Study: ED questionnaire lacks crucial questions

Chicago-A patient-reported outcomes survey that is widely used to determine whether men are experiencing erectile dysfunction (ED) fails to ask three critical questions that could uncover whether men truly have ED and the extent to which they face challenges, researchers say.

In a presentation at the AUA annual meeting in Chicago, one research methodologist said there are three obvious problems to using the six-question version of the International Index of Erectile Function (IIEF-6) to assess erectile function:

• Men who respond that they are not sexually active are not asked why-and their answer significantly lowers their survey score. Yet for many men, lack of sexual activity is not due to a loss of sexual function.

• Men are not asked whether they are using erectile aids.

• Because men do not report use of erectile aids, physicians miss an opportunity to ask patients to rate their level of sexual function with these aids.

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“Too often, a man who says he is not having sex is automatically defined as having ED when that may not be true. If someone is not having sexual activity, you cannot assume that person has ED. You must ask additional questions,” Andrew Vickers, PhD, attending research methodologist, Memorial Sloan Kettering Cancer Center, told Urology Times.

Once men share the answer to this question, it’s important to adjust survey results to reflect the reason men are not having sex. Only in doing so can health care professionals gain valid insight into a man’s sexual health, Dr. Vickers said.

The study was conducted by researchers at the University of Michigan Medical School, Ann Arbor and Memorial Sloan Kettering Cancer Center under the direction of Karandeep Singh, MD, MMSc, assistant professor of learning health sciences and assistant professor of medicine for the University of Michigan Medical School. The study was supported in part by funding from the National Institutes of Health/National Cancer Institute, Blue Cross and Blue Shield of Michigan, and the National Institute of Diabetes and Digestive and Kidney Disease.

Men with prostate cancer who had undergone radical prostatectomy were asked to complete the existing version of IIEF-6 as well as adjusted versions that added a question about the use of erectile aids, instructed men to respond to the survey based on their level of erectile function without use of aids, and asked men who reported not having intercourse to share the reason why. EPIC sexual function scores were analyzed for men who reported no sexual activity on the IIEF-6.

A total of 24,732 surveys were completed by 6,780 men as part of their routine care. The results show the extent to which the IIEF-6 provides limited insight around erectile function in some men who have undergone radical prostatectomy.

Next: 15% report using erectile aidsAmong the 16,573 surveys that included data around the use of erectile aids, 15% reported the use of erectile aids, predominantly injections (89%). A simple modeling analysis showed that before a question around the use of erectile aids was introduced, some men would report their level of erectile function using the aids; others would assess their erectile function without the use of aids.

Among men who stated they were not having sexual intercourse, 46% gave reasons other than ED for the absence of sexual activity, including lack of a partner, sexual orientation, sexual preference, and health problems of the female partner. In men who were having sexual intercourse, doubling the first three questions on the survey resulted in almost perfect scores compared with the full IIEF-6.

In the 251 men who reported not having sexual activity, 13% reported they continued to have erections sufficient for sexual activity. Meanwhile, 5.6% reported scores of at least 65 on the EPIC sexual function domain.

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Adjusting the survey to provide more detailed and informative insight into the erectile function of men who have undergone radical prostatectomy “is an easy fix,” Dr. Vickers said.

“The problem is not in calculating a group average. The problem is in working with individual patients,” he added.

It’s also important to ensure patients understand what is meant by the word “intercourse,” Dr. Vickers said.

“Some men think ‘sex’ means ‘intercourse’ [only],” he said.