (IIEF) and its shorter version, the IIEF-5, are commonly used to assess its severity. Although nocturnal penile tumescence and rigidity (NPTR) monitoring, as an objective test, can help diagnose ED, it is complex and not economical. Therefore, this study aimed to compare NPTR with the IIEF to assess the IIEF’s potential as a cost-effective diagnostic tool for ED. Methods A correlation analysis study was performed on 139 men with ED between August 2017 and March 2023 who had undergone NPTR assessment in Jakarta, Indonesia. ED was assessed using detailed evaluations and IIEF-5 questionnaires. NPTR data was collected using a Rigiscan ® device. Serum testosterone, total cholesterol, HbA1c, and vitamin D-25(OH) from blood samples were also evaluated. Bivariate analysis was used to explore the correlations between IIEF-5 scores, NPTR measurements, and blood parameters. Results In total, 139 men with ED (median age: 42 years) were included. The median IIEF-5 score was 11, and comorbidities included dyslipidemia (20%) and diabetes (12%). There are significant correlations between IIEF scores and NPTR variables (number of erections recorded, base tumescence increment, average base tumescence, and duration of base erection with ˃ 60% rigidity). Additionally, significant negative correlations were observed between HbA1c levels and several NPTR variables, including the number and quality of nocturnal erections. Significant correlations were also found between HbA1c and various NPTR variables. Conclusion This study underscores the value of subjective questionnaires such as the IIEF-5 in diagnosing ED, especially in the absence of advanced tests like the NPTR assessment. We found correlations between IIEF scores and nocturnal erection frequency, as well as specific erection characteristics. Our findings highlight the importance of a personalized approach to ED diagnosis. We also observed that higher HbA1c levels were associated with reduced nocturnal erection quality, highlighting the metabolic influence on erectile function. Although IIEF aids in cost-effective assessments, it should not replace objective testing. READ ALL READ LESS Keywords IIEF-5, Erectile Dysfunction, Nocturnal Penile Tumescence and Rigidity, Diagnosis Corresponding Author(s) Ponco Birowo ( [email protected] ) Close Corresponding author: Ponco Birowo Competing interests: No competing interests were disclosed. Grant information: This work was supported by Hibah PUTI 2023 Universitas Indonesia (NKB-394/UN2.RST/HKP.05.00/2023; to PB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Christanto RBI et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Christanto RBI, Wijaya C, Birowo P et al. Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.12688/f1000research.149499.2 ) First published: 28 Jan 2025, 14 :142 ( https://doi.org/10.12688/f1000research.149499.1 ) Latest published: 30 Jul 2025, 14 :142 ( https://doi.org/10.12688/f1000research.149499.2 ) Revised Amendments from Version 1 1. We have revised the title of our paper by adding "Primary Research on the Correlation..." according to the reviewers advice 2. We have made adjustments on a few sections of our work (Abstract, results) that have previous discrepancies 3. References: we have added two new citations and corresponding full references, now listed as reference numbers 12 and 13 in the updated version of the manuscript. 1. We have revised the title of our paper by adding "Primary Research on the Correlation..." according to the reviewers advice 2. We have made adjustments on a few sections of our work (Abstract, results) that have previous discrepancies 3. References: we have added two new citations and corresponding full references, now listed as reference numbers 12 and 13 in the updated version of the manuscript. See the authors' detailed response to the review by Syah Mirsya Warli See the authors' detailed response to the review by Hong-Jun Li READ REVIEWER RESPONSES Introduction Erectile dysfunction (ED), difficulty in obtaining or maintaining an erection to complete sexual intercourse, is found in approximately 40% of men. 1 Because of the existing cultural factors, reporting bias, and patient considerations, such as shame and embarrassment, the true prevalence of ED is yet to be determined. ED may occur due to various etiologies and is often multifactorial. 2 Establishing ED diagnosis and differentiating between psychogenic and organic ED is imperative for physicians. 3 , 4 Diagnostic approaches in ED remain challenging, as information obtained from patient history and physical examination may not suffice. Supplemental examinations may be needed, and non-invasive tests are generally preferred. Therefore, the scoring system and questionnaire are vital for assessing ED severity and treatment progress. 5 The International Index of Erectile Function (IIEF) is a widely accepted patient-reported outcome measure (PROM) to evaluate ED. The IIEF aims to assess several domains of male sexual function, consisting of erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. 6 A shorter version of the five questions, known as the IIEF-5, was developed to assess patients’ erectile function and sexual intercourse satisfaction. The lower the IIEF-5 scores, the higher the severity of ED. 7 Nocturnal penile tumescence and rigidity (NPTR) monitoring with RigiScan device has been considered one of the most reliable methods to differentiate psychogenic erectile dysfunction (pED) from organic ED and to diagnose ED in general. 8 Nonetheless, NPTR monitoring has shortcomings, as previously reported. 9 , 10 Furthermore, the main disadvantages of NPTR assessment include its high cost, intricate nature, and limited ability to yield consistent results. Other means of ED diagnostics incorporate laboratory tests such as hypothalamic-pituitary-gonadal axis evaluation, including testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), lipid profile, blood glucose, and thyroid function tests. 11 However, as non-invasive and cost-efficient diagnostic evaluations are preferred, the IIEF could be an alternative diagnostic tool to assess Emerging evidence also suggests that several metabolic parameters, such as vitamin D, serum cholesterol, and glycated hemoglobin (HbA1c), may influence erectile function. Studies have found that low vitamin D levels, high cholesterol, and poor glycemic control are independently associated with ED severity. 12 , 13 Therefore, this study aimed to compare the parameters of NPTR testing with the domain score of the IIEF to determine the sufficiency of the IIEF in diagnosing ED. We also aimed to explore the correlation between erectile dysfunction and selected blood parameters. Methods This was a correlation analysis study to determine the correlation between the IIEF-5 questionnaire and NPTR parameters. The data were collected through a database. A total of 139 men presenting with ED between August 2017 and March 2023 who had undergone NPTR assessment were included in the study. The inclusion criteria were complaints of ED for at least 3 months without medical treatment. Men with depression, anxiety, and psychological problems, or those on antidepressant, antipsychotic, or anxiolytic medications, were excluded. Men with poor quality of sleep were also excluded from the study. All the patients were evaluated for complete medical histories, sexual histories, and physical examinations. The IIEF-5 questionnaire was used to evaluate the presence and severity of ED. The IIEF-5 contains five questions on erectile function and intercourse satisfaction. 7 This questionnaire is a non-proprietary tool that is widely used in clinical practice, including in our hospital, as a reliable and routine method for assessing erectile dysfunction severity. Ethical approval was obtained from the Health Research Ethics Committee, Faculty of Medicine, Universitas Indonesia, and Cipto Mangunkusumo National General Hospital (No: KET-1624/UN2.F1/ETIK/PPM.00.02/2023), covering the use of patient data recorded in routine clinical care prior to study initiation. Study was conducted per the Declaration of Helsinki. As this study involved correlation analysis of de-identified medical records, the ethics committee waived the requirement for individual informed consent. All patient data used in this study were collected as part of routine standard care, and no identifying information was included in the analysis to ensure confidentiality. Nocturnal Penile Tumescence and Rigidity (NPTR) NPTR was evaluated using the Rigiscan ® device with Rigiscan Plus software (Timm Medical Technologies Inc., USA). The data collected from the NPTR examinations included the number of erections recorded, number of erections with normal tip duration, number of erections with normal tip tumescence, number of erections with adequate tip criteria, tip tumescence increment, average tip rigidity, duration of tip with > 60% rigidity, number of erections with normal base duration, number of erections with normal base tumescence, number of erections with adequate base criteria, base tumescence increment, average base rigidity, and duration of base with > 60% rigidity. Blood samples were collected before the NPTR examination and analyzed for total cholesterol, HbA1c, vitamin D-25(OH), and testosterone. Software availability The Rigiscan device operates with the proprietary Rigiscan Plus software , which is included with the purchase of the device from Timm Medical Technologies Inc., USA. This software is essential for collecting and analyzing Nocturnal Penile Tumescence and Rigidity (NPTR) data. As this software is proprietary and bundled with the device, no free or open-source alternatives are available for equivalent functionality. The Rigiscan device and its software are widely used in clinical practice as standard tools for erectile dysfunction assessment, and their use in this study complies with institutional clinical protocols. Statistical analysis All statistical analyses were performed using SPSS 27.0 software (IBM, Armonk, NY, USA). All continuous data are presented as meaminus SD for normal distributions and medians (min-max) for data, not within the normal distribution. The normal distribution of variables was analyzed using the Kolmogorov–Smirnoff sample test. Table 1 summarizes the patients’ characteristics. The correlation between the IIEF-5 score and NPTR measurements was performed using Pearson bivariate analysis for normally distributed data or Spearman bivariate analysis for skewed distribution. A p<0.05 indicated statistical significance. Further bivariate analysis was performed to analyze the correlation between blood parameters and NPTR measurement. Table 1. Patients’ characteristics (n=139). Variable Median (range) or N Age (in years) 42 (19–76) IIEF-5 score 11 (0–24) Dyslipidemia 27 Type-2 DM Prediabetic 65 Diabetic 16 Results A total of 139 men with ED were included in the study. The median patient age was 42 years. The IIEF-5 scores ranged between 0 and 24, with a median of 11. Comorbidities included dyslipidemia in 27 patients (20%), prediabetes in 65 patients (47%), and diabetes in 16 patients (12%). The Kolmogorov–Smirnov normality test showed that all numeric variables of NPTR measurements did not have a normal data distribution ( Table 2 ). Pearson’s correlation for the IIEF scores vs. NPTR variables showed significant correlations with the number of erections recorded r =0.188 (95% confidence interval (CI), 0.017–0.348; P =0.026), base tumescence increment r =0.198 (95% CI, 0.027–0.357; P =0.020), average base tumescence r =0.185 (95% CI, 0.014–0.346; P =0.029), and duration of base erection with more than 60% rigidity r =0.198 (95% CI, 0.027–0.357; P =0.020). No correlations were observed between the IIEF scores and other NPTR variables ( Table 3 ). Table 2. Nocturnal penile tumescence and rigidity (NPTR) measurements (n=139). Variable Median (range) Number of erection(s) recorded 3 (0–10) Number of erection(s) with normal tip duration 0 (0–4) Number of erection(s) with normal tip tumescence 0 (0–6) Number of erection(s) with adequate tip criteria 0 (0–4) Δ Tip Tumescence 0.9 (0.0–3.4) Average tip rigidity 38.0 (0.0e85.0) Duration of tip with > 60% rigidity 660 (0–10530) Number of erection(s) with normal base duration 2 (0–6) Number of erection(s) with normal base tumescence 0 (0–5) Number of erection(s) with adequate base criteria 0 (0–3) Δ Base Tumescence 1.9 (0.0–3.6) Average base rigidity 55.5 (0.0–100.0) Duration of base with > 60% rigidity 2280 (0–15480) Table 3. IIEF correlations with nocturnal penile tumescence and rigidity (NPTR) measurements (n=139). Variables r 95% CI P -value Number of erection(s) recorded 0.188* 0.017–0.348 0.026 Number of erection(s) with normal tip duration 0.004 -0.168–0.175 0.967 Number of erection(s) with normal tip tumescence 0.115 -0.058–0.281 0.179 Number of erection(s) with adequate tip criteria 0.162 -0.010–0.324 0.057 Δ Tip Tumescence 0.134 -0.039–0.298 0.117 Average tip tumescence 0.184 0.013–0.344 0.030 Average tip rigidity 0.093 -0.079–0.260 0.275 Duration of tip with > 60% rigidity 0.111 -0.061–2.77 0.192 Number of erection(s) with normal base duration 0.151 -0.021–0.314 0.077 Number of erection(s) with normal base tumescence 0.083 -0.090–0.250 0.333 Number of erection(s) with adequate base criteria 0.064 -0.108–0.233 0.452 Δ Base Tumescence 0.198* 0.027–0.357 0.020 Average base tumescence 0.185* 0.014–0.346 0.029 Average base rigidity 0.163 -0.008–0.326 0.055 Duration of base with > 60% rigidity 0.198* 0.027e0.357 0.020 Pearson’s correlation for HbA1c vs. NPTR variables showed significant correlations with the number of erections recorded r =-0.280 (95% CI; P <0.01), number of erections with normal tip duration r =-0.238 (95% CI; P <0.05), tip tumescence increment r =-0.269 (95% CI; P <0.05), average tip rigidity r =-0.336 (95% CI; P 60% rigidity r =-0.277 (95% CI; P <0.01), number of erections with normal base duration r =-0.249 (95% CI; P 60% rigidity r =-0.262 (95% CI; P <0.05). No significant correlations were observed between NPTR variables and other blood parameters (total cholesterol, vitamin D 25(OH), and testosterone) ( Table 4 ). Table 4. Correlation between nocturnal penile tumescence and rigidity (NPTR) measurements and blood parameters. Variables Total cholesterol (n=97) HbA1c (n=85) Vitamin D-25(OH) (n=97) Testosterone (n=96) Number of erection(s) recorded 0.075 -0.280 ** 0.051 0.067 Number of erection(s) with normal tip duration 0.024 -0.238 * -0.040 -0.096 Number of erection(s) with normal tip tumescence 0.092 -0.006 -0.110 -0.024 Number of erection(s) with adequate tip criteria 0.042 0.019 -0.095 -0.177 Δ Tip Tumescence -0.056 -0.269 * -0.022 0.009 Average tip tumescence -0.066 -0.203 -0.039 -0.073 Average tip rigidity -0.020 -0.336 ** 0.009 -0.032 Duration of tip with > 60% rigidity -0.003 -0.277 ** 0.040 -0.049 Number of erection(s) with normal base duration 0.099 -0.249 * 0.049 -0.119 Number of erection(s) with normal base tumescence 0.075 -0.171 -0.048 -0.104 Number of erection(s) with adequate base criteria 0.116 -0.172 -0.051 -0.103 Δ Base tumescence 0.065 -0.140 -0.028 -0.037 Average base tumescence 092 -0.055 -0.063 -0.128 Average base rigidity -0.064 -0.168 0.143 -0.030 Duration of base with > 60% rigidity 0.136 -0.262 * 0.059 -0.097 * p-value<0.05. ** p-value<0.01. Discussion Correlation between IIEF-5 and NPTR parameters To our knowledge, this study was the first to explore the association between the IIEF-5 score and specific components of nocturnal erection using NPTR or NPT measurements. Although previous studies have examined the correlation between nocturnal erections and IIEF-5 questionnaire scores, serving as a clinical measure of ED, these studies have primarily categorized nocturnal erections as either “adequate” or “inadequate” and compared them with the IIEF-5 questionnaire scores. The components of nocturnal erections encompass various aspects, including the number of erections, the quality of erections, and aspects related to both the tip and the base of the erection. The present study aimed to compare and correlate these individual aspects with IIEF-5 questionnaire scores. Overview of NPTR physiology and assessment Spontaneous nighttime penile erections, initially observed by Halverson et al. in infants during sleep in 1940 and confirmed by subsequent studies, are part of the normal NPTR phenomenon. 14 They involve 3–6 episodes of tumescence during sleep, including at least one instance with a tip rigidity exceeding 60%, lasting 1–15 min over 8 h. 15 These regular NPTR occurrences indicate a healthy vascular and neural supply to the penis and the structural integrity of penile components. NPTR assessment employs seven methods, with the Rigiscan device introduced in 1985. 16 Rigiscan device provides continuous and quantitative measurements of penile circumference and rigidity, helping distinguish between physiological ED and organic cases of ED. This differentiation relies on the assumption that psychological factors do not substantially impact nighttime erectile activity. 8 Strengths and limitations of NPTR testing The application of NPT relies on the premise that to generate a nocturnal erection, both the corticospinal nerve signals to the penis and the vascular responsiveness of penile tissue to these signals must remain functional. Nevertheless, achieving an erection during sexual activity also necessitates proper responsiveness to sensory cues. Notably, the inability to assess any deficits in afferent signals originating from the penis is a potential limitation of NPT. 17 Consequently, NPTR has been subjected to validation procedures recently. The evolution of the Rigiscan Plus software has led to a standardized approach to NPTR examinations, thereby enhancing sensitivity and specificity and allowing for the precise identification of erections possessing the requisite rigidity and duration for engaging in sexual intercourse. Empirical studies have reported sensitivities ranging from 42% to 85% and specificities ranging from 93% to 100%. 17 – 19 In another investigation, the study examined the sensitivity, specificity, positive predictive value, and accuracy rate of Rigiscan device monitoring in differentiating organic and pED. 20 These assessments were made in the context of a comprehensive diagnostic approach incorporating advanced techniques, and the results indicated values of 81%, 82%, 89%, and 81%, respectively, for NPTR measurements using the Rigiscan device. 20 However, the utilization of NPTR has several limitations, as highlighted in previous studies. One study that employed NPT with the Minnesota Multiphasic Personality Inventory for diagnosing primary organic or primary psychogenic ED reported a misclassification rate of 63%. 9 Certain specific populations further complicate the accuracy of NPT assessment, with a decreased diagnostic accuracy observed in men experiencing depression. 10 Additionally, the absence of universally accepted normative data for interpreting NPTR readings makes it challenging to reproduce the assessments. 15 The utilization of NPTR assessment presents a substantial drawback owing to its cost, complexity, and relatively low reproducibility. Moreover, it is worth considering that endocrine, vascular, and neurological diagnostic techniques offer cost-effective alternatives and can identify organic causes of ED to resolve ED issues. 21 These limitations prompt us to question whether standardized questionnaires, such as the IIEF-5, may suffice as more cost-effective diagnostic measures in conjunction with laboratory investigations. Consequently, our primary aim was to explore the correlation between the IIEF-5 questionnaires and specific parameters within NPTR measurements. Diagnostic value and limitations of IIEF-5 The IIEF questionnaire was initially created not for diagnostic purposes but as a tool to track treatment outcomes over time. 17 Moreover, IIEF and similar self-assessment questionnaires cannot discriminate among different etiologies of ED. 22 , 23 Nevertheless, examining its association with objective assessments like NPTR is intriguing. Kassouf et al. examined the diagnostic utility of the IIEF-5 in identifying the vascular causes and severity of ED, comparing it with pharmacological testing and duplex Doppler ultrasonography. 24 Their findings showed no significant differences in IIEF scores among patients with normal vascular responses, arterial insufficiency, or venous leakage. Correlation between IIEF-5 and NPTR findings The median number of erections recorded in our study was three, which is consistent with previous studies that reported a similar number of erection episodes in patients without diabetes. 25 Our findings revealed a significant correlation between the IIEF-5 questionnaire and the number of recorded nocturnal erections. These findings bolster the hypothesis that a reduced number of nocturnal erections may manifest as subjective erectile symptoms. Our findings indicate that the base aspects of penile erections are the most strongly correlated with the IIEF-5 score, with no significant correlation observed for tip erections. In contrast, Lee et al. (2021) analyzed the potential link between lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and erectile function in eugonadal men and demonstrated that the rigidity activity unit in the penile tip emerged as the most statistically significant parameter in its association with the IIEF score. 26 Both tip and base erections are essential in assessing erectile function. However, based on a cross-sectional study on the effect of prolactin on penile erection, the penile base may be more meaningful than the penile tip in assessing the effect of prolactin on erectile function. 27 Another cross-sectional study on the effect of estradiol on penile erection found no apparent relationship between erection time at the penile tip and estradiol levels. However, a negative correlation was observed between base erection time and estradiol levels. 28 Association with metabolic and hormonal parameters In the context of blood parameters, this study determined that only HbA1c levels displayed a statistically significant correlation with several NPTR parameters. Several studies have investigated the relationship between diabetes and nocturnal penile tumescence (NPT); NPT test results were abnormal in sexually functional men with diabetes. 29 10 men with diabetes who reported normal daytime sexual function with four nights of polysomnography, including NPT assessment, had significantly diminished NPT profiles compared to an age-matched, nondiabetic, healthy control group. 30 Anwar et al. revealed that in ED and diabetes, men with diabetes experiencing severe ED tended to be older and experience more challenges maintaining proper glycemic control. 31 No significant correlation was observed between NPTR variables and other blood parameters (total cholesterol, vitamin D-25(OH), and testosterone). The two main types of cholesterol are high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Elevated levels of LDL can contribute to the development of ED, whereas HDL cholesterol improves penile erectile function. 32 Therefore, the relationship between cholesterol and nocturnal erections may depend on the measured cholesterol type. Furthermore, a study has found that statin drugs improve erectile function in men with hypercholesterolemia. 33 Therefore, statin drugs may mask any potential correlation between cholesterol and nocturnal erections. Low serum 25-hydroxyvitamin D (25(OH)D) levels were associated with an increased risk of ED in older adults with moderate to severe lower urinary tract symptoms. 34 Furthermore, a study by Dumbraveanu et al. investigated the correlations of clinical and biochemical indices of vitamin D with ED. 35 The study found that vitamin D level reduction, concomitantly with decreased testosterone and increased cholesterol, contributed to the development and maintenance of ED. Further research is needed to validate this association. A study investigating the relationship between sleep-related erections and testosterone levels in men found that the serum testosterone threshold for sleep-related erections was lower than the low end of the standard laboratory male range at approximately 200 ng/dL. 36 The study also found that participants with higher testosterone serum levels showed higher values for some erectile parameters than those with serum testosterone between 100 and 199 ng/dL, without any significant difference among the groups with testosterone serum levels in the normal range. 36 Although some studies suggest a correlation between NPT and testosterone, other studies demonstrated no significant correlation. A review article on the relationship between testosterone and sleep-related erections reported that men with androgen deficiency may have normal NPT, and sleep-related erections increased in response to testosterone administration. 37 A prospective cross-sectional pilot study found that testosterone levels were weakly associated with penile rigidity and disappeared when associated with metabolic syndrome. 38 Study limitations The present study had several limitations. First, the study was not population-based. The patients included in the study were individuals seeking treatment at a urologist’s office who reported erectile ED and underwent NPTR testing. Therefore, the current study was prone to selection bias. Second, not all patients were assessed for essential laboratory exams such as HbA1c, cholesterol, testosterone, and vitamin D-25(OH). Another aspect to consider is the use of single NPTR testing in our study, which may not have accurately evaluated nocturnal erectile capacity. Consecutive nocturnal measurements are widely accepted to differentiate pED from organic ED. However, only a single NPTR test was performed in this study to prioritize patient comfort. Moreover, the correlation study design might have introduced biases, and the sample size, constrained by specific criteria and exclusions (e.g., depression, anxiety, poor sleep quality), may have impacted the generalizability of the results. Additionally, reliance on secondary data and potential variations in recording practices might have affected the reliability of the results. We acknowledge that psychosocial and interpersonal aspects were not thoroughly evaluated in this study and should be considered in future research. Conclusion Despite its limitations, this study provides insights into IIEF-5 and NPTR correlations within a specific cohort. Current research suggests that subjective questionnaires, including the IIEF-5, can be utilized in the diagnosis of ED, particularly in settings where advanced diagnostic tests, such as the NPTR assessment, are not available. We observed a correlation between IIEF questionnaire scores and the frequency of nocturnal erections, as well as the tip aspects of these nocturnal erections. Additionally, we identified a significant correlation between HbA1c levels and nocturnal erections. The method used to diagnose ED should be personalized and multidisciplinary. The primary objective should be to conduct a thorough assessment of erectile function, and NPTR assessment, which was used to monitor NPT, remains a valuable diagnostic tool for ED. Although the IIEF can facilitate cost-effective diagnoses, it should not be considered as a substitute for objective testing. Ethical approval Ethical approval for this study was obtained from the Health Research Ethics Committee, Faculty of Medicine, Universitas Indonesia, and Cipto Mangunkusumo National General Hospital. The approval number is KET-1624/UN2.F1/ETIK/PPM.00.02/2023, and the approval was granted on November 17, 2023. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. As the study involved correlation analysis of anonymized medical records collected during routine care, the ethics committee waived the requirement for individual informed consent. To ensure confidentiality, all patient data were de-identified prior to analysis. Consent This study utilized secondary data from patient medical records collected during routine clinical care. Ethical approval was obtained from the Health Research Ethics Committee, Faculty of Medicine, Universitas Indonesia, and Cipto Mangunkusumo National General Hospital (Approval No: KET-1624/UN2.F1/ETIK/PPM.00.02/2023). The committee waived the requirement for individual informed consent as the data were anonymized and de-identified prior to analysis to ensure patient confidentiality. No additional data collection or interventions were performed as part of this study, and all analyses were conducted in compliance with the Declaration of Helsinki. Data availability Underlying data All raw data underlying the findings of this study, prior to any data analysis, have been made publicly available through the Open Science Framework (OSF). The data can be accessed through Open Science Framework: Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction. OSF | Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction . 39 Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication). Extended data All supplementary materials and documents used in this study have been made publicly available through the Open Science Framework (OSF). The extended data include the International Index of Erectile Function (IIEF) questionnaires, as well as other supporting materials. 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Christanto RBI, Birowo P: Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction. [Dataset]. OSF. 2024. osf.io/xfwyq. Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 28 Jan 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of Urology, Rumah Sakit Dr Cipto Mangunkusumo, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Jakarta, 10430, Indonesia 2 Cleveland Clinic, Cleveland, Ohio, USA 3 Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India Roberto Bagaskara Indy Christanto Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing Cindy Wijaya Roles: Data Curation, Formal Analysis, Investigation, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Ponco Birowo Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Supervision, Validation, Visualization, Writing – Review & Editing Widi Atmoko Roles: Formal Analysis, Investigation, Methodology, Supervision, Validation Gerhard Reinaldi Situmorang Roles: Supervision, Validation, Writing – Review & Editing Ashok Agarwal Roles: Supervision, Validation, Writing – Review & Editing Rupin Shah Roles: Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This work was supported by Hibah PUTI 2023 Universitas Indonesia (NKB-394/UN2.RST/HKP.05.00/2023; to PB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) version 2 Revised Published: 30 Jul 2025, 14:142 https://doi.org/10.12688/f1000research.149499.2 version 1 Published: 28 Jan 2025, 14:142 https://doi.org/10.12688/f1000research.149499.1 Copyright © 2025 Christanto RBI et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Christanto RBI, Wijaya C, Birowo P et al. Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.12688/f1000research.149499.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 30 Jul 2025 Revised Views 0 Cite How to cite this report: Warli SM. Reviewer Report For: Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.5256/f1000research.184430.r401594 ) The direct URL for this report is: https://f1000research.com/articles/14-142/v2#referee-response-401594 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Aug 2025 Syah Mirsya Warli , Universitas Sumatera Utara, Medan, Indonesia Approved VIEWS 0 https://doi.org/10.5256/f1000research.184430.r401594 I have reviewed the revised manuscript and have no further ... Continue reading READ ALL I have reviewed the revised manuscript and have no further comments from my side. Thank you for the opportunity to review. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Urology, Oncology, Andrology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Warli SM. Reviewer Report For: Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.5256/f1000research.184430.r401594 ) The direct URL for this report is: https://f1000research.com/articles/14-142/v2#referee-response-401594 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Li HJ. Reviewer Report For: Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.5256/f1000research.184430.r401595 ) The direct URL for this report is: https://f1000research.com/articles/14-142/v2#referee-response-401595 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 04 Aug 2025 Hong-Jun Li , Department of Urology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China Approved VIEWS 0 https://doi.org/10.5256/f1000research.184430.r401595 I am very happy to read the revised paper, because all my concerns are revised, adjusted and supplemented. Another suggestion is as follow: It is not wise to state that “To our knowledge, this study was the first ... Continue reading READ ALL I am very happy to read the revised paper, because all my concerns are revised, adjusted and supplemented. Another suggestion is as follow: It is not wise to state that “To our knowledge, this study was the first to explore the association between the IIEF-5 score and specific components of nocturnal erection using NPTR or NPT measurements”, and also the expression is not much valuable. Therefore, from the opinion of modest and objectiveness, I suggest delete the sentence. Actually, related researches are existed. Competing Interests: No competing interests were disclosed. Reviewer Expertise: basic and clinical research on andrology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Li HJ. Reviewer Report For: Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.5256/f1000research.184430.r401595 ) The direct URL for this report is: https://f1000research.com/articles/14-142/v2#referee-response-401595 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 28 Jan 2025 Views 0 Cite How to cite this report: Warli SM. Reviewer Report For: Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.5256/f1000research.163969.r376089 ) The direct URL for this report is: https://f1000research.com/articles/14-142/v1#referee-response-376089 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 11 Apr 2025 Syah Mirsya Warli , Universitas Sumatera Utara, Medan, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.163969.r376089 First of all, I would like to comment about the idea and the title itself. All of us know that IIEF-5 Questionnaire is meant to be a screening tools, not a diagnostic tool. Meanwhile, NPTR is an objective diagnostic tool ... Continue reading READ ALL First of all, I would like to comment about the idea and the title itself. All of us know that IIEF-5 Questionnaire is meant to be a screening tools, not a diagnostic tool. Meanwhile, NPTR is an objective diagnostic tool which widely known as the gold standard for Erectile Dysfunction. Finding a correlation between those two might be unwise. However, I understand that the author has the idea of promoting IIEF-5 as a diagnostic tool in a rural area which NPTR might not be available Secondly, I would like to comment about the method of this study. The author wrote that this study is a retrospective cohort study. As we know, cohort is a a type of observational study that follows a group of individuals (a cohort) with a shared characteristic over time to examine how certain factors or exposures affect their health outcomes, which is not the case in this study. The end result of Cohort study should be Relative Risk, while this study is trying to find a correlation between two diagnostic tools. I suggest to change the term in methods section from A retrospective cohort study to a correlation analysis study. In addition, I would like to appreciate the author on using the right statistical tools, which is Kolmogorov Smirnoff analysis on determining the data distribution. In this study, we found that the data is non-parametric. Therefore, Spearman analysis is used in this study. The author also presents the data in median instead of mean, which is the correct way to present a non-parametric data. Thirdly, I also found an unusual thing in this manuscript. This study aim is to find a correlation two diagnostic tools. I do not see the importance of performing evaluation on serum testosterone, total cholesterol, HbA1c, and vitamin D-25(OH). The title, the method, the result and the conclusion of this study is scrambled. If you want to add those data in this manuscript, the author should add the study aims in the introduction. I suggest the author to add the study aims as this study would like to investigate the correlation of erectile dysfunction with several variable such as serum testosterone, total cholesterol, HbA1c, and vitamin D-25(OH). The other options would be to delete all of those from this manuscript. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly References 1. Andrade C: Research Design: Cohort Studies. Indian J Psychol Med . 2022; 44 (2): 189-191 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Urology, Oncology, Andrology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Warli SM. Reviewer Report For: Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.5256/f1000research.163969.r376089 ) The direct URL for this report is: https://f1000research.com/articles/14-142/v1#referee-response-376089 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 09 Aug 2025 Ponco Birowo , Department of Urology, Rumah Sakit Dr Cipto Mangunkusumo, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 09 Aug 2025 Author Response 1. We clarified that the IIEF-5 should not replace NPTR but may serve as an initial tool in settings lacking advanced diagnostics. Added the sentence: "Although the IIEF aids in cost-effective ... Continue reading 1. We clarified that the IIEF-5 should not replace NPTR but may serve as an initial tool in settings lacking advanced diagnostics. Added the sentence: "Although the IIEF aids in cost-effective assessments, it should not replace objective testing." 2. We have rephrased our study design in the Methods section: The phrase "A retrospective cohort study" was replaced with "a correlation analysis study", as suggested. 3. Regarding the relevance of the blood parameters, we have revised our Introduction : Added the sentence: "This study also aimed to explore the correlation between erectile dysfunction and selected blood parameters (serum testosterone, total cholesterol, HbA1c, and vitamin D-25(OH))." This aligns the aim with the presented data. We have also added a discussion section regarding the relevance of these parameters with erectile dysfunction. 4. Regarding the mentions of genital and psychosocial examinations, We have added in the Discussion : "All subjects underwent a comprehensive physical examination, and no abnormalities nor defects of the genital organs were observed." "We acknowledge that psychosocial and interpersonal aspects were not thoroughly evaluated in this study and should be considered in future research." 1. We clarified that the IIEF-5 should not replace NPTR but may serve as an initial tool in settings lacking advanced diagnostics. Added the sentence: "Although the IIEF aids in cost-effective assessments, it should not replace objective testing." 2. We have rephrased our study design in the Methods section: The phrase "A retrospective cohort study" was replaced with "a correlation analysis study", as suggested. 3. Regarding the relevance of the blood parameters, we have revised our Introduction : Added the sentence: "This study also aimed to explore the correlation between erectile dysfunction and selected blood parameters (serum testosterone, total cholesterol, HbA1c, and vitamin D-25(OH))." This aligns the aim with the presented data. We have also added a discussion section regarding the relevance of these parameters with erectile dysfunction. 4. Regarding the mentions of genital and psychosocial examinations, We have added in the Discussion : "All subjects underwent a comprehensive physical examination, and no abnormalities nor defects of the genital organs were observed." "We acknowledge that psychosocial and interpersonal aspects were not thoroughly evaluated in this study and should be considered in future research." Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 09 Aug 2025 Ponco Birowo , Department of Urology, Rumah Sakit Dr Cipto Mangunkusumo, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 09 Aug 2025 Author Response 1. We clarified that the IIEF-5 should not replace NPTR but may serve as an initial tool in settings lacking advanced diagnostics. Added the sentence: "Although the IIEF aids in cost-effective ... Continue reading 1. We clarified that the IIEF-5 should not replace NPTR but may serve as an initial tool in settings lacking advanced diagnostics. Added the sentence: "Although the IIEF aids in cost-effective assessments, it should not replace objective testing." 2. We have rephrased our study design in the Methods section: The phrase "A retrospective cohort study" was replaced with "a correlation analysis study", as suggested. 3. Regarding the relevance of the blood parameters, we have revised our Introduction : Added the sentence: "This study also aimed to explore the correlation between erectile dysfunction and selected blood parameters (serum testosterone, total cholesterol, HbA1c, and vitamin D-25(OH))." This aligns the aim with the presented data. We have also added a discussion section regarding the relevance of these parameters with erectile dysfunction. 4. Regarding the mentions of genital and psychosocial examinations, We have added in the Discussion : "All subjects underwent a comprehensive physical examination, and no abnormalities nor defects of the genital organs were observed." "We acknowledge that psychosocial and interpersonal aspects were not thoroughly evaluated in this study and should be considered in future research." 1. We clarified that the IIEF-5 should not replace NPTR but may serve as an initial tool in settings lacking advanced diagnostics. Added the sentence: "Although the IIEF aids in cost-effective assessments, it should not replace objective testing." 2. We have rephrased our study design in the Methods section: The phrase "A retrospective cohort study" was replaced with "a correlation analysis study", as suggested. 3. Regarding the relevance of the blood parameters, we have revised our Introduction : Added the sentence: "This study also aimed to explore the correlation between erectile dysfunction and selected blood parameters (serum testosterone, total cholesterol, HbA1c, and vitamin D-25(OH))." This aligns the aim with the presented data. We have also added a discussion section regarding the relevance of these parameters with erectile dysfunction. 4. Regarding the mentions of genital and psychosocial examinations, We have added in the Discussion : "All subjects underwent a comprehensive physical examination, and no abnormalities nor defects of the genital organs were observed." "We acknowledge that psychosocial and interpersonal aspects were not thoroughly evaluated in this study and should be considered in future research." Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Li HJ. Reviewer Report For: Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.5256/f1000research.163969.r376083 ) The direct URL for this report is: https://f1000research.com/articles/14-142/v1#referee-response-376083 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 Apr 2025 Hong-Jun Li , Department of Urology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.163969.r376083 Due to the existing cultural factors, reporting bias, and patient considerations, diagnosing ED accurately is challenging. Both the International Index of Erectile Function (IIEF)-5 score and an objective test with nocturnal penile tumescence and rigidity (NPTR) monitoring are all used ... Continue reading READ ALL Due to the existing cultural factors, reporting bias, and patient considerations, diagnosing ED accurately is challenging. Both the International Index of Erectile Function (IIEF)-5 score and an objective test with nocturnal penile tumescence and rigidity (NPTR) monitoring are all used in routine diagnostic evaluation of men with Erectile Dysfunction. Of course, I accept that diagnosis of ED with NPTR is relatively complex and not economical. The authors tried to compare NPTR with the IIEF to assess the IIEF’ potentials as a cost-effective diagnostic tool for ED, and concluded correlations between IIEF scores and nocturnal erection frequency, as well as specific erection characteristics. The research was meaningful and interesting, but some problems should be considered before it can be accepted for indexing. My major concerns are as follows: The title does not indicate the specific type of article. It is recommended to add a few words before the title，that is “Primary Research on”. Primary Research on the Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction. Research design was simple and clear. No examination results were available for the genital area, including testicular volume and varicocele. In addition to that, the real challenge of ED diagnosis is mainly the patient's mental and psychological state, as well as their interpersonal relationships, particularly with sexual partners, which were not considered by the author. Mentioning these aspects in the introduction or discussion might provide a more comprehensive analysis. It would be even more perfect if it could be included in the study design. Was the author concerned about the NPTR test being affected by the patient's sleep conditions? How is the sample size determined? The sample size of this study (138 cases) is somewhat small, the age range of the enrolled patients was quite broad（19–76），and the duration of the practical research period (6 years) is relatively long. This makes it difficult to conduct detailed analysis and increases the likelihood that changes in lifestyle, environment, cognition, diagnostic methods, and criteria could affect the results and conclusions. For instance, testosterone levels are significantly related to age, with middle-aged and older men showing marked differences compared to younger adults. The small sample size makes it impossible to discuss testosterone issues by age group. Similar situations are widespread, affecting the reliability and objectivity of the various analyses presented in this article. It's strange that the abstract mentions 138 patients included in the method, but the results section shows 139 patients. It is well accepted that there are significant correlations between IIEF scores and NPTR variables. Therefore, the main results and conclusions for the paper are not very valuable, and the author should explore deeply to demonstrate the paper’s value. Conclusions in the abstract were not properly organized. Results in abstract could not cover the conclusions. In another way, some conclusions in abstract did not based on the results in abstract, such as last part sentences in abstract, that was “Our findings highlight the importance of a personalized approach to ED diagnosis. Although IIEF aids in cost effective assessments, it should not replace objective testing”. It is recommended to use subheadings in the discussion section to clearly display the topic of each paragraph, which helps with the organization and logical flow of the article. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: basic and clinical research on andrology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Li HJ. Reviewer Report For: Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.5256/f1000research.163969.r376083 ) The direct URL for this report is: https://f1000research.com/articles/14-142/v1#referee-response-376083 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 09 Aug 2025 Ponco Birowo , Department of Urology, Rumah Sakit Dr Cipto Mangunkusumo, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 09 Aug 2025 Author Response 1. We have revises the title to our paper: " Primary Research on the Correlation between Erectile Function Assessment through IIEF Score and NPTR Measurements…" as commented by the reviewer 2. We have ... Continue reading 1. We have revises the title to our paper: " Primary Research on the Correlation between Erectile Function Assessment through IIEF Score and NPTR Measurements…" as commented by the reviewer 2. We have adjusted a few discrepancies that has been noted (number of subjects, results and conclusion in the abstract). We have also introduced subheadings in the discussion. 3. A discussion on sample size has been added, explaining how the extended study period may introduce variability due to shifts in clinical practice, lifestyle, and diagnostic standards. We will also suggest stratified analysis in future research. 4. Regarding the patient's sleeping conditions, we recognize that NPTR results are highly dependent on sleep quality. Prior to NPTR testing, each patient was given standardized instructions, including avoiding alcohol, sedatives, and strenuous physical activity 24 hours before the test, ensuring adequate sleep, and abstaining from sexual activity on the night of testing. These steps were intended to minimize external factors that could affect the results of nocturnal penile tumescence 5. Regarding the examination for the genital area, we can confirm that all subjects underwent a comprehensive physical examination, and no abnormalities nor defects of the genital organs were observed. 6. We have also demonstrated the value of our paper through explanation tht our study now will serve as a pilot study in Indonesia, more comprehensive analysis will be advised for further enhancement of future studies 1. We have revises the title to our paper: " Primary Research on the Correlation between Erectile Function Assessment through IIEF Score and NPTR Measurements…" as commented by the reviewer 2. We have adjusted a few discrepancies that has been noted (number of subjects, results and conclusion in the abstract). We have also introduced subheadings in the discussion. 3. A discussion on sample size has been added, explaining how the extended study period may introduce variability due to shifts in clinical practice, lifestyle, and diagnostic standards. We will also suggest stratified analysis in future research. 4. Regarding the patient's sleeping conditions, we recognize that NPTR results are highly dependent on sleep quality. Prior to NPTR testing, each patient was given standardized instructions, including avoiding alcohol, sedatives, and strenuous physical activity 24 hours before the test, ensuring adequate sleep, and abstaining from sexual activity on the night of testing. These steps were intended to minimize external factors that could affect the results of nocturnal penile tumescence 5. Regarding the examination for the genital area, we can confirm that all subjects underwent a comprehensive physical examination, and no abnormalities nor defects of the genital organs were observed. 6. We have also demonstrated the value of our paper through explanation tht our study now will serve as a pilot study in Indonesia, more comprehensive analysis will be advised for further enhancement of future studies Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 09 Aug 2025 Ponco Birowo , Department of Urology, Rumah Sakit Dr Cipto Mangunkusumo, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 09 Aug 2025 Author Response 1. We have revises the title to our paper: " Primary Research on the Correlation between Erectile Function Assessment through IIEF Score and NPTR Measurements…" as commented by the reviewer 2. We have ... Continue reading 1. We have revises the title to our paper: " Primary Research on the Correlation between Erectile Function Assessment through IIEF Score and NPTR Measurements…" as commented by the reviewer 2. We have adjusted a few discrepancies that has been noted (number of subjects, results and conclusion in the abstract). We have also introduced subheadings in the discussion. 3. A discussion on sample size has been added, explaining how the extended study period may introduce variability due to shifts in clinical practice, lifestyle, and diagnostic standards. We will also suggest stratified analysis in future research. 4. Regarding the patient's sleeping conditions, we recognize that NPTR results are highly dependent on sleep quality. Prior to NPTR testing, each patient was given standardized instructions, including avoiding alcohol, sedatives, and strenuous physical activity 24 hours before the test, ensuring adequate sleep, and abstaining from sexual activity on the night of testing. These steps were intended to minimize external factors that could affect the results of nocturnal penile tumescence 5. Regarding the examination for the genital area, we can confirm that all subjects underwent a comprehensive physical examination, and no abnormalities nor defects of the genital organs were observed. 6. We have also demonstrated the value of our paper through explanation tht our study now will serve as a pilot study in Indonesia, more comprehensive analysis will be advised for further enhancement of future studies 1. We have revises the title to our paper: " Primary Research on the Correlation between Erectile Function Assessment through IIEF Score and NPTR Measurements…" as commented by the reviewer 2. We have adjusted a few discrepancies that has been noted (number of subjects, results and conclusion in the abstract). We have also introduced subheadings in the discussion. 3. A discussion on sample size has been added, explaining how the extended study period may introduce variability due to shifts in clinical practice, lifestyle, and diagnostic standards. We will also suggest stratified analysis in future research. 4. Regarding the patient's sleeping conditions, we recognize that NPTR results are highly dependent on sleep quality. Prior to NPTR testing, each patient was given standardized instructions, including avoiding alcohol, sedatives, and strenuous physical activity 24 hours before the test, ensuring adequate sleep, and abstaining from sexual activity on the night of testing. These steps were intended to minimize external factors that could affect the results of nocturnal penile tumescence 5. Regarding the examination for the genital area, we can confirm that all subjects underwent a comprehensive physical examination, and no abnormalities nor defects of the genital organs were observed. 6. We have also demonstrated the value of our paper through explanation tht our study now will serve as a pilot study in Indonesia, more comprehensive analysis will be advised for further enhancement of future studies Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 28 Jan 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 30 Jul 25 read read Version 1 28 Jan 25 read read Hong-Jun Li , Chinese Academy of Medical Sciences, Beijing, China Syah Mirsya Warli , Universitas Sumatera Utara, Medan, Indonesia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Warli S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Aug 2025 | for Version 2 Syah Mirsya Warli , Universitas Sumatera Utara, Medan, Indonesia 0 Views copyright © 2025 Warli S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I have reviewed the revised manuscript and have no further comments from my side. Thank you for the opportunity to review. Competing Interests No competing interests were disclosed. Reviewer Expertise Urology, Oncology, Andrology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Warli SM. Peer Review Report For: Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.5256/f1000research.184430.r401594) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-142/v2#referee-response-401594 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Li H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 04 Aug 2025 | for Version 2 Hong-Jun Li , Department of Urology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China 0 Views copyright © 2025 Li H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I am very happy to read the revised paper, because all my concerns are revised, adjusted and supplemented. Another suggestion is as follow: It is not wise to state that “To our knowledge, this study was the first to explore the association between the IIEF-5 score and specific components of nocturnal erection using NPTR or NPT measurements”, and also the expression is not much valuable. Therefore, from the opinion of modest and objectiveness, I suggest delete the sentence. Actually, related researches are existed. Competing Interests No competing interests were disclosed. Reviewer Expertise basic and clinical research on andrology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Li HJ. Peer Review Report For: Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.5256/f1000research.184430.r401595) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-142/v2#referee-response-401595 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Warli S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 11 Apr 2025 | for Version 1 Syah Mirsya Warli , Universitas Sumatera Utara, Medan, Indonesia 0 Views copyright © 2025 Warli S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions First of all, I would like to comment about the idea and the title itself. All of us know that IIEF-5 Questionnaire is meant to be a screening tools, not a diagnostic tool. Meanwhile, NPTR is an objective diagnostic tool which widely known as the gold standard for Erectile Dysfunction. Finding a correlation between those two might be unwise. However, I understand that the author has the idea of promoting IIEF-5 as a diagnostic tool in a rural area which NPTR might not be available Secondly, I would like to comment about the method of this study. The author wrote that this study is a retrospective cohort study. As we know, cohort is a a type of observational study that follows a group of individuals (a cohort) with a shared characteristic over time to examine how certain factors or exposures affect their health outcomes, which is not the case in this study. The end result of Cohort study should be Relative Risk, while this study is trying to find a correlation between two diagnostic tools. I suggest to change the term in methods section from A retrospective cohort study to a correlation analysis study. In addition, I would like to appreciate the author on using the right statistical tools, which is Kolmogorov Smirnoff analysis on determining the data distribution. In this study, we found that the data is non-parametric. Therefore, Spearman analysis is used in this study. The author also presents the data in median instead of mean, which is the correct way to present a non-parametric data. Thirdly, I also found an unusual thing in this manuscript. This study aim is to find a correlation two diagnostic tools. I do not see the importance of performing evaluation on serum testosterone, total cholesterol, HbA1c, and vitamin D-25(OH). The title, the method, the result and the conclusion of this study is scrambled. If you want to add those data in this manuscript, the author should add the study aims in the introduction. I suggest the author to add the study aims as this study would like to investigate the correlation of erectile dysfunction with several variable such as serum testosterone, total cholesterol, HbA1c, and vitamin D-25(OH). The other options would be to delete all of those from this manuscript. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly References 1. Andrade C: Research Design: Cohort Studies. Indian J Psychol Med . 2022; 44 (2): 189-191 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Urology, Oncology, Andrology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 09 Aug 2025 Ponco Birowo, Department of Urology, Rumah Sakit Dr Cipto Mangunkusumo, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 1. We clarified that the IIEF-5 should not replace NPTR but may serve as an initial tool in settings lacking advanced diagnostics. Added the sentence: "Although the IIEF aids in cost-effective assessments, it should not replace objective testing." 2. We have rephrased our study design in the Methods section: The phrase "A retrospective cohort study" was replaced with "a correlation analysis study", as suggested. 3. Regarding the relevance of the blood parameters, we have revised our Introduction : Added the sentence: "This study also aimed to explore the correlation between erectile dysfunction and selected blood parameters (serum testosterone, total cholesterol, HbA1c, and vitamin D-25(OH))." This aligns the aim with the presented data. We have also added a discussion section regarding the relevance of these parameters with erectile dysfunction. 4. Regarding the mentions of genital and psychosocial examinations, We have added in the Discussion : "All subjects underwent a comprehensive physical examination, and no abnormalities nor defects of the genital organs were observed." "We acknowledge that psychosocial and interpersonal aspects were not thoroughly evaluated in this study and should be considered in future research." View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Warli SM. Peer Review Report For: Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.5256/f1000research.163969.r376089) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-142/v1#referee-response-376089 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Li H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 08 Apr 2025 | for Version 1 Hong-Jun Li , Department of Urology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China 0 Views copyright © 2025 Li H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Due to the existing cultural factors, reporting bias, and patient considerations, diagnosing ED accurately is challenging. Both the International Index of Erectile Function (IIEF)-5 score and an objective test with nocturnal penile tumescence and rigidity (NPTR) monitoring are all used in routine diagnostic evaluation of men with Erectile Dysfunction. Of course, I accept that diagnosis of ED with NPTR is relatively complex and not economical. The authors tried to compare NPTR with the IIEF to assess the IIEF’ potentials as a cost-effective diagnostic tool for ED, and concluded correlations between IIEF scores and nocturnal erection frequency, as well as specific erection characteristics. The research was meaningful and interesting, but some problems should be considered before it can be accepted for indexing. My major concerns are as follows: The title does not indicate the specific type of article. It is recommended to add a few words before the title，that is “Primary Research on”. Primary Research on the Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction. Research design was simple and clear. No examination results were available for the genital area, including testicular volume and varicocele. In addition to that, the real challenge of ED diagnosis is mainly the patient's mental and psychological state, as well as their interpersonal relationships, particularly with sexual partners, which were not considered by the author. Mentioning these aspects in the introduction or discussion might provide a more comprehensive analysis. It would be even more perfect if it could be included in the study design. Was the author concerned about the NPTR test being affected by the patient's sleep conditions? How is the sample size determined? The sample size of this study (138 cases) is somewhat small, the age range of the enrolled patients was quite broad（19–76），and the duration of the practical research period (6 years) is relatively long. This makes it difficult to conduct detailed analysis and increases the likelihood that changes in lifestyle, environment, cognition, diagnostic methods, and criteria could affect the results and conclusions. For instance, testosterone levels are significantly related to age, with middle-aged and older men showing marked differences compared to younger adults. The small sample size makes it impossible to discuss testosterone issues by age group. Similar situations are widespread, affecting the reliability and objectivity of the various analyses presented in this article. It's strange that the abstract mentions 138 patients included in the method, but the results section shows 139 patients. It is well accepted that there are significant correlations between IIEF scores and NPTR variables. Therefore, the main results and conclusions for the paper are not very valuable, and the author should explore deeply to demonstrate the paper’s value. Conclusions in the abstract were not properly organized. Results in abstract could not cover the conclusions. In another way, some conclusions in abstract did not based on the results in abstract, such as last part sentences in abstract, that was “Our findings highlight the importance of a personalized approach to ED diagnosis. Although IIEF aids in cost effective assessments, it should not replace objective testing”. It is recommended to use subheadings in the discussion section to clearly display the topic of each paragraph, which helps with the organization and logical flow of the article. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise basic and clinical research on andrology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 09 Aug 2025 Ponco Birowo, Department of Urology, Rumah Sakit Dr Cipto Mangunkusumo, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 1. We have revises the title to our paper: " Primary Research on the Correlation between Erectile Function Assessment through IIEF Score and NPTR Measurements…" as commented by the reviewer 2. We have adjusted a few discrepancies that has been noted (number of subjects, results and conclusion in the abstract). We have also introduced subheadings in the discussion. 3. A discussion on sample size has been added, explaining how the extended study period may introduce variability due to shifts in clinical practice, lifestyle, and diagnostic standards. We will also suggest stratified analysis in future research. 4. Regarding the patient's sleeping conditions, we recognize that NPTR results are highly dependent on sleep quality. Prior to NPTR testing, each patient was given standardized instructions, including avoiding alcohol, sedatives, and strenuous physical activity 24 hours before the test, ensuring adequate sleep, and abstaining from sexual activity on the night of testing. These steps were intended to minimize external factors that could affect the results of nocturnal penile tumescence 5. Regarding the examination for the genital area, we can confirm that all subjects underwent a comprehensive physical examination, and no abnormalities nor defects of the genital organs were observed. 6. We have also demonstrated the value of our paper through explanation tht our study now will serve as a pilot study in Indonesia, more comprehensive analysis will be advised for further enhancement of future studies View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Li HJ. Peer Review Report For: Primary Research on Correlation between Erectile Function Assessment through International Index of Erectile Function Score and Nocturnal Penile Tumescence and Rigidity Measurements in Men with Erectile Dysfunction [version 2; peer review: 2 approved] . F1000Research 2025, 14 :142 ( https://doi.org/10.5256/f1000research.163969.r376083) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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