ORIGINAL RESEARCHInternational Index of Erectile Function (IIEF) Scores Generated by Men or Female Partners Correlate Equally Well With Own Satisfaction (Sexual, Partnership, Life, and Mental Health)
Introduction
Studies from a variety of countries have indicated that specifically penile–vaginal intercourse (PVI) frequency and the orgasm it produces (the latter sometimes being more precisely measured for women with the specification of vaginal orgasm—elicited by PVI without concurrent clitoral masturbation) are associated with indices of better physiological and psychological function for both sexes [1], including greater satisfaction with sex life 2, 3, 4, partnership, one's own mental health, and life in general 5, 6, 7. A prerequisite for adequate (or better than adequate) PVI is an adequate erection.
A French study indicated that erectile dysfunction was associated with poorer sexual satisfaction for the affected men's female partners [8]. Successful treatment of erectile dysfunction was shown to improve sexual satisfaction (or sexual quality of life) and sexual function in female partners of affected Turkish men [9], French men [10], North American men [11], and men from international studies [12]. Successful treatment of erectile dysfunction was also shown to improve relationship satisfaction in men from several countries [13]. In a recent sample from India, spouses of men with erectile dysfunction had less marital and sexual satisfaction and more psychiatric symptoms than did women in a control group [14]. The association of erectile dysfunction with poorer life and relationship (among other aspects) satisfaction led to a proposal to use satisfaction measures as a screening tool for erectile dysfunction [15].
One of the most common means of screening for erectile dysfunction is the self-report measure International Index of Erectile Function (IIEF). The shorter 5-item version of the IIEF [16], also known as the Sexual Health Inventory for Men, has been shown to correlate well with the longer version, and is in widespread use [17]. IIEF scores and treatment-related increases in IIEF scores are associated with men's sexual satisfaction [18]. In an American sample of infertile couples, male and female sexual function (as measured by the IIEF and FSFI) were moderately correlated [19]. Sufficient duration of erection is also among the parameters tapped by the IIEF, and greater duration of PVI (well beyond the range associated with premature ejaculation) is associated with greater likelihood of woman's orgasm 20, 21. Although a scale was recently developed for female partners to assess men's erectile function [22], the IIEF remains most likely the most common self-report measure of erectile function in sexual medicine. Awareness of the similarity of self-report and female reporting of erectile functioning with the IIEF is of both theoretical and potential clinical value, as it would inform understanding of the similarity of men's and women's perceptions of erectile function.
Similarly, the association of the IIEF with vaginal orgasm consistency (percentage of PVI occasions in which at least one vaginal orgasm occurs) would be of interest, as it might inform an understanding of the degree to which women's 6, 7, 20, 23, 24, 25, 26, 27, 28 and men's 1, 20, 21 characteristics contribute to vaginal orgasm. Among other benefits, a history of vaginal orgasm is protective against the risk of current female sexual arousal disorder with distress [29].
The degree to which IIEF-5 scores are associated with aspects of satisfaction (sexual, life, own mental health, partnership) for each sex could inform the degree to which having an adequate erection is fulfilling in sexual, partnership, and broader realms. An examination of possible sex differences in the strength of associations with aspects of satisfaction would also inform our understanding of similarities and differences in sexual needs of the sexes.
The special role of PVI frequency merits its being examined as an additional correlate 1, 30 of satisfaction. Thus, a multivariate examination of the possible independent contribution to satisfaction measures of IIEF-5 scores, PVI frequency, age, and, for women, vaginal orgasm consistency is also conducted in this study.
Section snippets
Aims
The aims of the study are to examine in a representative sample of the middle-aged population: (i) sex differences in IIEF-5 scores generated by men and by women; (ii) the associations of IIEF-5 scores with aspects of satisfaction (sexual, life, own mental health, partner relationship); (iii) sex differences in the associations of IIEF-5 scores with aspects of satisfaction; and (iv) the associations of IIEF-5 scores with women's vaginal orgasm consistency. We hypothesized that: (i) there would
Methods
The study was approved by 1st Faculty of Medicine, Charles University, Prague, and was conducted as per the principles of the Helsinki Declaration. A large representative sample of heterosexual citizens of the Czech Republic aged 35–65 years was collected by a marketing agency STEM/MARK in the year 2010, under the supervision of 1st Faculty of Medicine, Charles University, Prague. The middle-age range was chosen to provide a combination of age-related risk of erectile dysfunction as well as
Main Outcome Measures
Participants completed a questionnaire, which included demographic questions, as well as PVI frequency (past month), and consistency of vaginal orgasm (for women only; vaginal orgasm defined as orgasm produced by movements of the penis in the vagina without extrinsic stimulation for the orgasm such as fingers on the clitoris; consistency options: never, ever but <25% of PVI occasions, 25–50%, 50–75%, or 75–100%). In addition, participants completed the IIEF-5 and satisfaction items (their sex
Results
The 720 women who provided complete data had a mean (standard deviation [SD]) age of 47.6 (8.6), and the 787 men who provided complete data had a mean (SD) age of 49.4 (8.6). Eighty-seven percent of respondents reported currently being in a stable partnership. A total of 60.1% are married, 11% are single, 24.6% are divorced, and are 4% widowed (0.3% did not answer this question). Overall, 85.3% were in a stable relationship. Education levels were: 56.3% basic, 32.3% higher secondary to
Discussion
IIEF-5 scores generated by men and by women were similar, and were also similarly positively correlated with all aspects of satisfaction (sexual, life, own mental health, partnership). The similarity of IIEF-5 scores generated by men and by women is noteworthy, especially given that they were not matched partners. The lack of sex differences in mean IIEF-5 scores suggests: (i) that the sampling was indeed quite representative, and (ii) the Czech women on average evaluate erectile function
Conclusions
In this large representative sample of middle-aged Czechs, IIEF-5 scores generated by men and by women were similar and similarly correlated with satisfaction (with life, sex life, partnership, and one's own mental health). For both sexes, PVI frequency and IIEF-5 score (as well as vaginal orgasm for women) are associated with greater life, sexual, partnership, and mental health satisfaction. Greater support for optimizing all aspects of specifically PVI function and response (including vaginal
Category 1
- (a)
Conception and Design
Petr Weiss
- (b)
Acquisition of Data
Petr Weiss
- (c)
Analysis and Interpretation of Data
Petr Weiss; Stuart Brody
Category 2
- (a)
Drafting the Article
Stuart Brody
- (b)
Revising It for Intellectual Content
Petr Weiss; Stuart Brody
Category 3
- (a)
Final Approval of the Completed Article
Petr Weiss; Stuart Brody
Acknowledgment
The underlying survey was funded by Eli Lilly Co (Czech Republic).
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