Relationship between patient self-assessment of erectile function and the erectile function domain of the international index of erectile function

doi:10.1016/S0090-4295(00)00697-X

Urology

Volume 56, Issue 3, September 2000, Pages 477-481

https://doi.org/10.1016/S0090-4295(00)00697-X Get rights and content

Abstract

Objectives. To assess the validity of severity classes on the erectile function (EF) domain of the International Index of Erectile Function by determining their relationship with the self-assessment of EF, before and after treatment, in an independent cohort of patients.

Methods. Two hundred forty-seven men with clinically diagnosed erectile dysfunction (ED) and in a stable heterosexual relationship were enrolled in a randomized, double-blind, multicenter, placebo-controlled, parallel-group, 12-week, flexible-dose study. Patients assessed their degree of ED as severe, moderate, minimal/mild, or no problem at baseline and after treatment. They also responded to the six questions of the EF domain, with the total score indicating the following degrees of ED: severe, EF score 1 to 10; moderate, EF score 11 to 16; mild to moderate, EF score 17 to 21; mild, EF score 22 to 25; and no ED, EF score 26 to 30. Descriptive profiles of the two diagnostic instruments were compared. The correlations between the instruments were evaluated with Kendall’s tau-b at baseline, after treatment at 12 weeks, and at change from baseline.

Results. The two measures gave generally similar descriptive profiles of ED severity. The correlations were 0.65 (95% confidence interval 0.57 to 0.73) at baseline, 0.86 (95% confidence interval 0.83 to 0.89) after 12 weeks of treatment, and 0.73 (95% confidence interval 0.67 to 0.79) at change from baseline.

Conclusions. The moderate-to-high correlation between the patients’ self-assessment of EF and the EF domain of the International Index of Erectile Function provides a validation of this domain for the reliable diagnostic classification of ED severity.

Section snippets

Study population

The study population consisted of 247 male outpatients with ED of broad-spectrum etiology. Subjects participated in a double-blind, placebo-controlled, multicenter, flexible-dose (25 to 100 mg) Phase IIIb clinical trial in which they were randomized equally to either sildenafil citrate (Viagra) or a corresponding placebo treatment. The primary findings on efficacy, safety, and patient and partner satisfaction have been presented elsewhere.14, 15, 16 Doses were taken as required (but not more

Results

Table II provides a summary of the baseline characteristics of the patients in the study. No differences existed between treatment groups for any of these characteristics.

Figure 1 (baseline) and Figure 2 (end of treatment) depict, for the self-assessed level of severity, the percentage of patients in a severity grade of the EF domain. The two measures showed greater correspondence in classifying no ED (at end of treatment) and severe ED than in classifying mild or moderate ED.

Table III

Comment

Associations between the measures were noticeably lower at baseline than after treatment and the change from baseline. The restricted range of severity grades at baseline reduced the potential variability of responses and hence the correlation between the measures, and the wider distribution of severity grades after treatment increased the variability of responses and hence the correlation between the two measures.18 For example, the EF domain indicated severe ED in 63.6% of the patients at

Conclusions

The moderate-to-high correlations of the EF domain with patients’ self-assessment of ED severity lends support to the use of the EF domain in clinical and research settings as a diagnostic aid for assigning degrees of ED severity. The severity classifications, which address a vital research need, are intended to enhance the decision making of medical researchers, clinicians, and health-care providers who are likely to perform more detailed clinical evaluations in individual cases. The results

Acknowledgements

To Joyce Healey, Sue Huang, and Steve Smith for helpful support.

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A cross-sectional survey study of 1,004 Czech men aged between 15 and 85 years (M = 42.8 years; Standard deviation = 17.6 years) have been conducted. The participants anonymously answered a questionnaire on multiple aspects of their life and sexuality. This questionnaire included sought data on history of CSA and self-reported intravaginal ejaculation latency time and the 5-item International Index of Erectile Function.
25 men (2.5%) indicated a history of CSA. 71% of the perpetrators where known by the victims, with a minority declaring the crime to authorities (37.5%). Half of those reporting assault also reported sexual function issues in the present or at some time in their life. Significant correlations were recorded between a history of CSA and erectile dysfunction but not significantly with premature ejaculation.
Men who reported a history of CSA are more likely to report sexual function issues than those who do not. The identified association between CSA and sexual function issues in adult life contributes to the small body of literature on the topic. When taking a sexual history, it is recommended to practitioner to include questions about CSA, considering its correlation with erectile dysfunction. An understanding of the relationship between CSA and adult sexual function helps practitioner to improve his patient's well--being and life satisfaction.
Kamnerdsiri WA, Fox C, Weiss P, et al. Impact of Childhood Sexual Assault on Sexual Function in the Czech Male Population. J Sex Med 2020;8:446–453.
May Dyspnea Sensation Influence the Sexual Function in Men With Obstructive Sleep Apnea Syndrome? A Prospective Control Study
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Citation Excerpt :
The researched questionnaire contained questions on general health, socioeconomic issues, sexual history, and OSA symptoms. Sexual functions were evaluated by International Index of Erectile Function (IIEF-15) in 5 domains: erectile function (EF), orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction.24,25 Men scoring <26 points in EF domain were recognized as being at risk of ED.24,25
Dyspnea sensation is frequently present in obstructive sleep apnea syndrome (OSA) patients; however, its possible influence on sexual function and body image has not been well analyzed.
To evaluate sexual function, the prevalence of sexual dysfunction (SD), and body image during sexual activity and its relationship with dyspnea in men with OSA.
129 men were included in the prospective study, with 61 diagnosed with OSA (cases) and 68 age- and BMI-matched healthy control subjects. Patients were assessed for the severity of heart failure by the New York Heart Association scale and dyspnea by the Visual Analogue Scale. OSA was confirmed by in-laboratory polysomnography.
International Index of Erectile Function (IIEF) was used as a measure of sexual function, body image during sexual activity was assessed by the Body Exposure During Sexual Activity Questionnaire, whereas SD was diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.
The mean age of the studied population was 57.9 ± 10.8 years. Presence of dyspnea interfered with sexual life in 20% of men diagnosed with OSA and with work performance in 33%. Men with OSA had worse scores in IIEF-15 compared with control subjects and higher frequency of sexual distress compared with men with OSA. There were no differences in the rate of SD according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. The presence of OSA worsened the perceived body image during sexual activity. The presence of dyspnea was the only negative factor affecting sexual function in general (IIEF-15 score) and 1 of the factors affecting erectile function and orgasmic function.
In men with OSA, body image is negatively influenced by the presence of OSA. Furthermore, the presence of dyspnea assessed by the New York Heart Association scale impairs sexual function in that group of men.
Skoczyński S, Nowosielski K, Minarowski Ł, et al. May Dyspnea Sensation Influence the Sexual Function in Men With Obstructive Sleep Apnea Syndrome? A Prospective Control Study. Sex Med 2019;7:303–310.
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2019, Journal of Sexual Medicine
The International Index of Erectile Function (IIEF) is a patient-reported outcome measure to evaluate erectile dysfunction and other sexual problems in men.
To perform a systematic review of the measurement properties of the 15-item patient-reported outcome measure (IIEF-15) and the shortened 5-item version (IIEF-5).
A systematic search of scientific literature up to April 2018 was performed. Data were extracted and analyzed according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines for structural validity, internal consistency, reliability, measurement error, hypothesis testing for construct validity, and responsiveness. Evidence of measurement properties was categorized into sufficient, insufficient, inconsistent, or indeterminate, and quality of evidence as very high, high, moderate, or low.
40 studies were included. The evidence for criterion validity (of the Erectile Function subscale), and responsiveness of the IIEF-15 was sufficient (high quality), but inconsistent (moderate quality) for structural validity, internal consistency, construct validity, and test-retest reliability. Evidence for structural validity, test-retest reliability, construct validity, and criterion validity of the IIEF-5 was sufficient (moderate quality) but indeterminate for internal consistency, measurement error, and responsiveness.
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Neijenhuijs KI, Holtmaat K, Aaronson NK, et al. The International Index of Erectile Function (IIEF)—A Systematic Review of Measurement Properties. J Sex Med 2019;16:1078–1091.
The Efficacy of Tadalafil Daily vs on Demand in the Treatment of Erectile Dysfunction: A Systematic Review and Meta-analysis
2018, Urology
We present a review comparing the use of tadalafil daily vs on-demand for erectile dysfunction. We examined randomized controlled trials and observational studies that examined the use of tadalafil for at least 8 weeks of follow-up with the primary outcome of International Index for Erectile Dysfunction-Erectile Function domain. Eight studies that examined the desired dosing regimens were identified. Of these, 6 studies included the primary end point of 12 weeks. Those patients taking tadalafil daily for 12 weeks scored on average 1.82 points higher in International Index for Erectile Dysfunction-Erectile Function domain scores, although the difference may not be clinically significant (Fig. 1).
Erectile Dysfunction Following Pelvic Fracture Urethral Injury
2018, Sexual Medicine Reviews
Although pelvic fracture urethral injuries (PFUIs) are rare, approximately half these patients will report erectile dysfunction (ED) after their injuries. The anatomic relations of the cavernosal nerves and arteries to the bones of the pelvis and the urethra put these structures at significant risk at the time of PFUI. This review examines the epidemiology, evaluation, and management of ED in this patient population.
To evaluate the epidemiology, pathophysiology, diagnosis, and management of patients with ED after PFUI.
A literature review was performed to identify articles on PubMed published before May 2017 addressing PFUI and ED.
Incidence, mechanisms, risk factors, evaluation, and management strategies of ED after PFUI were analyzed.
Patients with pelvic fractures are at risk of post-injury ED, whereas those with PFUI appear to be at even higher risk. Different potential mechanisms contributing to the pathophysiology of ED in this setting have been described in the literature, including damage to the nervous supply to the penis, arterial insufficiency, and veno-occlusive dysfunction. However, there is a lack of consensus on the predominant etiology. Appropriate diagnostic evaluation can help to elucidate the underlying pathophysiology on an individual basis and can help guide management. Oral therapies, intracavernosal injections, and inflatable penile prostheses have shown great success. Furthermore, unlike patients with ED from other causes, select patients with isolated arteriogenic ED are potentially eligible for penile revascularization procedures.
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¹: Drs. Cappelleri, Siegel, and Osterloh are employees of Pfizer Inc., and Dr. Rosen is a consultant to Pfizer Inc

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Adult urologyRelationship between patient self-assessment of erectile function and the erectile function domain of the international index of erectile function

Abstract

Section snippets

Study population

Results

Comment

Conclusions

Acknowledgements

J Urol

Urology

Urology

J Urol

J Clin Epidemiol

Impotence

JAMA

New insights into erectile dysfunctiona practical approach

Am J Med

Evidence based assessment of erectile dysfunction

Int J Impotence Res

Sexual function assessment in the malephysiological and self-report measures

Int J Impotence Res

Adult urology
Relationship between patient self-assessment of erectile function and the erectile function domain of the international index of erectile function