Validation of the International Index of Erectile Function (IIEF) and presentation of norms in older men

The Role of Emotion Regulation Strategies for Sexual Function and Mental Health: A Cluster Analytical Approach

We investigated distinct profiles in emotion regulation strategies (reappraisal and suppression) and their associations with sexual function and mental health. The online survey sample consisted of 5436 adult participants. The gender stratified cluster analysis resulted in a four-cluster solution for both men and women. Better sexual function and mental health scores were found for participants with high cognitive reappraisal and low expressive suppression. High expressive suppression was associated with higher anxiety and depression and worse sexual function. Sexological care should take into account the assessment of emotion regulation abilities and emotion regulation training interventions to support reappraisal strategies.

Colombian Clinical Validation of the International Index of Erectile Function (IIEF-5)

Background

Erectile dysfunction represents an important health problem and the instrument most frequently used for the evaluation of its evaluation is the International Index of Erectile Function (IIEF-5).

Aim

Due to lack of adaptation and validation for Spanish-speaking populations, this study aimed to adapt and validate the Colombian version of International Index of Erectile Function (IIEF-5).

Methods

Two independent samples were evaluated. One used to validate the scale and the other to calculate cut-off point of this version, with 2,021 men from the general population and outpatients from a clinic. The age range was 18 to 75 years old (M = 37.80; SD = 14.06). The second sample included 74 men, 64.9% did not meet DSM-5 criteria for erectile dysfunction, and 35.1% meet DSM-5 criteria to ED. Age range was 19 to 73 years old (M = 40.38; SD = 13.22).

Outcomes

All participants answered the Spanish versions of the International Index of Erectile Function-5 (IIEF-5) and the Massachusetts General Health-Sexual Functioning Questionnaire.

Results

The Colombian version of IIEF-5 showed adequate psychometric properties, confirmed the one-dimension factorization of the scale, and showed adequate evidence of reliability and validity. Significant differences were observed in the IIEF-5 total score between the non-clinical and clinical groups who meet DSM-5 criteria for erectile dysfunction, with a large effect size. Also, the cut-off the Colombian version was set to 16, with an area under the curve of 94.9%.

Clinical Implications

The Colombian version of the IIEF-5 is a useful evaluation instrument that provides to determine the presence of erectile dysfunction compatible with DSM-5 criteria.

Strengths & Limitations

The inventory reports adequate psychometric properties, a confirmed one-dimensional structure, evidence of reliability and validity, and the first cut-off point for Hispanic populations. A more in-depth evaluation of the diagnosis of ED and thus replication in other Spanish-speaking countries and sexual minorities is recommended.

Conclusion

The Spanish version of the IIEF-5 is a useful evaluation tool for identifying erectile dysfunction, following DSM-5 criteria.

Vallejo-Medina P, Saffon JP, Álvarez-Muelas A Colombian Clinical Validation of the International Index of Erectile Function (IIEF-5). Sex Med 2022;10:100461.

Accurately Assessing Gay Men's Erectile Functioning: A Critique of the International Index of Erectile Function (IIEF) Use with Gay Men

The International Index of Erectile Functioning (IIEF) has been widely used to measure gay men's erectile functioning. However, the IIEF was initially developed using a sample of men whose sexual orientation was unspecified. Using scales not validated for specific populations can result in inaccurate assessments. The purpose of the current study was to evaluate the dimensionality, reliability, and validity of the IIEF with a large sample of gay men. One thousand and eighteen men self-identifying as "exclusively gay" completed an online survey consisting of demographics, the IIEF, the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale 4 (PSS4), and the Gay Male Sexual Difficulties (GMSD) erectile difficulties sub-scale. The replicability of the IIEF factor structure with a gay male sample was determined using exploratory and confirmatory factor analyses. Additionally, the HADS, PSS4, and GMSD were used to determine the validity of the IIEF. The current study was unable to replicate the IIEF factor structure. Four items required deletion and the factor solution differed from the original. Thus, reinterpretation of the latent variables was deemed necessary. Although the resultant 12-item IIEF evidenced model fit, validity, and reliability, it is not recommended for use with gay men. The revised IIEF is unable to accurately measure gay men's erectile functioning as the content of the items fail to capture their sexual behaviors (i.e., insertive and receptive anal sex).

Male erectile function after treatment for colorectal cancer: a population-based cross-sectional study

AIM

The aim of this work was to determine the knowledge gap in the field of erectile function (EF) after colorectal cancer surgery and investigate and compare long-term male EF in colon and rectal cancer survivors in a national population.

METHOD

Danish male patients alive without evidence of recurrence who were treated for colon or rectal cancer between May 2001 and December 2014 were invited to participate. Using the International Index of Erectile Function (IIEF) score the derived dichotomized erectile dysfunction (ED) was defined as moderate/severe or no/mild. Patients were grouped based on type of surgery [colon resection, rectal resection (RR) or local resection] and stratified for stoma, preoperative radiotherapy (RT), age and American Society of Anesthesiologists (ASA) score.

RESULTS

Of 10 037 eligible patients, 4334 responded (43.18%). The EF score was significantly lower for RR (mean 12.14) compared with both colon resection (mean 15.82) and local resection (mean 14.81) (p < 0.0001). No significant difference between colon resection and local resection was found (p = 0.29). Both a stoma and the use of RT were independent risk factors for ED. After excluding patients with stoma and RT and adjusting for age and ASA score, RR still had a higher risk of ED (OR 1.42, CI 1.20-1.67) compared with colon resection.

CONCLUSION

RR has a negative affect on EF. No difference between patients who underwent colon resection and local resection was found. RT and stoma were independent risk factors for ED.

Prostatic Artery Embolization Allows to Maintain Full Sexual Activity in Patients Suffering from Bothersome Lower Urinary Tracts Symptoms related to Benign Prostatic Hyperplasia

INTRODUCTION

The effect of prostate artery embolization (PAE) on male sexual function is currently the subject of debate in the literature. The main purpose of this study was to define changes in all domains of sexual activity after PAE, using the international index of erectile function score (IIEF-15).

METHODS

A single-center retrospective study was conducted on 129 patients (mean age of 65.5 ± 7 years), who underwent PAE from February 2014 to January 2017 for symptomatic benign prostatic hyperplasia (BPH). Fifty consecutive patients fulfilling the inclusion criteria were evaluated before and after PAE follow-up using the IIEF-15, IPSS, prostate volume (PV) and cardiovascular risk factor and BPH drugs. The IIEF-15 domains analyzed were: erectile function (EF) ejaculation and orgasm (Ej/O), sexual desire (SD), intercourse satisfaction (IS) and overall satisfaction (OS). A paired sample t test or Wilcoxon signed-rank test was used to compare IIEF-15 between baseline and follow-up.

RESULTS

The study showed nonsignificant change in IIEF-15 total score (58.0 ± 13.8 SD; p = 0.71) and the five domains (EF 24.5 ± 7.0 SD, p = 0.82; EJ/O 8.2 ± 2.3 SD, p = 0.50; SD 7.2 ± 2.7 SD, p = 0.57; IS 10.3 ± 3.0 SD, p = 0.77; OS 8.2 ± 2.7 SD; p = 0.11) after PAE. We also found a significant improvement in IPSS score after PAE.

CONCLUSION

Based on the IIEF-15 questionnaire, PAE was showed to allow good urinary symptoms results and no deterioration in sexual function.

A prospective study of erectile dysfunction in men after pelvic surgical procedures and its association with non-modifiable risk factors

Objective

A pelvic surgery can cause erectile dysfunction. The purpose of this study was to evaluate erectile function at various times after pelvic surgery in male patients; to search the non-modifiable risk factors associated with the presence and intensity of sexuality in these patients. This prospective study used the erectile dysfunction IIEF scale.

Results

The study population comprised of 106 male patients who had undergone minor pelvic surgery at least 9 months before and during the 2010–2016 period in the 4th Surgical Clinic. A control group of healthy males (N = 106) who underwent no pelvic surgery matched for age was also used for reference values. The main age of the participants was 66.16 ± 13.07 years old. A history of colectomy was present in 36.8%, 18.9% had undergone sigmoidectomy, and 33% inguinal hernia repair. The percentage of severe erectile function increased from 38.7% before surgery to 48.1% (25% increase) after surgery, at the end of the follow-up period (p < 0.05). In the multivariate analysis model, age emerged as an independent predictor of erectile function (p < 0.001). Age was the most important determinant of the IIEF score, which was aggravated by 25% from the first to the last assessment of patients.

Anxiety, Dispositional Mindfulness, and Sexual Desire in Men Consulting in Clinical Sexology: A Mediational Model

This study aimed to examine dispositional mindfulness as a mediator of the relationship between anxiety and sexual desire in men consulting in clinical sexology. A sample of 105 adult men seeking sex therapy completed measures of dispositional mindfulness, anxiety, and sexual desire. Close to a third (28.7%) of participants reported lack or absence of sexual desire as their main reason to consult in sex therapy. Path analysis confirmed a mediation model and revealed that the association between anxiety and lower sexual desire was fully mediated by dispositional mindfulness. These findings suggest that mindfulness-based interventions may be a relevant component to integrate in the treatment of men who present anxiety symptoms and low sexual desire.

Health-related quality of life, psychological well-being, and sexual function in patients with benign prostatic hyperplasia after prostatic surgery

AIMS AND BACKGROUND

Patients with benign prostatic hyperplasia (BPH) may receive prostatic surgery due to severe lower urinary tract symptoms (LUTS). This study aimed to investigate the health-related quality of life (HRQoL), psychological well-being, and sexual function of patients with BPH after prostatic surgery and identify the predictors of HRQoL among this group of patients.

METHODS

This was a cross-sectional, descriptive, correlational study. A convenience sample of 94 participants was recruited from a urology center in a tertiary public hospital in Singapore. The 12-item Short Form Health Survey version 2 (SF-12v2), International Prostate Symptom Score (IPSS), Hospital Anxiety and Depression Scale (HADS), and 5-item International Index of Erectile Function (IIEF-5) were used to measure the study variables.

RESULTS

Compared to the general population norms and the findings of similar studies conducted in western countries, this group of patients reported poorer physical health but better mental health as assessed by SF-12v2. Despite the prostatic surgery, over a quarter of the patients experienced moderate LUTS, and 13.8% experienced severe erectile dysfunction. Multiple linear regression analysis identified that LUTS (B=-0.51, p=0.02) and maximum flow rate (B=-0.23, p=0.02) predicted poor physical health, accounting for 45.9% of variance, while HADS-Anxiety (B=-1.07, p<0.01) and LUTS (B=-0.32, p=0.03) predicted poor mental health, accounting for 57.2% of variance.

CONCLUSION

The physical health of BPH patients with prostatic surgery was poor, with many suffering moderate LUTS and sexual dysfunction. Special attention should be given to those patients with severe LUTS who have a low maximum flow rate or have anxiety symptoms.

Association between body size and composition and erectile dysfunction in older men: Osteoporotic Fractures in Men Study

OBJECTIVES

To examine the association between body size and composition and erectile dysfunction (ED) in older men.

DESIGN

Cross-sectional analysis of the Osteoporotic Fractures in Men study.

SETTING

Six U.S. clinical sites.

PARTICIPANTS

Community-dwelling men aged 65 and older.

MEASUREMENTS

Body composition measures using anthropometry (body weight, body mass index (BMI)) and dual X-ray absorptiometry (total body fat percentage, trunk fat percentage, ratio of trunk and total body fat). ED was assessed using the single-item Massachusetts Male Aging Study (MMAS) scale and the five-item International Index of Erectile Function questionnaire (IIEF-5).

RESULTS

In men completing the MMAS scale (n = 4,108), prevalence of complete ED was 42%. In sexually active men completing the IIEF-5 questionnaire (n = 1,659), prevalence of moderate to severe ED was 56%. In multivariate-adjusted analyses reporting prevalence ratios (PRs) and 95% confidence intervals (CIs), the prevalence of MMAS-defined complete ED was significantly greater in men in the highest quartile of body weight (PR = 1.24, 95% CI = 1.16-1.34), total body fat percentage (PR = 1.25, 95% CI = 1.13-1.40), and trunk fat percentage (PR = 1.24, 95% CI = 1.15-1.38), and was greater in men with a BMI greater than 30.0 kg/m(2) than in those with BMI of 22.0 to 24.9 kg/m(2) (PR = 1.17, 95% CI = 1.05-1.31). Associations appeared similar for IIEF-5-defined moderate to severe ED in analyses adjusted for age and study site.

CONCLUSION

In a cohort of older men, high body weight, BMI, and total body fat percentage were independently associated with greater prevalence of moderate to severe and complete ED. Future studies should investigate whether interventions to promote weight loss and fat loss will improve erectile function in older men.