In Patients Using Treatment for Erectile Dysfunction, Does the International Index of Erectile Function (IIEF) Accurately Measure Sexual Drive, Ejaculation, and Orgasmic Sensation?

In Patients Using Treatment for Erectile Dysfunction, Does the International Index of Erectile Function (IIEF) Accurately Measure Sexual Drive, Ejaculation, and Orgasmic Sensation?, Derek Rutherford, Ayr Hospital, Scotland

In most studies of treatment for erectile dysfunction (ED), mean IIEF baseline to endpoint scores are reported, neglecting qualitative analysis of individual patient feedback. I assessed IIEF feedback on sexual drive, ejaculation, and orgasmic sensation in patients using ED treatments (sildenafil and apomorphine) by comparing baseline to endpoint scores with an alternative measurement of male sexual function (The Ayr Index of Male Sexual Function, AIMSF). Patients were randomized to commence either sildenafil or apomorphine treatment. 44 patients (mean age 51 years) were recruited, and 33 patients completed both questionnaires at baseline and after each treatment. Patients that had experienced ED for less than 6 months and patients that were contraindicated to using sildenafil or apomorphine were excluded. Efficacy of treatment influenced outcomes in all sexual domains. The difference from baseline to endpoint scores between sildenafil and apomorphine reached statistical significance for the IIEF Erectile Function (EF) domain and Orgasmic Function (OF) domain. Mean baseline to endpoint scores from IIEF and AIMSF feedback did not reveal a significant difference in sexual drive/desire. However, subgroup analysis and comparison of individual scores revealed that lack of sexual drive/desire was common in patients with severe ED at baseline. Six of these patients responded to ED treatment, though only 4 patients reported significant improvement in sexual drive/desire at endpoint. Endpoint comparison of IIEF and AIMSF scores revealed that of responders to ED treatment (n = 28), 11 patients (38%) reported persistent problems with ejaculation and orgasmic sensation via feedback from the AIMSF. IIEF feedback failed to identify these problems. Lack of sexual drive/desire may be evident in patients with severe ED, and therefore, sexual drive/desire should be monitored when assessing the effect of erectogenic treatment. Although the IIEF has been used as the primary endpoint in most recent studies of ED treatment, feedback may not provide accurate information on the effect of treatment on sexual drive, ejaculation, and orgasmic sensation.