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Structured interview on erectile dysfunction (SIEDY©): a new, multidimensional instrument for quantification of pathogenetic issues on erectile dysfunction

Abstract

The aim of the present study is the definition of a brief structured interview (SI) providing scores useful for identification and quantification of pathogenetic factors of erectile dysfunction (ED). A SI was developed and applied to a consecutive series of 320 ED patients. A 13-item SI, with three-factor analysis-derived scales, was identified and applied for validation to an independent consecutive series of 194 ED patients. PGE1 (10 μg) intracavernosal injection, penile duplex ultrasound (PDU), blood hormones, PSA, glycemia, and lipids were used for the assessment of an organic component (OC), and Middlesex Hospital Questionnaire (MHQ) modified for psychological disturbances. Scale 1, dealing with OC, showed a positive correlation with age, BMI, blood pressure, glycemia, and inverse correlation, with testosterone, PGE1 and several parameters derived from PDU. Scale 2, related to partner's relationship, was not correlated with organic parameters. Scale 3, which measures psychopathological traits was correlated with MHQ scales. Scale 1 (>3) had a sensitivity of 67.9% and a specificity of 67.6% for OC. SIEDY© provides information on ED pathogenesis and might assist physicians in diagnostic and therapeutic choices.

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Acknowledgements

We thank Angela Magini, Antonio Cilotti, Csilla Krausz and Michela Cameron Smith of the Andrology Unit of the University of Florence; Luca Maria Carusi of the Radiology Unit of the University of Florence; Leonardo Fei of the Psychiatric Unit of the University of Florence, Andrea Fabbri and Antonio Aversa of the Endocrinology Unit, ‘Tor Vergata’, University of Rome, and Concetto Vasta of Eli Lilly & Co, Sesto Fiorentino, Italy, for their fruitful collaboration during the course of the study. This study was partially supported by a grant from Ministero Istruzione Università e Ricerca (MIUR), Rome, Italy. Note: a patent is pending on the use of SIEDY©.

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Correspondence to M Maggi.

Appendices

Appendix A

SI for the assessment of severity of ED. The main question is boldfaced. Facultative questions are indicated after the main one. In italic is reported the correct way to score answers by the interviewer.

(1) Describe what happens during sexual intercourse: do you have an erection?

Is it a complete erection? Is it sufficient for penetration? How often?

Among what we said, what does it happen more frequently, particularly during the last three months?

The patient has to describe the erectile problem answering the previous questions. The interviewer should reformulate the patient's answers, in order to confirm that there was no misunderstanding. The description of the problem refers to the last three months. Sometimes =<25% of cases, quite often = 25-50%, often =>50%.

  1. a)

    Full erection

    • 0 sometimes

    • 1 quite often

    • 2 often

    • 3 always

  2. b)

    Partial erection but hard enough for penetration

    • 0 sometimes

    • 1 quite often

    • 2 often

    • 3 always

  3. c)

    Partial erection but not hard enough for penetration

    • 0 sometimes

    • 1 quite often

    •  2 often

    •  3 always

    • Absent erection

    • 0 sometimes

    • 1 quite often

    •  2 often

    •  3 always

(2) Does it occur to have a normal erection which you are not able to maintain? How often?

Sometimes =at least 25% of times; quite often =between 25–50% of times; often more than 50% of times. We relate to the last three months.

  • 0 never

  • 1 sometimes

  • 2 quite often

  • 3 often

(3) Since when do you have erectile problems?

  • 0 <1 month

  • 1 <6 months

  • 2 <2 years

  • 3 >2 years

(4) Since when did it get worse?

  • 0 <1 month

  • 1 <6 months

  • 2 <2 years

  • 3 >2 years

(5) Did the problem start suddenly or gradually?

  • 0 suddenly

  • 1 gradually

Appendix B

Instructions to perform SIEDY©. SIEDY© is a structured interview for the definition of the pathogenesis of ED.

The interview is composed of 13 key items, plus two accessory items (number 1 and 5), which do not contribute to the scoring system, but are useful to introduce the key items.

The interviewer should ask the questions written in bold, using the exact words proposed. The further questions written in normal characters can be used to clarify the patient's answers if needed.The patient should be permitted to answer freely, using his own words.

The patient's answers are codified on a 0–3 scale by the interviewer, following the detailed instructions reported after each item. The order in which the questions are made should be observed, as alterations in this succession could theoretically modify the patient's answers. The items, form three scales. Scale 1, which is composed of items 4, 13 and 15, quantifies the organic component of ED; scale 2, which is composed of items 7, 8, 9 and 10, identifies and quantifies the relational component of ED; scale 3, composed of items 2, 3, 6, 11, 12 and 14, quantifies the psychogenic component of ED.

SIEDY ©

(1) Do you have a job?

What is your job?

  • 0 Retired

  • 1 Student

  • 2 Unemployed

  • 3 Employed

(2) Are you satisfied with your job/occupation?

Rank 0 if the patient has a gratifying job/occupation; 1 if the patient is fairly satisfied; 2 if the patient would have preferred to have a different job/occupation; 3 Completely unsatisfied.

For those who do not have a job (i.e. retired patients), consider the main occupations (housekeeping, gardening, hobbies, etc.).

  • 0 Very satisfied

  • 1 Fairly satisfied

  • 2 Not very satisfied

  • 3 Unsatisfied

(3) Do you ever think of your job out of the working hours?

We refer to the last three months. Sometimes : the patient has got occasional thoughts about his job which do not interfere with his normal life; quite often : frequent thoughts that interfere with normal life; often : very frequent thoughts rendering the patient incapable to concentrate on his normal life.

For those who do not have a job, score is 0.

  • 0 never

  • 1 sometimes

  • 2 quite often

  • 3 often

(4) Have you ever undergone surgery? Have you ever been admitted to a hospital without undergoing surgery? Have you had any other relevant disease without being admitted to a hospital?

Mark only diseases specified below, if present. The score will be 0 if none of the conditions specified is present, and 3 if at least one of those conditions is present.

* Pelvic radiotherapy is considered in the aetiology of erectile dysfunction if ED arises after radiotherapy

Cardiovascular disease

  • Coronary artery disease  □

  • Stroke  □

  • Diabetes mellitus  □

  • Hypertension  □

  • Hyperlipidaemia  □

  • Arteriopathy of lower limbs  □

  • Pelvic radiotherapy*  □

  • 0 No

  • 3 Yes

b. Neurological diseases

Abdominal surgery should be considered only in the case that erectile dysfunction arises after the surgical procedure. The score will be 0 if none of the conditions specified is present, and 3 if at least one of those conditions is present.

  • Lesion/disease/surgery of pelvic plexus  □

  • Lesion/disease/surgery of spinal cord  □

  • Lesion/disease/surgery of the central nervous system  □

  • 0 No

  • 3 Yes

(5) Do you have a stable relationship with a partner?

Do you live together?

Stable relationship means a relation lasting for at least two months, which includes sexual intercourse.

  • 0 Stable relationship, living together

  • 1 Stable relationship, not living together

  • 2 No stable relationship

(6) Do you have a difficult relationship with your partner?

Do you quarrel often? Do you avoid each other?

A relationship in which there is little conflict and a good dialogue is ranked as normal; occasional quarrels (1) when there is a good dialogue and quarrels occur seldom, without disturbing family relationships; frequent quarrels (2) if the partners try to establish some form of dialogue, but the quarrels disturb family relationship; always (3) means a total absence of dialogue including total avoidance of each other.

  • 0 No, I have normal relationships

  • 1 No, occasional quarrels

  • 2 Yes, frequent quarrels

  • 3 Always

(7) Does your partner have any major illness?

Which diseases? Do these diseases affect the quality of your partner's life?

Do these diseases make your sexual intercourse more difficult?

Saying important diseases, we mean those that affect in a considerable way the quality of the patient's life. Some of these diseases can affect sexual activity in a considerable manner; the obstacle to sexual activity has to be considered as an objective obstacle and not as a subjective one. For example: the patient may have subjective difficulties in making love with a woman affected by breast cancer and who underwent mastectomy, even if she is healthy at the moment; while the objective obstacle can be represented by the partner's advanced disease stage or by the side effects of treatment.

  • 0 No

  • 1 Yes, but not compromising sexual activity

  • 2 Yes, compromising sexual activity

  • 3 Yes, so that sexual intercourse is impossible

(8) Does your partner have more or less desire to make love than in the past?

Rank 0 when the partner's desire is unmodified or increased; 1 if desire is moderately reduced, but the frequency of sexual intercourse is not reduced in a relevant manner; 2 if desire is reduced in such a way as to reduce considerably the frequency of sexual intercourse; 3 if the partner has never showed a real desire to make love. The question investigates only the partner's, and not the patient's, desire. If the frequency of the sexual intercourse is reduced due to the impairment of the patient's (and not the partner's) desire, rank 0. The last three months should be considered.

  • 0 Unmodified or increased desire

  • 1 Desire present but moderately reduced

  • 2 Desire remarkably reduced

  • 3 Desire never present

(9) Does your partner reach climax?

How often?

0 if the partner reaches climax in all intercourses; 1 if climax is reached in more than half of occasions, but not always; 2 if less than half of occasions; 3 if climax has never been reached.

  • 0 Always

  • 1 Most of the times

  • 2 Sometimes

  • 3 Never

(10) Is your partner in menopause?

Does she have any problems due to menopause? Do these problems make sexual activity more difficult? Does your partner have vaginal dryness? Does she have pain during penetration?

If the partner is a male, or if the partner is a premenopausal woman, the score is 0. If the partner is in menopause, but she has no menopause-related disturbances, or she has disturbances which do not interfere with sexual intercourse (e.g., flushing), the score is 1. The score is 2 when there is sporadic vaginal dryness and/or dyspareunia; the score is 3 when menopause-related symptoms are such as to make sexual intercourse impossible.

  • 0 Not in menopause

  • 1 In menopause, with no problems, or with problems not interfering with sexual intercourse

  • 2 Problems which moderately interfere with sexual intercourse

  • 3 Problems which remarkably interfere with sexual life.

(11) Are there any conflicts at home (with children, or other persons living with you?)

A relationship in which there is little conflict and a good dialogue is considered normal (0); occasional quarrels (1) when there is a good dialogue and quarrels occur seldom, without disturbing family relationships; frequent quarrels (2); family members try to establish some form of dialogue, but the quarrels disturb family relationship; always (3) means a total absence of dialogue including total avoidance of each other.

  • 0 No, normal relationships

  • 1 No, occasional quarrels

  • 2 Yes, frequent quarrels

  • 3 Always

(12) Do you have other sexual relationships (with people other than your usual partner)?

“Stable relationship” is defined as a relationship lasting more than two months, in which the partners meet regularly and have sexual intercourse. “Occasional” sexual relationships are those which last less than two months or do not include regularity of relationship.

  • 0 No

  • 1 Occasionally

  • 2 Another stable relationship

  • 3 Another stable relationship and occasional intercourse with different partners

(13) Does it ever occur to you to wake up with an erection?

How often did it happen in the last three months? How often did it happen in the past?

Rank 0 if the patient reports spontaneous nocturnal/morning erections, with the same frequency previously observed; 1 nocturnal/morning erections are present, but their frequency during the last three months is somewhat lower than that observed previously; 2 if the frequency of nocturnal/morning erections of the last three months is reduced by at least 50%; 3 if nocturnal/morning erections are present.

  • 0 Yes, regularly

  • 1 Less frequently than in the past

  • 2 Only occasionally

  • 3 Never

(14) Did you have more or less desire to make love in the last three months? Was your desire increased or reduced when compared to the past?

Rank 0 when the patient's desire is unmodified or increased; 1 if desire is moderately reduced, in less than 50% of potential occasions; 2 if desire is reduced in more than 50% of potential occasions; 3 if the patient has had no desire to make love. The question investigates only the patient's, and not the partner's, desire. The last three months should be considered.

  • 0 Unmodified or increased desire

  • 1 Desire present but moderately reduced

  • 2 Desire remarkably reduced

  • 3 Desire never present

(15) Did you notice a reduction of the quantity of the volume of ejaculate?

Rank 0 when the patient did not notice any modification of the volume of ejaculate; 1 when the patient has the feeling that the volume of the ejaculate could be slightly reduced; 2 when the volume of ejaculate is markedly reduced; 3 when no ejaculation occurs. The last three months should be considered.

  • 0 No modification

  • 1 Slightly reduced

  • 2 Markedly reduced

  • 3 Ejaculation absent

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Petrone, L., Mannucci, E., Corona, G. et al. Structured interview on erectile dysfunction (SIEDY©): a new, multidimensional instrument for quantification of pathogenetic issues on erectile dysfunction. Int J Impot Res 15, 210–220 (2003). https://doi.org/10.1038/sj.ijir.3901006

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Keywords

  • erectile dysfunction
  • anamnesis
  • penile duplex ultrasound
  • structured interview

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