(473) Insertion-phase Predominant Erectile Dysfunction: A Distinct Clinical Phenotype with Preserved Post-Penetration Rigidity

Introduction Erectile dysfunction (ED) is typically diagnosed using total scores from standardized questionnaires such as the IIEF-5 or the Erectile Function domain of the IIEF (IIEF-EF). While practical, this approach may overlook phase-specific dysfunctions across initiation, penetration, and post-penetration maintenance. Objective To introduce and characterize Insertion-phase Predominant Erectile Dysfunction (IP-ED), a distinct clinical presentation, and to evaluate both the diagnostic value of IIEF-EF subdomain analysis and treatment response to tadalafil combined with sexual education. Methods We retrospectively analyzed six men presenting with recurrent penetration difficulties despite preserved rigidity and ejaculation after penetration. In addition to IIEF-EF total scores, we calculated insertion subscores (Q2–Q3) and post-penetration maintenance subscores (Q4–Q5) at baseline and after tadalafil 5 mg once daily, supplemented by sexual education highlighting the psychogenic and reversible nature of this condition. Results At baseline, penetration success was approximately 50%, while post-penetration maintenance was consistently intact (100%). All participants had normal anxiety scale scores and no major organic risk factors. After treatment, IIEF-EF total and Q1–Q3 scores improved significantly (p < 0.05). The insertion subscore rose markedly (5.5 to 10.0, p < 0.05), while post-penetration scores remained stable. Three patients achieved drug-free normalization of erectile function (IIEF-EF ≥26). Conclusions IP-ED represents a clinically meaningful, phase-specific ED phenotype characterized by erectile instability limited to penetration. Recognition of this presentation can improve diagnostic accuracy, prevent unnecessary escalation to generalized ED treatment, and highlight the therapeutic role of tailored interventions combining low-dose tadalafil with structured sexual education. Larger prospective studies are warranted to validate these findings. Disclosure No