{ "model": { "rank": 5828, "code": "thing-q184674", "model_id": "vr.tr.erectile-dysfunction", "name": "erectile dysfunction", "purpose": "Enable an AI agent to recognise reported erectile dysfunction, assess its pattern and impact, and support appropriate evaluation and clinician-directed care while preserving uncertainty.", "family": "Thing Registry", "category": "Information and virtual systems", "status": "research-draft", "kind": "thing", "plane": "INF", "domain": "INF.KNW", "industry": "", "version": "", "url": "/models/thing/q184674/", "tier": 2, "score": 64, "payload": { "layer": "wikidata", "aliases": [ "vasculogenic impotence", "condom-associated erection problem" ], "aliasCount": 2, "merged": 2, "knownIn": 64, "facets": null, "markers": [], "lexicalClass": "", "senseRank": null, "alsoRegisteredAs": null, "source": { "dataset": "wikidata", "item": "Q184674", "url": "https://www.wikidata.org/wiki/Q184674", "license": "CC0 1.0" } }, "research": { "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-07T09:31:35Z", "providers": [ "Codex", "Grok" ], "missingProviders": [], "pass": 2, "cost": { "grok": { "usd": 0.01206592, "turns": 1, "seconds": 147.5, "error": null }, "codex": { "seconds": 96.9, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.3\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a07b32-d962-7161-b8c2-80be7434a4cd\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: erectile dysfunction\nRegistry id: vr.tr.erectile-dysfunction\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into thi" } } }, "metaModel": { "id": "THING-Q184674", "registryId": "vr.tr.erectile-dysfunction", "name": "erectile dysfunction", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q184674/", "model": { "registry_id": "vr.tr.erectile-dysfunction", "name": "erectile dysfunction", "purpose": "Enable an AI agent to recognise reported erectile dysfunction, assess its pattern and impact, and support appropriate evaluation and clinician-directed care while preserving uncertainty.", "definition": "Erectile dysfunction is a male sexual dysfunction in which a man cannot repeatedly attain or keep a penile erection rigid and lasting enough for satisfactory sexual activity, generally diagnosed only after the problem has been present for at least three months.", "scope_statement": "This model owns the erectile-function state registered as vr.tr.erectile-dysfunction in XCT / XCT.STA: difficulty attaining or maintaining sufficient penile rigidity for desired sexual activity, its course, explanatory evidence, and management constraints.", "in_scope": [ "Difficulty attaining, maintaining, or achieving sufficient rigidity of an erection", "Onset, recurrence, situational variation, and change from the person's usual erectile function", "Patient-reported impact, distress, and goals for erectile function", "Evidence linking erectile difficulty to physical, psychological, medication-related, or contextual contributors", "ED-specific evaluation, treatment suitability, treatment experience, and follow-up" ], "out_of_scope": [ "Sexual desire, arousal, orgasm, and ejaculation disorders as independent conditions", "Infertility, semen quality, and reproductive planning", "Primary models of cardiovascular, endocrine, neurological, or metabolic disease", "Penile curvature, injury, anatomical variation, and pain as independent conditions", "Priapism and other acute emergencies as independently managed conditions", "General relationship quality, sexual identity, and sexual orientation" ], "distinguishing_features": [ "Establish whether the reported limitation concerns erection attainment, rigidity, or maintenance; low desire alone does not establish ED. [NIDDK overview](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction)", "Ask separately about erection, ejaculation, and orgasm: a difficulty in one does not identify the state of the others. [NIDDK diagnosis](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/diagnosis)", "Distinguish an isolated unsuccessful attempt from a recurring pattern by recording frequency, duration, and the diagnostic framework used.", "Distinguish inadequate erection from sexual activity limited principally by penile pain or curvature; record coexistence without merging the conditions.", "Distinguish current unaided function from function achieved using medicine, a vacuum device, or an implant; assisted success does not by itself establish unaided recovery." ], "characteristics": [ { "name": "Erectile-function limitation", "kind": "category", "unit_or_values": "attainment difficulty; insufficient rigidity; maintenance difficulty; combined; unclear", "why_it_matters": "Identifies the actual functional problem rather than treating every sexual complaint as ED." }, { "name": "Assessment state", "kind": "state", "unit_or_values": "reported concern; under evaluation; clinician-diagnosed; historical; clinician-assessed remission; uncertain", "why_it_matters": "Separates a person's report from a clinical determination." }, { "name": "Onset and duration", "kind": "measurement", "unit_or_values": "onset date or estimated interval; duration in days, months, or years; uncertainty recorded", "why_it_matters": "Supports assessment of persistence and temporal relationships to illness, injury, medication, or life events." }, { "name": "Difficulty frequency", "kind": "measurement", "unit_or_values": "attempts with difficulty / relevant attempts within a stated interval; unknown or no attempts permitted", "why_it_matters": "Avoids confusing lack of sexual opportunity with erectile failure." }, { "name": "Context dependence", "kind": "category", "unit_or_values": "generalised; situational; mixed; unassessed, with relevant contexts described", "why_it_matters": "Shows whether the limitation varies with activity, setting, or partner without assigning a cause automatically." }, { "name": "Spontaneous and self-stimulated erections", "kind": "category", "unit_or_values": "preserved; reduced; absent by report; variable; unknown, separately by context", "why_it_matters": "Adds contextual evidence without treating one observation as a definitive causal test." }, { "name": "Structured erectile-function assessment", "kind": "measurement", "unit_or_values": "instrument name, version, language, score, recall interval, and assistance status", "why_it_matters": "Makes repeated assessments interpretable without assuming different instruments are interchangeable." }, { "name": "Experienced impact", "kind": "category", "unit_or_values": "patient-described distress, avoidance, satisfaction, and interference with desired activities", "why_it_matters": "Keeps care goals grounded in the person's experience rather than a presumed sexual norm." }, { "name": "Suspected contributors", "kind": "relation", "unit_or_values": "links to conditions, exposures, procedures, and contextual factors, each with evidence and confidence", "why_it_matters": "Supports multiple simultaneous explanations while distinguishing association from established causation." }, { "name": "Current treatment dependence", "kind": "state", "unit_or_values": "untreated; treatment attempted; effective with assistance; insufficient response; stopped; unknown", "why_it_matters": "Prevents successful treatment from being mistaken for resolution of the underlying difficulty." }, { "name": "Management suitability", "kind": "state", "unit_or_values": "not assessed; clinician review required; suitable for a specified option; contraindicated for a specified option; urgent assessment required", "why_it_matters": "Makes action boundaries specific to the proposed intervention and current clinical information." } ], "affordances": [ "Elicit a private, consent-based account of erectile difficulty, its contexts, and the person's goals.", "Summarise the symptom pattern and missing evidence for clinical evaluation without independently assigning a diagnosis.", "Relate onset and fluctuations to documented conditions, medicines, procedures, and psychological circumstances.", "Flag documented treatment contraindications and symptoms requiring urgent clinical assessment.", "Support discussion of clinician-approved options against the person's preferences and practical constraints.", "Track assisted and unaided outcomes separately and prepare an evidence-based reassessment summary." ] }, "sources": [ { "id": "nih-consensus-1993", "title": "Impotence: NIH Consensus Development Panel on Impotence", "url": "", "what_it_supports": "The still-cited specialist definition that replaced the older term impotence: inability to attain and/or maintain erection sufficient for satisfactory sexual performance." }, { "id": "aua-ed-guideline-2018", "title": "Erectile Dysfunction: AUA Guideline", "url": "", "what_it_supports": "Practice classification, work-up (including cardiovascular risk), IIEF-based severity, and treatment pathway used in North American urology." }, { "id": "eau-srh-guideline", "title": "EAU Guidelines on Sexual and Reproductive Health", "url": "", "what_it_supports": "European diagnostic threshold of about three months, organic versus psychogenic work-up, Doppler criteria, and first- to third-line therapy." }, { "id": "icd-who", "title": "ICD-10 code N52 Male erectile dysfunction; ICD-11 code HA01.1 Male erectile dysfunction", "url": "", "what_it_supports": "The coding identifiers used in health systems to name the condition." }, { "id": "dsm-5-tr", "title": "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision: Erectile Disorder", "url": "", "what_it_supports": "Psychiatric diagnostic criteria, duration, and situational versus generalised specifiers." }, { "id": "mmas-1994", "title": "Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study", "url": "", "what_it_supports": "Age-associated prevalence and the mixed organic-psychogenic picture seen in community practice." }, { "id": "iief-rosen-1997", "title": "The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction", "url": "", "what_it_supports": "The IIEF and later IIEF-5/SHIM scores used to grade severity in clinic and trials." }, { "id": "princeton-iii-2012", "title": "The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease", "url": "", "what_it_supports": "Use of ED as a cardiovascular-risk sentinel and the nitrate contraindication for PDE5 inhibitors." } ], "structure": { "bundles": [ { "id": "erectile-difficulty-recognition", "name": "Erectile difficulty recognition", "description": "Identify the erectile limitation and establish the evidential status of the ED label.", "rationale": "An agent must distinguish a specific erectile complaint from other sexual difficulties and from an established diagnosis.", "layers": [ { "id": "functional-complaint", "name": "Functional complaint", "description": "Describe what the erection does not permit in the person's intended activity.", "findings": [ { "id": "attainment-rigidity-maintenance", "name": "Attainment, rigidity, and maintenance", "description": "Record each erectile limitation separately, including the person's meaning of sufficient function.", "questions": [ { "text": "Is the difficulty obtaining an erection, achieving sufficient firmness, maintaining it, or a combination?", "kind": "definition", "id": "attainment-rigidity-maintenance-q01" }, { "text": "Which desired activities are limited, and is erection inadequacy the limiting factor rather than desire, pain, ejaculation, or orgasm?", "kind": "boundary", "id": "attainment-rigidity-maintenance-q02" } ] } ] }, { "id": "diagnostic-standing", "name": "Diagnostic standing", "description": "Keep reported symptoms, assessment findings, and diagnostic conclusions distinguishable.", "findings": [ { "id": "label-and-criteria", "name": "Label and criteria", "description": "Retain who applied the ED label, when, and under which criteria; leave unresolved criteria explicit.", "questions": [ { "text": "Is ED self-reported, suspected during evaluation, or diagnosed by a clinician, and what record supports that status?", "kind": "provenance", "id": "label-and-criteria-q01" }, { "text": "Which diagnostic framework, if any, supplies the persistence, frequency, or distress requirements used for this assessment?", "kind": "definition", "id": "label-and-criteria-q02" } ] } ] } ] }, { "id": "erection-pattern-and-burden", "name": "Erection pattern and burden", "description": "Describe recurrence, context, severity, and lived consequences.", "rationale": "The same complaint can represent substantially different patterns and care priorities.", "layers": [ { "id": "temporal-situational-pattern", "name": "Temporal and situational pattern", "description": "Place erectile difficulty against baseline function, time, and relevant sexual contexts.", "findings": [ { "id": "onset-recurrence-variation", "name": "Onset, recurrence, and variation", "description": "Record lifelong or acquired presentation, sudden or gradual onset, and context-dependent differences without inferring their cause.", "questions": [ { "text": "When did the difficulty begin, how did it differ from prior function, and how often has it occurred within a specified interval?", "kind": "measurement", "id": "onset-recurrence-variation-q01" }, { "text": "How does function differ during partnered activity, self-stimulation, and spontaneous or waking erections, and which observations are unknown?", "kind": "measurement", "id": "onset-recurrence-variation-q02" } ] } ] }, { "id": "severity-and-personal-impact", "name": "Severity and personal impact", "description": "Pair structured assessment with the person's experience and desired outcomes.", "findings": [ { "id": "interpretable-severity-and-goals", "name": "Interpretable severity and goals", "description": "Record instrument context, opportunities for sexual activity, treatment assistance, and personally meaningful improvement.", "questions": [ { "text": "What assessment or description captures severity, over which interval, and were responses affected by assistance or lack of sexual opportunity?", "kind": "measurement", "id": "interpretable-severity-and-goals-q01" }, { "text": "What distress or activity limitation does the person report, and what change would they consider worthwhile?", "kind": "action", "id": "interpretable-severity-and-goals-q02" } ] } ] } ] }, { "id": "contributors-and-evaluation", "name": "Contributors and evaluation", "description": "Organise causal hypotheses and the evidence needed to assess them.", "rationale": "An agent must accommodate interacting contributors and avoid converting a plausible explanation into a confirmed cause.", "layers": [ { "id": "contributor-hypotheses", "name": "Contributor hypotheses", "description": "Link erectile difficulty to relevant health, exposure, and psychosexual information.", "findings": [ { "id": "multifactorial-explanation", "name": "Multifactorial explanation", "description": "Maintain separate hypotheses for vascular, neurological, hormonal, anatomical, medication-related, and psychological contributions. Clinical history and examination inform evaluation. [NIDDK diagnosis](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/diagnosis)", "questions": [ { "text": "Which conditions, medicines, substances, procedures, injuries, or psychological circumstances preceded or accompany the erectile change?", "kind": "provenance", "id": "multifactorial-explanation-q01" }, { "text": "What supports or weakens each proposed contribution, and which explanations remain possible together?", "kind": "boundary", "id": "multifactorial-explanation-q02" } ] } ] }, { "id": "targeted-assessment", "name": "Targeted assessment", "description": "Capture completed evaluation and the decision each additional assessment would inform.", "findings": [ { "id": "evaluation-evidence-and-gaps", "name": "Evaluation evidence and gaps", "description": "Record relevant examination and test results with dates, interpretation, and limitations; specialised testing is not treated as a universal prerequisite.", "questions": [ { "text": "What relevant history, examination, laboratory, or specialised erectile-function testing has been completed, and who interpreted it?", "kind": "provenance", "id": "evaluation-evidence-and-gaps-q01" }, { "text": "Which unresolved clinical decision would further assessment change, and has a clinician recommended that assessment?", "kind": "action", "id": "evaluation-evidence-and-gaps-q02" } ] } ] } ] }, { "id": "treatment-suitability-and-safety", "name": "Treatment suitability and safety", "description": "Represent the clinical constraints that govern ED management and escalation.", "rationale": "A treatment suggestion is incomplete without information about interactions, health status, and urgent complications.", "layers": [ { "id": "option-specific-eligibility", "name": "Option-specific eligibility", "description": "Attach suitability assessments to particular treatments and current clinical circumstances.", "findings": [ { "id": "cardiovascular-and-interaction-review", "name": "Cardiovascular and interaction review", "description": "Record cardiovascular review and medication reconciliation. Concomitant organic nitrates or nitric oxide donors, including poppers, contraindicate PDE5 inhibitors. [EAU guideline](https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/management-of-erectile-dysfunction)", "questions": [ { "text": "Has a clinician assessed cardiovascular suitability for sexual activity and the proposed ED treatment, and what remains unresolved?", "kind": "action", "id": "cardiovascular-and-interaction-review-q01" }, { "text": "Does the current medicine and substance history include nitrates, nitric oxide donors, or other contraindications or interactions relevant to the proposed option?", "kind": "boundary", "id": "cardiovascular-and-interaction-review-q02" } ] } ] }, { "id": "acute-complication-routing", "name": "Acute complication routing", "description": "Separate routine erectile difficulty from urgent symptoms arising during treatment.", "findings": [ { "id": "urgent-treatment-associated-symptoms", "name": "Urgent treatment-associated symptoms", "description": "An erection lasting longer than four hours or vision or hearing loss following oral ED medicine requires prompt medical attention. Record symptoms and route to urgent care. [NIDDK treatment](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment)", "questions": [ { "text": "Is there a prolonged erection, new vision or hearing loss, or another acute symptom, and when did it begin relative to treatment?", "kind": "measurement", "id": "urgent-treatment-associated-symptoms-q01" }, { "text": "What immediate clinical escalation is indicated by the reported symptom and applicable care pathway?", "kind": "action", "id": "urgent-treatment-associated-symptoms-q02" } ] } ] } ] }, { "id": "management-experience-and-response", "name": "Management experience and response", "description": "Connect patient preferences, treatment experience, and observed change in erectile function.", "rationale": "An agent must distinguish unsuitable treatment, an inadequately assessed trial, effective assistance, and improvement without assistance.", "layers": [ { "id": "shared-management-choice", "name": "Shared management choice", "description": "Document options discussed, preferences, and the agreed clinical plan.", "findings": [ { "id": "acceptable-treatment-plan", "name": "Acceptable treatment plan", "description": "Record the person's priorities concerning medication, devices, counselling, contributing conditions, and procedural options, including a preference to defer treatment.", "questions": [ { "text": "Which clinician-discussed options fit the person's goals, preferences about spontaneity and invasiveness, access, and willingness to involve a partner?", "kind": "action", "id": "acceptable-treatment-plan-q01" }, { "text": "What plan was agreed, including any prescribed treatment, use instructions, training, and review point?", "kind": "provenance", "id": "acceptable-treatment-plan-q02" } ] } ] }, { "id": "response-and-reassessment", "name": "Response and reassessment", "description": "Interpret outcomes against actual treatment exposure and the original goals.", "findings": [ { "id": "assisted-outcome-and-trial-adequacy", "name": "Assisted outcome and trial adequacy", "description": "Keep erectile response, satisfaction, adverse effects, and adherence distinct; avoid declaring treatment failure without assessing how it was used.", "questions": [ { "text": "What changed in attainment, rigidity, maintenance, and satisfaction, under what assistance and use conditions, and with which adverse effects?", "kind": "measurement", "id": "assisted-outcome-and-trial-adequacy-q01" }, { "text": "Does the clinician consider the trial adequate, and does the evidence support continuation, instruction review, another option, or renewed evaluation?", "kind": "action", "id": "assisted-outcome-and-trial-adequacy-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Vasculogenic (arteriogenic inflow failure or veno-occlusive/cavernosal leak)", "Neurogenic (central, spinal, or peripheral, including after pelvic surgery or neuropathy)", "Endocrinological (hypogonadism, hyperprolactinaemia, thyroid disease)", "Anatomical or structural (Peyronie's plaque, cavernosal fibrosis, congenital deformity)", "Drug-induced or iatrogenic (antihypertensives, SSRIs, anti-androgens, pelvic radiation)", "Psychogenic", "Mixed organic and psychogenic (the majority of clinic presentations)", "Situational versus generalised (partner-specific or context-limited versus present in all settings)" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of erectile dysfunction this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "scheme": "ICD-10", "value_or_pattern": "N52 (N52.0-N52.9)", "note": "WHO/ICD-10-CM Male erectile dysfunction, with cause-specific subcodes (e.g. drug-induced, post-procedural)." }, { "scheme": "ICD-11", "value_or_pattern": "HA01.1", "note": "WHO ICD-11 Male erectile dysfunction, under sexual arousal dysfunctions." }, { "scheme": "DSM-5 / DSM-5-TR", "value_or_pattern": "302.72 (F52.21)", "note": "Erectile Disorder in the mental-disorders classification; not a synonym for all organic ED." }, { "scheme": "SNOMED CT", "value_or_pattern": "397803000", "note": "Erectile dysfunction (disorder)." }, { "scheme": "MeSH", "value_or_pattern": "D007172", "note": "Erectile Dysfunction; older heading Impotence redirects here." }, { "scheme": "Wikidata", "value_or_pattern": "Q837551", "note": "Item for the medical condition erectile dysfunction." }, { "scheme": "UMLS CUI", "value_or_pattern": "C0242350", "note": "Unified Medical Language System concept for erectile dysfunction." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of erectile dysfunction this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-standards-and-regulation", "name": "Standards and regulation", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "American Urological Association - Erectile Dysfunction guideline (evaluation, cardiovascular risk, and treatment sequencing).", "European Association of Urology - Guidelines on Sexual and Reproductive Health (diagnostic criteria, imaging, and therapy).", "American Psychiatric Association - DSM-5-TR diagnostic criteria for Erectile Disorder.", "World Health Organization - ICD-10 N52 and ICD-11 HA01.1 as the statistical classification of the condition.", "U.S. Food and Drug Administration / EMA / national medicines regulators - marketing authorisation and labelling of PDE5 inhibitors, alprostadil, and penile prostheses; boxed contraindication with nitrates.", "Sexual Medicine Society of North America / International Society for Sexual Medicine - clinical guidance on specialised testing and third-line therapies.", "Princeton Consensus (I-III) - joint sexual-medicine and cardiology recommendations on ED as a cardiovascular-risk marker." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of erectile dysfunction this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Presents in general practice and urology as difficulty getting or keeping an erection, often first disclosed while requesting a PDE5 inhibitor.", "Used as a sentinel symptom of atherosclerotic and endothelial disease; new ED in a middle-aged man commonly triggers cardiovascular risk review rather than sexual counselling alone.", "Graded with IIEF-5/SHIM or EHS to decide watchful waiting, oral PDE5 inhibitors, vacuum devices, intraurethral or intracavernosal alprostadil, or penile prosthesis.", "Recorded after pelvic surgery, radiotherapy, diabetes, or antidepressant treatment as an expected iatrogenic outcome.", "Serves as the primary efficacy endpoint in drug and device trials (IIEF erectile-function domain, successful-penetration diaries).", "Encountered in online and unregulated markets as counterfeit sildenafil/tadalafil sold as 'herbal' sexual enhancers." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of erectile dysfunction this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "quantity": "IIEF-5 (SHIM) total score", "typical_range": "5-7 severe, 8-11 moderate, 12-16 mild-moderate, 17-21 mild, 22-25 no ED", "unit": "points" }, { "quantity": "IIEF erectile-function domain", "typical_range": "6-10 severe, 11-16 moderate, 17-21 mild-moderate, 22-25 mild, 26-30 no ED", "unit": "points" }, { "quantity": "Erection Hardness Score", "typical_range": "0 (none) to 4 (fully rigid); 3 is the usual minimum for penetrative sex", "unit": "score (0-4)" }, { "quantity": "Symptom duration before diagnosis", "typical_range": "≥3 months in EAU practice; DSM-5 requires about 6 months for Erectile Disorder", "unit": "months" }, { "quantity": "Penile duplex peak systolic velocity (after pharmacologic stimulation)", "typical_range": "<25 suggests arterial insufficiency; 25-30 borderline; >30 generally adequate inflow", "unit": "cm/s" }, { "quantity": "Penile duplex end-diastolic velocity", "typical_range": ">5 with resistive index <0.75 suggests veno-occlusive dysfunction", "unit": "cm/s" }, { "quantity": "Morning total testosterone (ED work-up)", "typical_range": "Adult male roughly 8-35 nmol/L (about 230-1000 ng/dL); many guidelines repeat and investigate below about 10.4 nmol/L (300 ng/dL)", "unit": "nmol/L or ng/dL" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of erectile dysfunction this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Combining a PDE5 inhibitor with organic nitrates or riociguat can cause profound hypotension, syncope, or coronary events.", "Intracavernosal or intraurethral alprostadil can cause priapism and, with repeated injection, cavernosal fibrosis.", "Inflatable or malleable penile implants can become infected, erode, or fail mechanically and then require explant.", "Treating ED as an isolated sexual complaint can miss occult coronary or peripheral arterial disease.", "Counterfeit or undeclared PDE5 inhibitors in 'herbal' products cause uncontrolled dosing and drug interactions.", "Chronic untreated ED is associated with anxiety, depression, relationship breakdown, and avoidance of medical care.", "Rare reported association of PDE5 inhibitors with non-arteritic anterior ischaemic optic neuropathy remains a labelled caution." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of erectile dysfunction this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Coding: ICD-10-CM N52.x in the United States versus ICD-11 HA01.1 where that revision is in force; older charts still say 'impotence'.", "Access: PDE5 inhibitors are prescription-only in the United States; several European systems allow pharmacy supply of sildenafil under protocol; some health systems historically rationed NHS/public reimbursement by cause or severity.", "The everyday word remains 'impotence' or local equivalents (impotencia, impuissance) in many languages and older statutes, while clinics use erectile dysfunction.", "Reporting is strongly shaped by stigma: under-ascertainment is common where sexual difficulty is not a legitimate medical complaint, and traditional frames (e.g. kidney-yang deficiency, semen-loss) still organise help-seeking.", "Unregulated markets for PDE5-adulterated sexual enhancers are a larger share of real-world exposure in parts of Asia, Africa, and online trade than in tightly regulated clinic pathways." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of erectile dysfunction this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "name": "Premature ejaculation", "difference": "Ejaculation latency and perceived control are impaired while erection rigidity is adequate; separate with IELT/PEDT versus IIEF erectile-function items." }, { "name": "Hypoactive sexual desire / male hypoactive sexual desire disorder", "difference": "The primary deficit is lack of desire, not inability to become rigid when desire and stimulation are present; IIEF desire domain and history of morning or masturbatory erections separate the two (they often coexist)." }, { "name": "Peyronie's disease", "difference": "Pain, palpable plaque, and curvature or hinge deformity on erection, with or without secondary ED; physical exam and stretched-penile or erect photography separate deformity from primary erectile failure." }, { "name": "Hypogonadism", "difference": "Low morning testosterone with compatible symptoms may cause or worsen ED but is a hormonal diagnosis; repeat total (and free) testosterone plus LH/FSH, not erection scores alone, establishes it." }, { "name": "Delayed ejaculation or anejaculation", "difference": "Orgasm or emission fails despite a usable erection; sexual history of rigidity versus climax, not Doppler, is the discriminator." }, { "name": "Age-related slowing of erection without dysfunction", "difference": "More stimulation or time is needed but rigidity remains sufficient for satisfactory sex; IIEF-5 ≥22 and patient/partner satisfaction mark the boundary with ED." }, { "name": "Priapism", "difference": "A prolonged unwanted erection, ischaemic or otherwise, is the opposite problem; duration >4 hours and pain/rigidity at rest separate it from ED." }, { "name": "Female sexual arousal disorder", "difference": "Different anatomy and diagnostic criteria; the shared word 'arousal' does not make the conditions interchangeable." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of erectile dysfunction this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which clinical diagnostic frameworks should this registry support, and how should their differing persistence, frequency, and distress requirements be represented without conflation?", "Which erectile-function instruments and interpretations are validated for the intended languages, sexual practices, anatomical contexts, and levels of sexual opportunity?", "What evidence is sufficient to assign confidence to individual causal contributors when physical and psychological factors coexist?", "Which jurisdiction-specific cardiovascular assessment, prescribing, interaction-checking, and urgent referral pathways should govern agent-supported actions?", "How should adequate treatment trials, meaningful improvement, and unaided remission be defined consistently across medicines, devices, counselling, and procedures?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 28 } }, "draft": { "generator": "vr.draft.v3", "status": "draft-generated", "researched": false, "archetype": "discipline or field of knowledge", "method": "Written from the archetype playbook - what this kind of thing needs beyond identity and provenance - and from the structure that recurred across 6,333 models already researched by two engines. Applied to this entry by rule. No source was read for this thing and no claim here is researched. This entry carries no facets of its own, so they were inferred from its domain - a guess about a whole domain applied to one thing.", "facetsInferred": true, "nextPass": "A researcher replaces this draft with a sourced specification. Treat every sentence below as a proposal to argue with.", "purpose": "Give an agent a durable, checkable way to recognise a erectile dysfunction, record what state it is in, and decide what may be done with it.", "whatItIs": "Enable an AI agent to recognise reported erectile dysfunction, assess its pattern and impact, and support appropriate evaluation and clinician-directed care while preserving uncertainty.", "characteristics": { "substance": "information", "origin": "conceptual", "agency": "inert" }, "whatYouCanDoWithIt": [ "read and interpreted" ], "distinguishingFeatures": [ "Names folded into this entry, which a task may need to split apart again: vasculogenic impotence, condom-associated erection problem.", "2 finer distinctions are held as aliases rather than separate entries, because telling them apart needs a task that asks for it.", "Described in 64 Wikipedia languages, which is a measure of how widely the thing is known, not of how important it is." ], "openQuestionsForResearch": [ "Which of the bundles below does a real task actually need, and which are ceremony?", "What does this thing have that the facets do not capture at all?", "Which neighbouring kind is most often confused with a erectile dysfunction, and on what evidence are they told apart?" ], "whatItIsMadeOf": "content that has to be carried by something else", "physicalCharacter": [ "Does nothing on its own; everything it does, something else did to it.", "These come from the domain this entry sits in rather than from the entry itself, so treat them as a first guess about the whole domain applied to one thing." ], "whatCanBeDoneWithIt": [ "read it and act on what it says" ], "howItIsRecognised": [], "relatedModels": [ { "relation": "covers", "note": "Finer kinds folded into this entry because telling them apart needs a task that asks for it. Each is a model waiting to be split out when one does.", "targets": [ "vasculogenic impotence", "condom-associated erection problem" ] } ], "standing": "Described in 64 Wikipedia languages, which measures how widely it is written about rather than how important or how common it is. 2 finer distinctions are held inside this entry as names rather than as separate models.", "structure": { "bundles": [ { "id": "identity-and-classification", "name": "Identity, naming and classification", "description": "How an agent tells one erectile dysfunction from another, and a erectile dysfunction from things that resemble it.", "rationale": "Recognition comes before every other claim. Without stable identity nothing else in the model can be trusted to be about the same thing twice.", "layers": [ { "id": "naming-and-identifiers", "name": "Names and identifiers", "description": "The names this thing goes by and the identifiers that survive translation and time.", "findings": [ { "id": "preferred-name-and-aliases", "name": "Preferred name, aliases and local names", "description": "Which name to use, which names mean the same thing, and which merely sound similar.", "questions": [ { "id": "preferred-name-and-aliases-q01", "text": "What identifies and describes the name of a erectile dysfunction, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "preferred-name-and-aliases-q02", "text": "Who or what asserted this about the name of a erectile dysfunction, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "preferred-name-and-aliases-q03", "text": "What may an agent decide or do once the name of a erectile dysfunction is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] }, { "id": "stable-identifiers", "name": "Stable identifiers and external keys", "description": "Identifiers that keep pointing at this kind of thing across systems and languages.", "questions": [ { "id": "stable-identifiers-q01", "text": "What identifies and describes an identifier for a erectile dysfunction, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "stable-identifiers-q02", "text": "Who or what asserted this about an identifier for a erectile dysfunction, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "stable-identifiers-q03", "text": "What may an agent decide or do once an identifier for a erectile dysfunction is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "classification-and-granularity", "name": "Classification and granularity", "description": "Where a erectile dysfunction sits among kinds, and how finely a task needs to cut it.", "findings": [ { "id": "kind-and-parents", "name": "Kind, parents and neighbouring kinds", "description": "The classes this thing belongs to and the ones it is next to.", "questions": [ { "id": "kind-and-parents-q01", "text": "What identifies and describes the kind of a erectile dysfunction, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "kind-and-parents-q02", "text": "Who or what asserted this about the kind of a erectile dysfunction, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "kind-and-parents-q03", "text": "What may an agent decide or do once the kind of a erectile dysfunction is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] }, { "id": "distinguishing-features", "name": "Distinguishing features", "description": "What separates a erectile dysfunction from the things most often confused with it.", "questions": [ { "id": "distinguishing-features-q01", "text": "What identifies and describes what distinguishes a erectile dysfunction, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "distinguishing-features-q02", "text": "Who or what asserted this about what distinguishes a erectile dysfunction, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "distinguishing-features-q03", "text": "What may an agent decide or do once what distinguishes a erectile dysfunction is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "state-and-lifecycle", "name": "State and lifecycle", "description": "The states a erectile dysfunction passes through and the events that move it between them.", "rationale": "Most decisions about a thing depend on what state it is in now, which is a claim with a time on it, not a property.", "layers": [ { "id": "lifecycle-stages", "name": "Lifecycle stages", "description": "From coming into existence to ceasing to be one of these.", "findings": [ { "id": "stages-and-transitions", "name": "Stages and transitions", "description": "The stages worth naming and what moves a erectile dysfunction between them.", "questions": [ { "id": "stages-and-transitions-q01", "text": "What identifies and describes the lifecycle of a erectile dysfunction, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "stages-and-transitions-q02", "text": "Who or what asserted this about the lifecycle of a erectile dysfunction, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "stages-and-transitions-q03", "text": "What may an agent decide or do once the lifecycle of a erectile dysfunction is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "observations-and-status", "name": "Observations and current status", "description": "What is observed about a erectile dysfunction, how often and by whom.", "findings": [ { "id": "observation-record", "name": "Observation record", "description": "How an observation of a erectile dysfunction is recorded so that it can be superseded rather than overwritten.", "questions": [ { "id": "observation-record-q01", "text": "What identifies and describes an observation of a erectile dysfunction, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "observation-record-q02", "text": "Who or what asserted this about an observation of a erectile dysfunction, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "observation-record-q03", "text": "What may an agent decide or do once an observation of a erectile dysfunction is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "content-and-access", "name": "Content, encoding and access", "description": "What a erectile dysfunction says, how it is encoded and who may read it.", "rationale": "An informational thing carries content that can be copied, versioned and withheld, none of which its physical carrier explains.", "layers": [ { "id": "content-and-encoding", "name": "Content and encoding", "description": "The content itself, its format and its language.", "findings": [ { "id": "content-and-format", "name": "Content, format and language", "description": "What a erectile dysfunction contains and in what form it is held.", "questions": [ { "id": "content-and-format-q01", "text": "What identifies and describes the content of a erectile dysfunction, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "content-and-format-q02", "text": "Who or what asserted this about the content of a erectile dysfunction, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "content-and-format-q03", "text": "What may an agent decide or do once the content of a erectile dysfunction is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "access-and-rights", "name": "Access, rights and retention", "description": "Who may read, copy or change it, and for how long it is kept.", "findings": [ { "id": "access-rules", "name": "Access rules and retention", "description": "The permissions attached to a erectile dysfunction and the period it survives.", "questions": [ { "id": "access-rules-q01", "text": "What identifies and describes access to a erectile dysfunction, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "access-rules-q02", "text": "Who or what asserted this about access to a erectile dysfunction, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "access-rules-q03", "text": "What may an agent decide or do once access to a erectile dysfunction is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "subject-and-method", "name": "Subject matter and method", "description": "What erectile dysfunction studies and how it establishes anything.", "rationale": "A field is identified by its questions and its methods, and those are what distinguish it from the fields next to it.", "layers": [ { "id": "subject", "name": "Subject matter", "description": "The questions it takes as its own.", "findings": [ { "id": "subject-record", "name": "Questions and objects of study", "description": "What it is about, stated so a neighbouring field can be told apart.", "questions": [ { "id": "subject-record-q01", "text": "What questions and objects does erectile dysfunction take as its own?", "kind": "definition" }, { "id": "subject-record-q02", "text": "Which questions does it share with a neighbouring field, and who claims them?", "kind": "boundary" } ] } ] }, { "id": "method", "name": "Method and evidence", "description": "How claims are established and what counts as evidence.", "findings": [ { "id": "method-record", "name": "Methods and standards of evidence", "description": "The methods used and what they are taken to establish.", "questions": [ { "id": "method-record-q01", "text": "By what methods does erectile dysfunction establish claims, and what counts as sufficient evidence?", "kind": "provenance" }, { "id": "method-record-q02", "text": "What kind of claim can this field not settle, and where should an agent look instead?", "kind": "action" } ] } ] } ] }, { "id": "institutions-and-classification", "name": "Institutions and classification", "description": "Where erectile dysfunction is practised and how catalogues place it.", "rationale": "The institutional footprint is the evidence that a field exists as a field rather than as a topic.", "layers": [ { "id": "institutions", "name": "Institutional markers", "description": "Societies, journals, degrees and departments.", "findings": [ { "id": "institution-record", "name": "Bodies and venues", "description": "Where the field organises itself.", "questions": [ { "id": "institution-record-q01", "text": "Which societies, journals or degrees mark erectile dysfunction as an established field?", "kind": "provenance" }, { "id": "institution-record-q02", "text": "What would show that it is emerging or dissolving rather than established?", "kind": "boundary" } ] } ] }, { "id": "classification", "name": "Classification schemes", "description": "Where library and research classifications put it.", "findings": [ { "id": "classification-record", "name": "Codes and their disagreements", "description": "The classification codes that place it, and where they differ.", "questions": [ { "id": "classification-record-q01", "text": "Which classification schemes place erectile dysfunction, under what codes?", "kind": "definition" }, { "id": "classification-record-q02", "text": "Where do those schemes disagree about its scope?", "kind": "boundary" } ] } ] } ] }, { "id": "provenance-and-evidence", "name": "Provenance, evidence and time", "description": "Where every claim about a erectile dysfunction came from and when it held.", "rationale": "A claim without a source and a time cannot be superseded, only overwritten, and an agent that overwrites loses the ability to explain itself.", "layers": [ { "id": "source-and-authority", "name": "Source and authority", "description": "Who said it, on what evidence, and how strongly.", "findings": [ { "id": "claim-provenance", "name": "Claim provenance and confidence", "description": "The authority behind each claim about a erectile dysfunction and how confident it is.", "questions": [ { "id": "claim-provenance-q01", "text": "What identifies and describes a claim about a erectile dysfunction, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "claim-provenance-q02", "text": "Who or what asserted this about a claim about a erectile dysfunction, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "claim-provenance-q03", "text": "What may an agent decide or do once a claim about a erectile dysfunction is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "time-and-versions", "name": "Time, versions and supersession", "description": "When a claim was true, when it was learnt, and what replaced it.", "findings": [ { "id": "validity-and-supersession", "name": "Validity period and supersession", "description": "How an old claim about a erectile dysfunction is retired without being erased.", "questions": [ { "id": "validity-and-supersession-q01", "text": "What identifies and describes the validity of a claim about a erectile dysfunction, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "validity-and-supersession-q02", "text": "Who or what asserted this about the validity of a claim about a erectile dysfunction, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "validity-and-supersession-q03", "text": "What may an agent decide or do once the validity of a claim about a erectile dysfunction is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] } ] }, "statistics": { "bundles": 6, "layers": 12, "findings": 14, "questions": 38 } } } }