Presentation Authors: Andrew Vickers*, Amy Tin, New York, NY, Karandeep Singh, Rodney Dunn, Ann Arbor, MI, John Mulhall, New York, NY
Introduction: The six-item version of the International Index of Erectile Function (IIEF6) is the predominant method of assessing erectile function in urology. There are, however, three obvious and immediate problems with using the IIEF6 in the clinic to evaluate an individual patient: i) no account of the use of erectile aids such as intracavernosal injections; ii) a man not engaging in sexual intercourse cannot reach the accepted threshold for erectile function (24+); iii) a man reporting no sexual activity is assigned a very low score ( < 6). We analyzed a large data set taken as part of routine care as well as a systematic comparison of the IIEF and EPIC sexual domain.
Methods: Data were from close to 25,000 IIEF questionnaires completed by radical prostatectomy patients as part of routine clinical follow-up at our institution, and 1550 surveys from patients who completed both an IIEF6 and an EPIC questionnaire in a prospective study. We examined results before and after adding a question concerning use of erectile aids along with instruction that the IIEF6 was to reflect experience without use of the aid. We also added a question for men who reported no intercourse, asking for the reason why. EPIC sexual function scores were analyzed for men who reported no sexual activity on the IIEF6.
Results: Of 16,753 surveys including data on erectile aide usage, 15% reported use, predominately injections (89%). A simple modeling analysis demonstrated that before introduction of the erectile aid question, some men using erectile aids would report IIEF6 scores with use of the aid, whereas other would not. Of men reporting not attempting sexual intercourse, 46% (95% C.I. 43%, 49%) gave a reason other than erectile dysfunction including lack of a partner, sexual orientation, sexual preference and health problems of the female partner. In men who did have sexual intercourse, doubling the first 3 questions on the IIEF6 gave almost perfect scores compared to the full IIEF6 (mean difference -0.1, limits of agreement was -3.3, 3.1). In 251 men reporting no sexual activity, 13% reported erections sufficient for sexual activity and 5.6% reported scores of at least 65 on the EPIC sexual function domain.
Conclusions: Patient-reported outcome instruments for erectile function should include a question about erectile aids with patients asked to report experience without the use of aids. Lack of sexual activity and, more specifically, lack of sexual intercourse, cannot be taken as being indicative of erectile dysfunction.
Source of Funding: This work was supported in part by the National Institutes of Health/National Cancer Institute (NIH/NCI) with a Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center [P30 CA008748]. This work was also supported by Blue Cross and Blue Shiel