Abstract: Objective To compare the application of the International Index of Erectile Function-5 (IIEF-5)/Erection Hardness Score (EHS) and phosphodiesterase-5 inhibitor (PDE-5i) combined with RigiScan-based audiovisual sexual stimulation (AVSS) test in evaluating erectile dysfunction (ED). Methods A total of 31 patients who were admitted to Department of Urology, the Affiliated Hospital of Xuzhou Medical University due to ED from November 2020 to November 2021 were enrolled and their clinical data was retrospectively evaluated. All patients underwent the IIEF-5/EHS and PDE-5i combined with RigiScan-based AVSS test to evaluate ED. According to the RigiScan test results and ED scale scores, the patients were divided into two groups: an ED group and a normal group. Both groups were compared for RigiScan related parameters and the scores of IIEF-5/EHS. Results The median age of the patients was 32 years, and the median duration of disease was 12 months. According to ED criteria, there were 7 ED cases (22.6%, the normal group) and 24 ED cases (77.4%, the ED group). The effective erection time (rigidity≥60%) and average tip/base rigidity in the ED group were significantly lower than those in the normal group (all P<0.05), but there was no significant difference in age, duration of disease and body mass index (BMI) (all P>0.05). The median IIEF-5 score was 9 (4,16), and EHS grades Ⅰ, Ⅱ, Ⅲ and Ⅳ hardness were 4, 8, 12 and 7 cases respectively. Spearman test showed that EHS was positively correlated with effective erection time and average tip/base rigidity (all P＜0.05); without statistical difference in IIEF-5 score (all P＞0.05). When EHS scores were evaluated to predict ED, the EHS ≤ grade III showed the highest diagnostic accuracy (sensitivity: 91.67%;specificity:71.43%). Conclusions EHS is a rapid and practical method for screening ED and positively correlated with PDE-5i combined with RigiScan-based AVSS test results. When the rigidity ≤ grade Ⅲ is used as a cutoff value, it shows the highest diagnostic accuracy.