Structured interview on erectile dysfunction (SIEDY©): a new, multidimensional instrument for quantification of pathogenetic issues on erectile dysfunction

Abstract

The aim of the present study is the definition of a brief structured interview (SI) providing scores useful for identification and quantification of pathogenetic factors of erectile dysfunction (ED). A SI was developed and applied to a consecutive series of 320 ED patients. A 13-item SI, with threefactor analysis-derived scales, was identified and applied for validation to an independent consecutive series of 194 ED patients. PGE 1 (10 lg) intracavernosal injection, penile duplex ultrasound (PDU), blood hormones, PSA, glycemia, and lipids were used for the assessment of an organic component (OC), and Middlesex Hospital Questionnaire (MHQ) modified for psychological disturbances. Scale 1, dealing with OC, showed a positive correlation with age, BMI, blood pressure, glycemia, and inverse correlation, with testosterone, PGE 1 and several parameters derived from PDU. Scale 2, related to partner's relationship, was not correlated with organic parameters. Scale 3, which measures psychopathological traits was correlated with MHQ scales. Scale 1 (43) had a sensitivity of 67.9% and a specificity of 67.6% for OC. SIEDY r provides information on ED pathogenesis and might assist physicians in diagnostic and therapeutic choices. International Journal of Impotence Research (2003Research ( ) 15, 210-220. doi:10.1038 Keywords: erectile dysfunction; anamnesis; penile duplex ultrasound; structured interview IntroductionErectile dysfunction (ED) is a relatively common multidimensional disorder that might significantly impair the quality of life. Several biological, psychological and lifestyle factors are often simultaneously present in each patient and they mutually concur in determining the disorder. 1 The correct assessment of the pathogenesis of ED is therefore rather difficult. Complex diagnostic procedures, such as intracavernosal injection of PGE 1 with or without penile duplex ultrasound (PDU) evaluation of penile vessels, cavernosometry and cavernosography, and nocturnal penile tumescence, can be very useful in the definition of pathogenetic factors underlying ED. 2 However, these procedures are rather expensive and they are not easily available in all practices. Conversely, anamnesis and physical examination can provide information accurate enough for a correct pathogenetic definition in most cases. 3 The accuracy of anamnestic information depends upon the specific experience and interviewing skills of the individual physician. In current clinical practice, structured interviews (SIs) can represent a standardized and therefore more reliable instrument, when compared to routine anamnesis.Specific self-reported questionnaires have been developed for the assessment of severity of ED. Selfreported measures of severity of ED 4,5 are widely recognized as valid instruments and are routinely used for the evaluation of the efficacy of treatments. However, attempts to use self-reported questionnaires as a means of differentiating psychogenic from organic impotence have produced mixed results. In 1975, Beutler et al 6,7 reported th...

Difficulties in achieving vs maintaining erection: organic, psychogenic and relational determinants

“…We found that patients with difficulties in achieving a valid erection (sample B) showed a higher prevalence of organic conditions related to ED, when compared with those complaining difficulties in maintaining erection (sample A), as confirmed by higher scores on the SIEDY r scale 1 which explores the organic component of ED. 5 The greater involvement of organic factors in patients with difficulties in obtaining rather than maintaining erection was further confirmed by results of FIC, NPT, and PDU tests. Our findings support the previously unproved hypothesis, that patients experiencing difficulties in maintaining erection could recognize a more psychogenic, rather than organic, pathogenesis.…”

“…7 Patients were asked to specify any current pharmacological treatment; drugs listed in Boderick and Foremann, 8 were considered capable of interfering with sexual function. Considering NIH definition of impotence 1 and using SIEDY r appendix A, 5 we identified two groups of patients: sample A, (difficulties in maintaining, rather than achieving, an erection) and sample B (with main problems in achieving an erection) ( Table 1). Sample A is composed of patients who reported erection not valid enough for penetration in less than 25% of cases and difficulties in maintaining erection in over 25% of the occasions.…”

“…5 This brief, multidimensional instrument designed for the pathogenetic assessment of ED, provides scores for organic, marital, and psychopathological factors affecting sexual function, which can be simultaneously present in the same patient. Hypoactive sexual desire (HSD) was assessed with item #14 and the reported reduction of nocturnal/ morning erections with item # 13 of SIEDY r Structured Interview.…”

“…Hypoactive sexual desire (HSD) was assessed with item #14 and the reported reduction of nocturnal/ morning erections with item # 13 of SIEDY r Structured Interview. 5 Rapid ejaculation (RE) was defined as ejaculation within 1 min of vaginal intromission as previously described using a stop-watch method. 7 Patients were asked to specify any current pharmacological treatment; drugs listed in Boderick and Foremann, 8 were considered capable of interfering with sexual function.…”

“…We employed SIEDY r , a previously validated pathogenic instrument, 5 along with several recognized psychometric (MHQ; 6) and instrumental tests, able to detect the different impact of 'organic', 'relational' and 'intrapsychic' factors on ED symptoms, such as difficulties to obtain and maintain erection.…”