Questionnaires for assessment of female sexual dysfunction: a review and proposal for a standardized screener.

INTRODUCTION: There are many methods to evaluate female sexual function and dysfunction (FSD) in clinical and research settings, including questionnaires, structured interviews, and detailed case histories. Of these, questionnaires have become an easy first choice to screen individuals into different categories of FSD. AIM: The aim of this study was to review the strengths and weaknesses of different questionnaires currently available to assess different dimensions of women's sexual function and dysfunction, and to suggest a simple screener for FSD. METHODS: A literature search of relevant databases, books, and articles in journals was used to identify questionnaires that have been used in basic or epidemiological research, clinical trials, or in clinical settings. MAIN OUTCOME MEASURE: Measures were grouped in four levels based on their purposes and degree of development, and were reviewed for their psychometric properties and utility in clinical or research settings. A Sexual Complaints Screener for Women (SCS-W) was then proposed based on epidemiological methods. RESULTS: Although many questionnaires are adequate for their own purposes, our review revealed a serious lack of standardized, internationally (culturally) acceptable questionnaires that are truly epidemiologically validated in general populations and that can be used to assess FSD in women with or without a partner and independent of the partner's gender. The SCS-W is proposed as a 10-item screener to aid clinicians in making a preliminary assessment of FSD. CONCLUSIONS: The definition of FSD continues to change and basic screening tools are essential to help advance clinical diagnosis and treatment, or to slate patients adequately into the right diagnostic categories for basic and epidemiological research or clinical trials.

Sexual satisfaction in men with erectile dysfunction: correlates and potential predictors.

INTRODUCTION: Sexual satisfaction is an important treatment objective for men with erectile dysfunction (ED). AIMS: To evaluate potential associations between International Index of Erectile Function (IIEF) satisfaction at study endpoint and a range of baseline, on-treatment, and endpoint variables. METHODS: An exploratory analysis was conducted involving 3,935 subjects with ED randomized to on-demand tadalafil (N = 2,824) or placebo (N = 1,111) in randomized, controlled trials across 28 countries. Patients achieving scores > or =16 on IIEF questions 7, 8, 13, and 14 at study endpoint were operationally defined as satisfied (vs. <16, not satisfied). Multivariate logistic regression and other analyses were conducted to ascertain correlates and potential predictors of improvements in the IIEF-erectile function domain (IIEF-EF). MAIN OUTCOME MEASURES: Satisfaction on the IIEF at study endpoint, on-treatment improvements in IIEF-EF, and endpoint sexual frequency. RESULTS: Patients who were satisfied with sexual function were on average younger and had less severe ED, a shorter history of the condition, and no history of vascular disorders, hypertension, or diabetes mellitus/insulin use at baseline (P < 0.01 vs. not satisfied for each). Satisfied patients were also more likely to experience a > or =4-point increase on the IIEF-EF domain on treatment (adjusted odds ratio [OR] = 22.4; 95% CI = 17.6-28.5; P < 0.0001) or IIEF-EF > or =26 at endpoint (adjusted OR = 41.0; 95% CI = 33.6-50.2; P < 0.0001). Satisfaction emerged as a strong correlate of a > or =4-point increase in the IIEF-EF on treatment; however, as a correlate of endpoint sexual frequency, baseline sexual frequency was stronger than endpoint satisfaction. CONCLUSIONS: Satisfaction is associated with certain baseline, on-treatment, and endpoint variables in ED patients. Further studies are needed to confirm these preliminary findings and explore their meaning for female partners.

The treatment satisfaction scale: a multidimensional instrument for the assessment of treatment satisfaction for erectile dysfunction patients and their partners.

BACKGROUND: The development of the Treatment Satisfaction Scale (TSS) was previously reported (Kubin et al., 2004). OBJECTIVE: This article describes the psychometric validation process and psychometric properties (e.g., reliability, validity, and responsiveness) of TSS. METHODS: Initial patient and partner questionnaires were administered in a multi-national clinical trial. On the basis of exploratory analyses, iterative psychometric testing, and consideration of face validity and interpretability, the number of items was reduced, and six scales were constructed: "Satisfaction with Medication," "Ease with Erection," "Satisfaction with Erectile Function," "Pleasure from Sexual Activity," "Satisfaction with Orgasm," and either "Sexual Confidence" (for patients) or "Confidence in Completion" (for partners). RESULTS: Multi-item scales had good internal consistency reliability and concurrent validity with the IIEF. All patient scales and most partner scales were valid in relation to clinical criteria, and all tested scales were responsive to change over time. CONCLUSION: The TSS is brief, culturally valid, and the most comprehensive multidimensional measure of satisfaction with ED treatment for patients and their partners, and addresses some of the shortcomings of existing measures.

Couples' happiness and its relationship to functioning in everyday life after brain injury.

The objective of this survey was to identify couples' joint perception of their satisfaction with life as a whole when one of the persons in the couple had acquired brain injury between one and five years earlier. The focus was on the influence that functioning and disability in everyday life have on the couple's joint life satisfaction after brain injury. The sample consisted of 55 couples, and the mean age of the brain-injured persons was 51 years. Both persons in the couple answered a mailed questionnaire encompassing questions concerning perceived impairments, activity limitations, participation restrictions, and life satisfaction. The results showed that in 16 of the 55 couples both partners were satisfied with life as a whole. The joint experience of life satisfaction was significantly related to the couple's functioning in everyday life, and specifically to perceived participation in leisure time and in their social life, and in their ability to wash clothes. Important implications from this study, showing that only one-third of the couples were satisfied, are that the partners should be included to a greater extent in the rehabilitation process and the couple's perspective of what they find difficult to deal with should serve as a guide during rehabilitation.

A Swedish telephone help-line for sexual problems: a 5-year survey.

INTRODUCTION: Telephone help-lines for people with sexual problems have been established in many European countries during the late decade. They, however, have very different modes of operation, and very few reports focusing on the way they function have been published internationally. AIM: To describe the methods and activities of a Swedish help-line for sexual problems. METHODS: In the 5 years, from 1999 to 2003, 27,387 persons called the Swedish toll-free help-line for "impotence and sexual problems" that operates around the clock. The majority of callers appeared to be looking for information on erectile dysfunction. A counseling option staffed by experts in sexual medicine counseled 2,817 (men 73%, women 27%). A further 478 callers were professionals wanting information or advice. RESULTS: Among a wide spectrum of problems associated with the callers' sexual life, sexual dysfunctions were the most frequent. Calls about sexual abuse, sexual preference, paraphilias, and other subjects were also received. Among those with sexual dysfunction, 33% of men and 41% of women had more than one sexual dysfunction. These were often concomitant with a frequently drug-treated, medical condition. In addition to counseling, the majority of callers were advised to contact physicians or specialists in sexology/sexual medicine for further help. CONCLUSION: Competent person-to-person telephone counseling in the multifaceted bio-psycho-social field of sexual problems requires broad knowledge on sexual medicine.

Epidemiology/risk factors of sexual dysfunction.

INTRODUCTION: Accurate estimates of prevalence/incidence are important in understanding the true burden of male and female sexual dysfunction and in identifying risk factors for prevention efforts. AIM: To provide recommendations/guidelines concerning state-of-the-art knowledge for the epidemiology/risk factors of sexual dysfunctions in men and women. METHODS: An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Epidemiology/Risk Factors Committee, there were seven experts from four countries. MAIN OUTCOME MEASURE: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. RESULTS: Standard definitions of male and female sexual dysfunctions are needed. The incidence rate for erectile dysfunction is 25-30 cases per thousand person years and increases with age. There are no parallel data for women's sexual dysfunctions. The prevalence of sexual dysfunction increases as men and women age; about 40-45% of adult women and 20-30% of adult men have at least one manifest sexual dysfunction. Common risk factor categories associated with sexual dysfunction exist for men and women including: individual general health status, diabetes mellitus, cardiovascular disease, other genitourinary disease, psychiatric/psychological disorders, other chronic diseases, and socio-demographic conditions. Endothelial dysfunction is a condition present in many cases of erectile dysfunction and there are common etiological pathways for other vascular disease states. Increasing physical activity lowers incidence of ED in males who initiate follow-up in their middle ages. CONCLUSIONS: There is a need for more epidemiologic research in male and female sexual dysfunction.

On prediction of vocational rehabilitation outcome at a Swedish employability institute.

OBJECTIVE: The main objective of this investigation was to identify a set of variables usable in early outcome prediction of vocational rehabilitation. DESIGN: On commencement of rehabilitation at an employability institute, data were sampled using structured interviews and checklists. Two years later the subjects were followed up by telephone interviews. SUBJECTS: The study sample was all unemployed with a somatic disorder as the cause of vocational disability, admitted from October 1995 to December 1996 (n = 149). Of these 109 (73%) agreed to participate. METHODS: Initially, data on demography, symptoms, expectations/beliefs about future capacity for gainful employment and sense of coherence (as an indicator of coping resources) were sampled. At follow-up the subjects' vocational situations were recorded. RESULTS: At follow-up, 40% were working or employable. Among the about 30 variables included, logistic regression showed that having a relatively high belief in vocational return (odds ratio, OR: 4.6, CI: 1.4-15.4), having a relatively high sense of coherence (OR: 3.5, CI: 1.5-8.4) and having a relatively high educational level (OR: 2.6, CI: 1.1-6.3) were significant predictors of positive outcome. CONCLUSION: In this sample, socio-psychological and educational aspects were far more predictive of outcome than were medical circumstances.

Self-efficacy in relation to impairments and activities of daily living disability in elderly patients with stroke: a prospective investigation.

OBJECTIVES: The objectives of this prospective study, undertaken in elderly patients with stroke undergoing rehabilitation, were to determine to what extent fall-related self-efficacy changes over time, its relationships to objectively assessed functions and activities, and the predictive capacity of self-efficacy at discharge for activities of daily living 10 months after stroke. METHODS: The study comprised 37 patients, aged 66-89 years. Main outcome measurement instruments were the Falls Efficacy Scale (Swedish version), Berg Balance Scale and Functional Independence Measure. RESULTS: Significant improvements occurred in all these measures from admission to discharge, but patients with low self-efficacy at discharge showed less pronounced improvements than those with high self-efficacy. Falls Efficacy Scale (Swedish version) was closely associated with all other measures and was a more powerful predictor of activities of daily living than the observer-based measures of balance. CONCLUSION: To minimize dependence in activities of daily living, rehabilitation interventions should incorporate self-efficacy enhancement.

Life satisfaction several years after severe multiple trauma--a retrospective investigation.

OBJECTIVES: To describe the prevalence of self-reported changes in life satisfaction after multiple trauma, to analyse associations between satisfaction with life as a whole and with domains in life, and to identify important contributors for satisfaction with life. DESIGN: Retrospective follow-up study. SETTING: Rehabilitation hospital three years after multiple trauma. SUBJECTS: Sixty-nine subjects with severe multiple trauma (ISS > or = 16). MAIN OUTCOME MEASURES: Clinical examinations to reveal prevalences of impairments and disabilities. Questionnaires about satisfaction with life as a whole and eight domains of life, both for the time before trauma, and for the actual situation; sense of coherence (SOC-13); social network. RESULTS: A total of 87% experienced a decrease in at least one of the nine life satisfaction items from before to after trauma (six-graded scale). After trauma significantly fewer subjects reported to be satisfied with life as a whole, as well as the domains sexual life, ADL, contact with friends, leisure, vocational and financial situation. Satisfaction with family life and partner relationship did not decrease significantly. The most important domains after trauma were satisfaction with leisure, family life and vocation. Vocational and leisure disability after trauma were important determinants for satisfaction with life as a whole. A strong sense of coherence and sufficient social network quality had significant impact on satisfaction with life as a whole and some of the domain-specific satisfactions. CONCLUSIONS: Both personal resources (a strong sense of coherence) and the presence of a qualitatively sufficient social network can buffer the negative influence of disabilities on life satisfaction after trauma.

Is sense of coherence stable after multiple trauma?

OBJECTIVES: To explore whether sense of coherence (SOC) is stable over time after multiple trauma. The associations between SOC and satisfaction with life as a whole, as well as aspects of psychological well-being, were explored. Finally, an overriding aim was to assess whether SOC has long-term prognostic value for global life satisfaction or psychological well-being. DESIGN: Prospective study. SETTING: Sunnaas Rehabilitation Hospital. SUBJECTS: Twenty-six subjects with severe multiple trauma, without neuropsychological deficits. MAIN OUTCOME MEASURES: Questionnaires that were answered at admission, at discharge and at follow-up 1-3 years after trauma were: Sense of Coherence Scale 13 items (SOC-13), satisfaction with life as a whole, General Health Questionnaire 20 items (GHQ-20), Hospital Anxiety and Depression Scale (HAD). RESULTS: While median SOC scores were fairly stable, individual scores were not stable over time, and for some subjects showed large variations. SOC score had neither long-term prognostic value for satisfaction with life as a whole nor for psychological well-being, at least not in the first years after severe multiple trauma. However, SOC was closely associated with overall life satisfaction when measured simultaneously. Furthermore, a weak SOC correlated with scores on psychological distress, anxiety and depression. SOC scores were also significantly related to being or not being in a state of anxiety, but not to being or not being depressed. Global life satisfaction was considerably reduced from before trauma (reported at admission) to the time of follow-up. CONCLUSION: SOC was not stable over time after severe multiple trauma. SOC measured at admission could neither predict future satisfaction with life as a whole nor future psychological well-being. Measured simultaneously, overall life satisfaction and occurrence of anxiety were significantly associated with SOC.

Life satisfaction in 18- to 64-year-old Swedes: in relation to education, employment situation, health and physical activity.

OBJECTIVE: The aim of this study is to relate different sociodemographic, health and physical activity parameters to levels of satisfaction with life as a whole and with 10 specific domains of life. DESIGN: Data on socio-demographic items were sampled, using strictly structured interviews, while a checklist (LiSat-11) was used for self-reported levels of life satisfaction. SUBJECTS: A nationally representative Swedish sample of 1207 women and 1326 men aged 18-64 years. RESULTS: Univariately most of these socio-demographic variables were associated with several of the LiSat-11 items. Using logistic regression, perceived good health and not being a first generation immigrant were the most prominent positive predictors of satisfaction with life as a whole and of most of the domains. Also educational level impacted predictively on satisfaction with many LiSat-11 items. Furthermore, those who were vocationally active, perceived their financial situation as better than or similar to most people's and had a steady partner relationship were particularly likely to be satisfied with life as a whole and with two or more of the domains. CONCLUSION: These results indicate that a multitude of aspects must be taken into account when assessing life satisfaction.

Life satisfaction in 18- to 64-year-old Swedes: in relation to gender, age, partner and immigrant status.

Satisfaction with life as a whole and with 10 domains of life was assessed in a nationally representative Swedish sample of 1207 women and 1326 men aged between 18 and 64 years, using a generic self-report checklist (LiSat-11), with levels of satisfaction ranging along a six-grade ordinal scale from 1 (very dissatisfied) to 6 (very satisfied). The main findings are that, with marginal exceptions, life satisfaction is gender independent, while age is systematically and positively associated with vocational and financial situations. Having no partner and being a first-generation immigrant implies for most LiSat-11 items a relatively low level of satisfaction. Factor analysis of the domain-specific items yields a gender-independent four-factor structure, which is robustly independent of different scaling reductions. Gross levels of satisfaction (dichotomized scales 1-4 vs 5-6) of seven domains were significant classifiers (odds ratio 1.7-3.9) of gross level of satisfaction with life as a whole. This investigation provides reference values for LiSat-11, which, with its ease of administration may be an adequate instrument for analysing, in terms of subjects' cognitive appraisal of emotions, aspirations-achievement gaps.