Which formal questionnaires may be used in the evaluation of erectile dysfunction (ED)?

Updated: Oct 14, 2020
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Various formal questionnaires have been developed to gather objective data regarding ED and to assist clinicians in the evaluation of their patients, [67, 68] including the following:

  • International Index of Erectile Function (IIEF)
  • Sexual Encounter Profile (SEP)
  • Global Assessment Question (GAQ)
  • Psychological and Interpersonal Relationship Scales (PAIRS)
  • Self-Esteem and Relationship (SEAR) questionnaire
  • Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS)

The IIEF is a sensitive, specific, and standardized tool that has been validated in several languages. [46] This 15-question instrument evaluates 5 domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and global satisfaction. It is used to evaluate pharmacologic and other therapies for the treatment of ED.

A shorter version of the IIEF, termed the IIEF-5, has been developed as a sexual health inventory for men. [45] This tool is helpful in screening patients for ED, a problem that many men are hesitant to discuss. In the IIEF-5, the patient is asked the following 5 questions with respect to the preceding 6 months:

  • How do you rate your confidence that you could achieve and maintain an erection?
  • When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
  • During sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner?
  • During sexual intercourse, how difficult was it to maintain your erection to the completion of intercourse?
  • When you attempted sexual intercourse, how often was it satisfactory for you?

The answers to these 5 questions are each scored on a scale of 0-5. A score of 25 is typical for a healthy man; scores of 11 or lower indicate moderate-to-severe ED. After completion of the IIEF or the IIEF-5 and a discussion with the patient, the physician should have a good understanding of the nature and scope of the patient’s problem.

The SEP is commonly used in clinical trials involving pharmacologic therapies for ED. It is a diary maintained by men after each sexual attempt, consisting of a series of yes/no questions regarding specific aspects of each encounter, as follows [69] :

  • Were you able to insert your penis into your partner’s vagina?
  • Did your erection last long enough for you to complete intercourse with ejaculation?

The GAQ has also been used in clinical trials. The questions are as follows:

  • Has the treatment you have been taking improved your erectile function?
  • If yes, has the treatment improved your ability to engage in sexual activity?

Psychosocial questionnaires have been developed, but they are infrequently used in clinical practice. They have been employed in clinical trials for product development.

The PAIRS is a self-administered questionnaire containing 3 domains (sexual self-confidence, time concerns, and spontaneity) related to the broader psychological and interpersonal outcomes associated with ED and its treatment. Patients rate their agreement or disagreement with a specific statement on a scale of 1 (“strongly disagree”) to 4 (“strongly agree”). If more than 50% of data are missing from a domain for any patient at any given visit, then that domain is considered missing for that patient at that visit. [70]

The SEAR questionnaire [71] is a subject-reported measure of psychosocial outcomes in men with ED. It consists of 14 items assessing two domains, as follows:

  • Sexual relationship (items 1-8)
  • Confidence (items 9-14)

The confidence domain consists of two subscales, as follows:

  • Self-esteem (items 9-12)
  • Overall relationship (items 13 and 14)

The EDITS is a reliable and validated questionnaire used to assess patients’ satisfaction with their ED treatment. For each question, satisfaction is rated on a scale of 0 (“extremely low treatment satisfaction”) to 4 (“extremely high treatment satisfaction”). [67]

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