The Sexual Health Inventory for Men (IIEF-5)

Letter to the Editor The sexual health inventory for men (IIEF-5)

JA Vroege1*

1Department of Psychiatry, Leiden University Medical Centre, Leiden & Netherlands Institute of Social Sexological Research (NISSO), Utrecht, The Netherlands

A few days after the Eighth World Meeting on you had erections with sexual stimulation, how Impotence Research in Amsterdam, all members of often were your erections hard enough for penetra- the Netherlands Society for Sexology (NVVS) re- tion?' The word `penetration' does not win the ceived a booklet for patients with erectile problems.1 beauty contest (at least in Dutch) and `sexual On page 12 of this booklet Ð produced in collabora- stimulation' is, in my opinion, too theoretical. More tion with P®zer Ð the authors presented a question- important, however, is that respondents who were naire consisting of ®ve items from the IIEF2: the sexually stimulated but never had an erection, Sexual Health Inventory for Men. In Supplement 3 simply cannot answer this question. Neither `no of the International Journal of Impotence Research sexual activity' or àlmost never=never' are options! (Volume 10) the authors give some background As a result of the large number of patients, the information on the IIEF-5. Based on their research sophisticated statistical techniques, and a sensitiv- they conclude that the Sexual Health Inventory for ity and speci®city of 0.98 and 0.88, the published Men is àn excellent diagnostic instrument for information looks quite impressive. It is important discriminating between men with ED and men to realize, however, that the authors probably did without ED in clinical practice or research settings'.3 not use a representative sample of patients in clinical After studying the Dutch version of this question- practice, and that the 15 item version of the IIEF naire, however, I come to a diametrically opposed functioned as `gold standard'. Moreover the time conclusion. In the booklet mentioned above, the frame of the IIEF-5 (the past six months) is different IIEF-5 was presented as a means of ®nding out if the from that in the IIEF (the past four weeks, or the past reader is suffering from erectile problems. For this two weeks).2,4 The most important objection to the purpose, however, using sumscores and cut-off IIEF-5, however, is that in some cases this ques- points is unnecessarily complicated. Besides, such tionnaire produces extremely curious results. The a procedure gives little insight into the diagnostic maximum score for respondents who: (1) do not criteria. Why not explain that the reader of the have a partner; or (2) do not have sexual contact booklet has an erectile problem if, during sexual with their partner; or (3) do have sexual contact but contact or masturbation: (1) his penis does not no sexual intercourse, is 10. Considering the present become as hard as, or remains hard for a shorter time cut-off point of 21, this implies they are all, per than he wants it to; and (2) this is troublesome to de®nition, impotent! That's something we, in The him or his partner? In the IIEF-5, sexual intercourse Netherlands, view quite differently. is the most important sexual situation. As a result of that, some of the items appear a bit clumsy. Take for example item 5: `When you attempted sexual References intercourse, how often was it satisfactory for you?'. For respondents who did not succeed in having sexual intercourse, the answer is so obvious that it 1 Rutgers Stichting. Erectieproblemen (Erectile problems). Utrecht, The Netherlands, 1998. will easily provoke irritation. In respondents who 2 Rosen RC et al. The international index of erectile function did succeed in having sexual intercourse, irritation (IIEF): A multidimensional scale for assessment of erectile will easily be provoked by the word àttempted'. dysfunction. Urology 1997; 49: 822 ± 830. Other items of the IIEF-5 also do not excel in their 3 Rosen RC et al. Constructing and evaluating the ``sexual health inventory for men: IIEF-5'' as a diagnostic tool for erectile transparency. What is one to think of item 2: `When dysfunction (ED). Int J Imp Res 1998; 10 (Suppl. 3): S35. 4 Rosen RC et al. The international index of erectile function (IIEF): A multi-dimensional scale for assessment of male *Correspondence: Jos A. Vroege, M.Sc., Department of erectile dysfunction (MED). Poster presented at the 22nd Psychiatry B1-P, Leiden University Medical Centre, P.O. Box Annual Meeting of the International Academy of Sex Re- 9600, 2300 RC Leiden, The Netherlands. search, Rotterdam, The Netherlands, 1996.