International Index of Erectile Function—Adapted Tool for Men Who Have Sex with Men

Introduction Quantitative research into sexual function and dysfunction in men who have sex with men (MSM) has been sparse due in large part to a lack of validated, quantitative instruments for the assessment of sexuality in this population. Aim To assess prevalence and associations of erectile problems and premature ejaculation in MSM. Methods MSM were invited to complete an online survey of sexual function. Ethnodemographic, sexuality, and health related factors were assessed. Main Outcome Measure Participants completed a version of the International Index of Erectile Function modified for use in MSM (IIEF-MSM) and the Premature Ejaculation Diagnostic Tool. Total score on the erectile function domain of the IIEF-EF (IIEF-MSM-EF) was used to stratify erectile dysfunction (ED) severity (25–30=no ED, 16–24 mild or mild moderate ED, 11–15 moderate ED, and ≤ 10 severe ED). PEDT scores were used to stratify risk of premature ejaculation (PE, diagnosed as PEDT score ≥9). Results Nearly 80% of the study cohort of 2,640 men resided in North America. The prevalence of ED was higher in older men whereas the prevalence of PE was relatively constant across age groups. Multivariate logistic regression revealed that increasing age, HIV seropositivity, prior use of erectogenic therapy, lower urinary tract symptoms (LUTS), and lack of a stable sexual partner were associated with greater odds of ED. A separate multivariate analysis revealed that younger age, LUTS, and lower number of lifetime sexual partners were associated with greater odds of PE. Conclusions Risk factors for sexual problems in MSM are similar to what has been observed in quantitative studies of non-MSM males. Urinary symptoms are associated with poorer sexual function in MSM.

Section: Description Of Variablesmentioning

confidence: 84%

Section: Description Of Variablesmentioning

confidence: 99%

Erectile Dysfunction and Premature Ejaculation in Men Who Have Sex with Men

Shindel

Vittinghoff

Breyer

2012

“…This follow-up revealed that these men did not exclusively practice sex without active penetration as a choice but experienced problems getting and maintaining an erection hard enough for penetration. Validation of an IIEF-5 questionnaire adapted to MSM, including an assessment of whether the absence of active penetration is voluntary, would be beneficial for future epidemiological studies [28,29].…”

Section: Discussionmentioning

confidence: 99%

Erectile Dysfunction, Testosterone Deficiency, and Risk of Coronary Heart Disease in a Cohort of Men Living with HIV in Belgium

Ryck

Laeken

Apers

et al. 2013

Self Cite

Introduction Erectile dysfunction (ED) is more prevalent in men living with HIV (MLHIV) when compared with age-matched HIV-negative men. This may be related to a premature decline in testosterone levels. In the general population, ED has been associated with an increased risk for coronary heart disease (CHD). Aim The aim of this study is to determine the prevalence of ED, testosterone deficiency, and risk of CHD in a cohort of young to middle-aged MLHIV in Belgium. Methods A cross-sectional, observational study among 244 MLHIV attending the outpatient clinic of the Institute of Tropical Medicine in Antwerp. Main Outcome Measures The short version of the international index of erectile function (IIEF-5) questionnaire diagnosed ED (cutoff score ≤21). The 10-year risk score for CHD was calculated. In a subset of men reporting ED, the calculated free testosterone (CFT) was determined using Vermeulen's formula. Testosterone deficiency was defined as CFT <0.22nmol/L. Results One hundred fifty-one men (61.9%) self-reported ED (median IIEF-5 score: 16 [interquartile range (IQR) 12–19]). In multivariate analysis, only increasing age, but none of the HIV-related parameters, nor any of the individual cardiovascular-risk related parameters, was statistically significantly associated with ED. Eighteen out of the 49 (36.7%) men with ED who received a blood test to assess testosterone levels were diagnosed with testosterone deficiency. The 10-year risk of CHD in the cohort was 4.3% (IQR 3.6–5.7) and was significantly higher in men with ED (5.1%, IQR 4.4–6.6) compared with men without ED (3.1%, IQR 2.5–4.2). Conclusions This study showed that ED and testosterone deficiency are highly prevalent in young to middle-aged MLHIV and that ED might be associated with an increased risk of CHD. Therefore, healthcare professionals should screen for clinical ED and should consider testing for underlying testosterone deficiency. A clinical diagnosis of ED should trigger a full evaluation of the patient's cardiovascular risk factors, even at younger age.

“…The IIEF, PEDT, and FSFI were designed and initially validated for subjects participating in heterosexual coitus; therefore, IIEF, PEDT, and FSFI scores from subjects who did not report prior intercourse were excluded from subsequent analysis. The FSFI has been validated for use in lesbian subjects and recently the IIEF was validated for use in HIV-positive men who have sex with men [7,20]. The modified IIEF was not available at the time of study inception; furthermore, our objective was to obtain data using single instruments in a diverse population; hence, we did not create separate questionnaires for homosexual and heterosexual subjects.…”

Section: Sexual Quality Of Life Instrumentsmentioning

confidence: 99%

“…Although the exclusion of homosexuals from these studies is grounded in the need for a homogenous study population for optimization of scientific rigor rather than prejudice, the end result is that homosexual people are often excluded from important clinical trials [4,5]. Furthermore, the majority of instruments for the assessment of sexual problems have not been validated in homosexual patients and feature language oriented towards heterosexual people [6,7].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Sexual Orientation on Sexuality and Sexual Practices in North American Medical Students

Breyer

Smith

Eisenberg

et al. 2010

Introduction There has been limited investigation of the sexuality and sexual dysfunction in non-heterosexual subjects by the sexual medicine community. Additional research in these populations is needed. Aims To investigate and compare sexuality and sexual function in students of varying sexual orientations. Methods An internet-based survey on sexuality was administered to medical students in North American between the months of February and July of 2008. Main Outcome Measures All subjects provided information on their ethnodemographic characteristics, sexual orientation, and sexual history. Subjects also completed a series of widely-utilized instruments for the assessment of human sexuality (International Index of Erectile Function [IIEF], Female Sexual Function Index [FSFI], Premature Ejaculation Diagnostic Tool [PEDT], Index of Sex Life [ISL]). Results There were 2,276 completed responses to the question on sexual orientation. 13.2% of male respondents and 4.7% of female respondents reported a homosexual orientation; 2.5% of male and 5.7% of female respondents reported a bisexual orientation. Many heterosexual males and females reported same-sex sexual experiences (4% and 10%, respectively). Opposite-sex experiences were very common in the male and female homosexual population (37% and 44%, respectively). The prevalence of premature ejaculation (PEDT > 8) was similar among heterosexual and homosexual men (16% and 17%, P = 0.7, respectively). Erectile dysfunction (IIEF-EF < 26) was more common in homosexual men relative to heterosexual men (24% vs. 12%, P = 0.02). High risk for female sexual dysfunction (FSFI < 26.55) was more common in heterosexual and bisexual women compared with lesbians (51%, 45%, and 29%, respectively, P = 0.005). Conclusion In this survey of highly educated young professionals, numerous similarities and some important differences in sexuality and sexual function were noted based on sexual orientation. It is unclear whether the dissimilarities represent differing relative prevalence of sexual problems or discrepancies in patterns of sex behavior and interpretation of the survey questions.