Self-Esteem And Relationship Scores Research Articles

MP36-01 AN ANALYSIS OF THE PSYCHOLOGICAL BOTHER IN MEN WITH PEYRONIE'S DISEASE

You have accessJournal of UrologyCME1 Apr 2023MP36-01 AN ANALYSIS OF THE PSYCHOLOGICAL BOTHER IN MEN WITH PEYRONIE'S DISEASE Luis F. Novaes, Lawrence C. Jenkins, Jean E. Terrier, Hisanori Taniguchi, Bruno Nascimento, Sigrid Carlsson, Christian Nelson, Jose M. Flores, and John P. Mulhall Luis F. NovaesLuis F. Novaes More articles by this author , Lawrence C. JenkinsLawrence C. Jenkins More articles by this author , Jean E. TerrierJean E. Terrier More articles by this author , Hisanori TaniguchiHisanori Taniguchi More articles by this author , Bruno NascimentoBruno Nascimento More articles by this author , Sigrid CarlssonSigrid Carlsson More articles by this author , Christian NelsonChristian Nelson More articles by this author , Jose M. FloresJose M. Flores More articles by this author , and John P. MulhallJohn P. Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is an association between Peyronie's disease (PD) and psychological bother, depression and relationship dissatisfaction. We aimed to describe the prevalence of these psychosocial issues using validated instruments. METHODS: On presentation, all patients with PD who responded to 3 validated questionnaires were included in this study. The inventories included: the Peyronie’s Disease Questionnaire (PDQ), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Self-Esteem and Relationship (SEAR) questionnaire. The PDQ has 3 subdomains, psychological and physical symptoms, penile pain, and bother signs. With worsening negative impact, PDQ scores are higher; a bother domain score ≥9 indicates clinically meaningful bother. A CES-D score, ≥16/60 suggests clinical depression. The SEAR contains 14 questions, divided into the domains of sexual relationship and confidence (self-esteem; overall relationship), with a normalized score of 0-100, (higher scores better QOL). Demographics and PD characteristics are reported. We evaluated potential predictors of psychological bother. Parameters included in univariable (UVA) and multivariable (MVA) analysis models: age, sexual orientation, PD duration, multiplanar curvature, pain, intercourse, curvature, penile instability. RESULTS: 720 patients were analyzed. Median age 58 [52, 64] years, 20% had ≥2 comorbidities, 7% were current smokers. Median PD duration was 10 [4, 24] months, 28% multiplanar curvature, median degree of the primary was 32° [21, 46]. Curvature location: mid-shaft 64%, distal 25%, proximal 11%. 49% had dorsal, 37% lateral, and 14% ventral curvature. Median PDQ scores: psychological and physical (0-24) was 9 [4, 14]; pain (0-30) was 3 [0, 8]; bother (0-16) was 4 [3, 6]; 5% had clinically significant bother. Median CES-D scores 8 [3, 15], 23% had scores ≥16, indicating clinical depression. Median SEAR scores: sexual relationship 28 [16, 41]; confidence 32 [23, 41]. On UVA, pain (OR: 4.67; 95% CI: 1.4, 14.8; p: 0.009) curvature magnitude (OR: 1.47; 95% CI: 1.1, 1.9; p: 0.007) were predictors of bother. Median PDQ pain scores in bothered patients was 14.5 [8.5, 21.2], vs 2 [0, 7] in non-bothered. On MVA (Table 1), pain was the only predictor of bother. CONCLUSIONS: Pain and curvature is associated with bother, and 1 in 4 PD patients have clinical depression. Source of Funding: SMSNA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e479 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luis F. Novaes More articles by this author Lawrence C. Jenkins More articles by this author Jean E. Terrier More articles by this author Hisanori Taniguchi More articles by this author Bruno Nascimento More articles by this author Sigrid Carlsson More articles by this author Christian Nelson More articles by this author Jose M. Flores More articles by this author John P. Mulhall More articles by this author Expand All Advertisement PDF downloadLoading ...

Penis Enlargement by Penile Suspensory Ligament Division with Cross-Plasty of the Skin.

To demonstrate modified technique of penile lengthening. We have reviewed 30 patients who underwent surgery with the use of the proposed "cross-method" and also compared with 35 patients who had surgery with the division of the suspensory ligament performed with the use of V-Y plasty method. We have achieved better enlargement and SEAR (self-esteem and relationship) scores with the "cross-method" compared to V-Y plasty. The cross-method is a simple alternative technique for penile lengthening that can be performed safely in order to treat small penis syndrome and obtain better results.

A Comparison of the Psychosocial Impact of Penile Prosthesis and Intracavernosal Injection Therapy for Erectile Dysfunction Using the Self-Esteem and Relationship (SEAR) Questionnaire

ABSTRACT Introduction The few studies that do compare penile prostheses (PP) and intracavernosal injections (ICI) focus predominantly on sexual function leaving self-esteem and relationships understudied. The Self-Esteem and Relationship (SEAR) questionnaire was developed to provide a reliable tool to assess psychosocial variables of ED treatments. We hypothesized that patients with PP would have higher SEAR scores compared to patients treated with ICI. Objective To compare psychosocial variables of PP and ICI treatments using the SEAR questionnaire. Methods IRB-approval was obtained to interview patients by phone who underwent ED treatment by a single surgeon. SEAR questionnaire results were calculated according to the previously described formula and individual questions and domains were compared using T-test statistics. Results Fifty patients (25 PP, 25 ICI) agreed to be interviewed for this study. Prostate cancer (n=21, 45%) and vascular disease (n=7, 14%) were the leading cause of ED in our cohort. PI patients on average suffered from ED for a longer period than patients on ICI (5.6 vs 2.7 years, p=0.005). There were no differences in age or marital status. PP patients reported numerically higher total SEAR scores than PP patients (63 vs 53, p=0.12). PI patients reported higher sexual relationships domain scores than ICI patients (64 vs 46, p=0.04), especially in “I felt confident that during sex my erection would last long enough” (p=0.004), “I was satisfied with my sexual performance” (p=0.05), and “I felt confident about performing sexually” (p=0.02). There were no statistical differences in the confidence domain (p=0.89) or self-esteem (p=0.68) and overall relationship (p=0.80) sub-domains. Conclusions PP patients reported higher sexual relationship domain scores than ICI patients, while confidence, self-esteem, and overall relationships were similar. Regular use of the SEAR questionnaire may help to identify areas of post-treatment psychosocial needs in ED patients that may benefit from support groups or discussion with a counselor. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific

In Vitro Fertilization Entails a High Prevalence of Erectile and Male Sexual Dysfunction: A Prospective Case-Control Study.

We evaluated the effect of in vitro fertilization (IVF) on sexual function in men, particularly for erectile dysfunction. A prospective case-control study at a tertiary medical center. The study group comprised men of infertile couples that required IVF to conceive. The control group comprised men of couples who conceived spontaneously. The effects of IVF on sexual and erectile function were assessed based on the International Index of Erectile Function (IIEF-15) and the Self-Esteem and Relationship (SEAR) questionnaires. Participants were followed up to 1 year postpartum. Compared to the control group (378), for the IVF group (356), mean IIEF-15 scores were significantly lower: prior to pregnancy (31.7±4.5 vs 64.4±7.2, p <0.0001), at mid-pregnancy (37.3±5.1 vs 66.4±5.5, p <0.0001) and up to one year postpartum (42.3±4.9 vs 68.6±4.3, p <0.0001). Compared to the control group, in the IVF group, mean SEAR scores were significantly lower at these 3 respective time points (29.9±6.3 vs 66.5±8.3; 34.1±5.8 vs 66.9±7.2; and 40.9±6.7 vs 67.3±5.6; p <0.0001). At the 3 time points, for the IVF compared to the control group, the median monthly sexual intercourse rate was lower; and both the use of phosphodiesterase-5 inhibitor and psychologist/sexologist care were higher. The prevalence of erectile dysfunction among men participating in IVF in order to conceive is significantly higher compared to couples that conceived spontaneously, thus leading to an extremely high rate of phosphodiesterase-5 inhibitor use.

Predictors of Depression in Men With Peyronie's Disease Seeking Evaluation

BackgroundPeyronie's disease (PD) has negative impacts on the psychosocial status of men including depression warranting clinical evaluation in up to 50% of men. AimTo examine predictors of depression in patients with early PD seeking evaluation. MethodsAll PD patients at a high-volume PD practice underwent screening and curvature assessment after intracavernosal injection. Complex deformity was defined as any degree of multiplanar curvature, curvature >60 degrees, or presence of hourglass deformity. Men completed the PD questionnaire (PDQ), a validated depression questionnaire (CES-D) as well as the Self-Esteem and Relationship (SEAR) questionnaire. Scores of ≥16 on CES-D were considered indicative of moderate/severe depression. Predictors of the presence of depression were defined using univariable and multivariable logistic regression. OutcomesDemographic, bother and curve related predictors of depression in men with PD. Results408 men completed all questionnaires. Mean age was similar between depressed and nondepressed groups (57 ± 10 years overall, P = .60 between groups). Proportions of erectile dysfunction were similar between groups (P = .96). Mean PD duration was similar between groups (19 ± 35 months overall, P = .46 between groups). Mean degree of curvature was 38 ± 2 degrees in the depressed vs 33 ± 1 degrees in the nondepressed groups (P = .03). A complex deformity was seen in 64.5% in the depressed vs 61.5% in the nondepressed (P = .56). A total of 110 (27%) patients had CESD scores ≥16. 74% depressed men were in relationships compared to 84% nondepressed men (P < .01). Other characteristics including bother, pain, duration of disease, curve complexity and instability were similar between the two groups. On univariable analysis, factors protective against depression included being partnered (OR 0.42, 95%CI 0.24–0.75, P < .01) and higher total SEAR scores (OR 0.95, 95%CI 0.94–0.97, P < .01). Elevated PDQ domain scores were associated with depression (Psychologic Symptoms 1.05, 95%CI 1.02–1.10, P < .01; Pain 1.08, 95%CI 1.03–1.12, P < .01; Bother 1.11, 95% CI 1.05–1.68, P < .01) as well as baseline history of depression (OR 2.93, 95%CI 1.67–5.14, P < .001). On multivariable analysis, only total SEAR score remained protective against depression (OR 0.96, 95%CI 0.94–0.97, P < .001). Clinical ImplicationsProviders must recognize that men with PD seeking evaluation have meaningful rates of depression for which early recognition is necessary. Strengths and LimitationsRetrospective review of a large prospectively collected dataset from a single center of men with PD utilizing a validated screening tool for depression. ConclusionWhile no significant demographic, bother or curve related factors predicted depression in early PD men seeking evaluation, it remains a significant problem warranting further prospective evaluation.P. Nahid, N. Bruno, S. Carolyn, et al. Predictors of Depression in Men With Peyronie's Disease Seeking Evaluation. J Sex Med 2021;18:783–788.

Evaluating the Impact of Penile Girth Discrepancy on Patient Bother in Men With Peyronie's Disease: An Observational Study

BackgroundMen with Peyronie's disease (PD) may experience penile narrowing. Little data on penile girth changes and their psychosocial impact exist. AimTo assess girth discrepancy in men with PD and its association with patient bother. MethodsThis was a retrospective observational study. All patients with PD at our institution who were seen in the sexual medicine clinic and who completed 3 validated instruments the PD questionnaire (PDQ), Self-Esteem and Relationship (SEAR) questionnaire, and a depression questionnaire, the Center for Epidemiologic Studies Depression Scale (CES-D), and a curvature assessment were included. Patient and PD characteristics are described. Associations of instability and bother to girth differences are assessed. 2 outcomes for girth differences are classified as (i) girth difference of ≥ 1 cm vs less and (ii) girth differences of ≥10% vs less. Unadjusted and adjusted effects of PD and patient characteristics are assessed on the outcome of high bother using logistic regression models. OutcomesThe main outcomes of this study were penile girth changes, instability, and questionnaire scores. High bother was defined as a PDQ bother score of ≥9. ResultsA total of131 men had midshaft curvature and were the focus of the study. Their mean age was 59 ± 9 (range 31–78) years. PD duration was 16 ± 25 (range 1–180) months, with a mean degree of primary curvature of 37 ± 20o. Mean girth difference between base and point of maximum curvature was 0.78 ± 0.53 cm equating to a mean girth difference at point of maximum curvature of 6 ± 4%. Instability was present in 53% of men. There were 54 men with a girth difference of ≥ 1 cm and 23 men with a ≥10% change in girth. There was no difference in CES-D, SEAR, or PDQ domain scores or high bother in men with significant girth changes. Univariable analysis of predictors of high bother included the degree of curvature (odds ratio [OR]: 1.06; P < .001), instability (OR 6.62; P < .001), CES-D sum (OR 1.09; P = .002), and SEAR score (OR 0.96; P = .001). On multivariate analysis, only the degree of primary curvature was predictive of high bother (OR 1.06; P < .001). Clinical ImplicationsPenile girth changes have little impact on overall psychosocial well-being. The degree of penile curvature is the primary predictor of patient bother. Strengths and LimitationsStrengths include a large patient population and use of validated questionnaires. Limitations include single-center, retrospective study and subjective instability grading. ConclusionsPenile girth discrepancy in men with PD has limited psychosocial impact. Clinically significant bother was associated with the degree of primary curvature.Salter CA, Nascimento B, Terrier, JE, et al. Evaluating the Impact of Penile Girth Discrepancy on Patient Bother in Men With Peyronie's Disease: An Observational Study. J Sex Med 2020;17:1560–1565.

The Relationship and Psychosocial Impact of Arousal Incontinence After Radical Prostatectomy

IntroductionArousal incontinence (AI) is a lesser known complication of radical prostatectomy (RP), and few data are available on its impact on self-esteem and sexual relationships. AimThe goal of this study was to assess the impact of AI on patient self-esteem, confidence, and sexual relationships. MethodsThis was a retrospective study. The validated Self-Esteem and Relationship (SEAR) questionnaire, as well as questions regarding AI, stress urinary incontinence (SUI), climacturia, International Prostate Symptom Score, and the International Index of Erectile Function erectile function domain, were sent to men who had undergone an RP within the past 24 months at a single institution. The data were de-identified and analyzed using descriptive statistics. OutcomesThe outcomes of this study include prevalence of AI, SEAR domain scores, patient and partner bother, management strategies employed by the patients, and the presence of concurrent climacturia or SUI. ResultsFifty-three percent of men experienced post-operative AI; of these, 41% were currently experiencing AI, and 12% reported having prior AI that had resolved. Bother of any severity was reported by 87% of men, and perceived partner bother was reported by 64% of men. Forty-one percent of men with current AI avoided sexual activity due to the presence of AI, and 14% of men with prior AI still avoided intercourse. There was no difference in total SEAR score or in the subdomains of self-esteem, sexual relationship, or confidence between men with current AI compared to those with no AI. Clinical ImplicationsAI leads to patient bother and avoidance of sexual situations. Strengths & LimitationsThis is the largest study specifically evaluating AI and the only study assessing its impact on self-esteem, sexual relationships, and self-confidence. Limitations include lack of a validated AI questionnaire, poor survey response rate, being a single-center study, and the potential for recall bias. ConclusionAlthough AI is a common occurrence post-RP and is associated with patient bother in the majority of men, it does not impact overall self-esteem, confidence, or sexual relationships compared to post-RP men who have not experienced AI.Salter CA, Bach PV, Katz D, et al. The Relationship and Psychosocial Impact of Arousal Incontinence After Radical Prostatectomy. J Sex Med 2020;17:94–98.

PD31-05 THE DEPRESSION AND RELATIONSHIP IMPACT IN PEYRONIE'S DISEASE STUDY (DRIPD): BASELINE POPULATION CHARACTERISTICS AND PREDICTORS

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie’s Disease I1 Apr 2017PD31-05 THE DEPRESSION AND RELATIONSHIP IMPACT IN PEYRONIE'S DISEASE STUDY (DRIPD): BASELINE POPULATION CHARACTERISTICS AND PREDICTORS Jean-Etienne Terrier, Lawrence C Jenkins, Christian J Nelson, and John P Mulhall Jean-Etienne TerrierJean-Etienne Terrier More articles by this author , Lawrence C JenkinsLawrence C Jenkins More articles by this author , Christian J NelsonChristian J Nelson More articles by this author , and John P MulhallJohn P Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1383AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a growing body of literature focusing on the impact PD on men's mental health and relationships. Aim: to assess the impact of PD on men's psychological and relationship health. METHODS Patients were administered 3 validated questionnaires at presentation: the Self-Esteem and Relationship (SEAR) questionnaire includes 5 components, scores standardized by transforming onto a scale of 0-100, higher scores being more favorable; the Center for Epidemiologic Studies Depression Scale (CES-D), with moderate and severe depressive symptoms were defined as >14 and >21, respectively; the Peyronie's Disease Questionnaire (PDQ) 3 domains, psychological & physical symptoms, pain, symptom bother. Multivariable analysis (MVA) was used to explore predictors of baseline scores. Factors entered into the model included: age, sexual orientation, degree of curvature; duration of PD at presentation, the presence of non-curvature deformity, patient reported loss of length, stretched flaccid penile length, pain, penile instability, and ability to penetrate. RESULTS Data from 204 men have been analyzed. Mean age = 56±12 years. Median PD duration = 9 months, mean curvature = 39±21 degrees, ED in 39%. 82% of patients were partnered with mean relationship duration=20 years. The mean penile length was 11 cms. 25% of the sample met the CES-D cut-off for depression: 13% moderate, 12% severe. Mean SEAR scores: total 54±24; sexual relationship 44±28 ; confidence 68±24; self esteem 68±25; overall relationship 70±30. These scores are similar to SEAR scores reported by men with moderate to severe ED. Mean PDQ scores: psychological & physical 11±6; pain 5±6; bother 7±4. Theses trends are similar to PDQ scores reported in the phase 3 Xiaflex studies (IMPRESS I & II). On MVA, higher CES-D scores were related to the inability to penetrate (β=0.18, p=0.04). Lower SEAR total scores were related to inability to penetrate (β=-0.30 p=0.01) and greater curvature (β=0.25, p=0.04). Higher PDQ Bother scores were related to greater curvature (β=0.33, p=0.02), and marginally related to perceived loss of penile length (β=0.24, p=0.06) and inability to penetrate (β=0.22 p=0.09). CONCLUSIONS The data reinforce the significant prevalence of depression as well as psychosexual and relationship health in degree to men with ED. Common predictors of psychological and relationship variables were inability to penetrate, greater curvature, and perceived loss of penile length. Quality of life questionnaires into clinical practice might benefit some patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e584-e585 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jean-Etienne Terrier More articles by this author Lawrence C Jenkins More articles by this author Christian J Nelson More articles by this author John P Mulhall More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Psychosocial outcomes after initial treatment of erectile dysfunction with tadalafil once daily, tadalafil on demand or sildenafil citrate on demand: results from a randomized, open-label study.

Initiation of ED treatment with a particular PDE5I may influence treatment-adherence and other outcomes. In this multicenter, open-label study, men with ED, naïve to PDE5I, were randomized to tadalafil 5 mg once-a-day (OaD; N=257), 10 mg on demand (PRN; N = 252) or sildenafil-citrate (sildenafil) 50 mg PRN (N = 261) for 8 weeks (dose adjustments allowed), followed by 16 weeks of pragmatic treatment (switching between PDE5I allowed). Primary outcomes (treatment-adherence) were reported previously. Here, we report effects on: Psychological and Interpersonal Relationship Scales, Self-Esteem and Relationship (SEAR) questionnaire, ED Inventory of Treatment Satisfaction (EDITS), International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP) and Global Assessment Questions (GAQ). Mixed-model for repeated measures and analysis of covariance were used to analyze changes from baseline; GAQ-responses were evaluated by logistic regression. Analyses were adjusted for treatment, country, ED-severity, baseline and baseline-by-treatment interaction. Patients randomized to tadalafil OaD or PRN reported greater improvement (least-square mean (s.e.) change) in Sexual Self-Confidence (OaD +0.90 (0.048), PRN +0.93 (0.050), vs +0.73 (0.049); P=0.006 and P=0.001) and Spontaneity (OaD +0.11 (0.035), PRN +0.13 (0.035), vs +0.02 (0.035); P = 0.044 and P = 0.010) compared with sildenafil. Improvements in GAQ and SEP responses, IIEF-EF, orgasmic function, sexual desire, overall satisfaction domains, SEAR and EDITS scores did not differ significantly between treatment groups.

Impact of a First Treatment with Phosphodiesterase Inhibitors on Men and Partners’ Quality of Sexual Life: Results of a Prospective Study in Primary Care

Phosphodiesterase type 5 inhibitors (PDE5is) as oral treatment for erectile dysfunction (ED) facilitate the management of ED in primary care. Still, compliance is low and general practitioners (GPs) do not always feel confident with this pathology. AIM.: The aim of this paper is to evaluate the impact of a first treatment with PDE5i on the patient and his partner and the management of ED by GPs. The Evaluation après traitement de la dyfonction erectile, du bien-êtré émotionnel d'un patient en fonction de la rigidité de son érection survey was a longitudinal, observational French study with prospective collection of data from the GP, the patient, and his partner at baseline and after 3 months of treatment. GPs benefited from a short educational session before starting the survey. The main outcome measures are the Erection Hardness Score (EHS), Self-Esteem and Relationship (SEAR) questionnaire, Index of Sexual Life (ISL), and Erectile Dysfunction Inventory of Treatment Satisfaction. A total of 478 men aged 19-80 years (mean 57 years) were included in the survey by 229 GPs. Before treatment, EHS was mostly grade 1 (28%) or 2 (44%). At the end of the survey, an improvement was reported for 88% of the patients and 58% achieved maximum score EHS 4 (penis completely hard and fully rigid). Mean SEAR scores significantly increased after 3 months for self-esteem, overall and sexual relationship, and more notably with greater improvement in EHS (P < 0.001). Improvement in partners' ISL scores was significantly higher with greater improvement in EHS (P < 0.001) and in SEAR score for self-esteem. The safety profile of PDE5i was good with few adverse events, mostly headaches. More than 80% of the participating GPs considered that the survey had changed their management of ED. After 3 months of treatment with PDE5i, a significant improvement in self-esteem was observed in patients with ED, associated with improvement in erection.

AB1357 Iris study: Impact of rheumatic diseases on sexuality

BackgroundSexual satisfaction is an important issue in everyday life of modern occidental societies. The quality of sexual life, self-esteem and relationship issues might be impaired in patients with chronic rheumatic...

Cumulative response curves to enhance interpretation of treatment differences on the Self‐Esteem And Relationship questionnaire for men with erectile dysfunction

What's known on the subject? and What does the study add? Studies on erectile dysfunction (ED) therapies rely heavily on patient-reported outcomes (PROs) to measure efficacy on treatment response. A challenge when using PROs is interpretation of the clinical meaning of changes in scores. A responder analysis provides a threshold score to indicate whether a change in score qualifies a patient as a responder. However, a major consideration with responder analysis is the sometimes arbitrary nature of defining the threshold for a response. By contrast, cumulative response curves (CRCs) display patient response rates over a continuum of possible thresholds, thus eliminating problems with a rigid threshold definition, allowing for a variety of response thresholds to be examined simultaneously, and encompassing all data. With respect to the psychosocial factors addressed in the Self-Esteem And Relationship questionnaire in ED, CRCs clearly, distinctly, and meaningfully highlighted the favourable profiles of responses to sildenafil compared with placebo. CRCs for PROs in urology can provide a clear, transparent and meaningful visual depiction of efficacy data that can supplement and complement other analyses. To use cumulative response curves (CRCs) to enrich meaning and enhance interpretation of scores on the Self-Esteem And Relationship (SEAR) questionnaire with respect to treatment differences for men with erectile dysfunction (ED). This post hoc analysis used data from all patients who took at least one dose of study drug and had at least one post-baseline efficacy evaluation in a previously published 12-week, multicentre, randomized, double-blind, placebo-controlled trial of flexible-dose (25, 50, or 100 mg) sildenafil citrate (Viagra) in adult men with ED who had scored ≤ 75 out of 100 on the Self-Esteem subscale of the SEAR questionnaire. CRCs were used on the numeric change in transformed SEAR scores from baseline to end-of-study for each SEAR component. The horizontal axis of the CRC represented change from baseline on the SEAR score, and the vertical axis represented the percentage of patients experiencing that change or greater. The differences between CRCs for the sildenafil group vs the placebo group were assessed using the Kolmogorov-Smirov test. For each of the SEAR components, there was essentially no overlap in the CRCs between the sildenafil group (n = 113) and placebo group (n = 115 or 116, depending on the component), showing that a greater percentage of sildenafil recipients compared with placebo recipients had a more favourable change across the spectrum of response thresholds (P ≤ 0.01). Previous research showed that a 10-point score increase is the minimal clinically meaningful improvement for most SEAR components. In the sildenafil vs placebo groups, a ≥10-point score increase occurred in 72 vs 37% of patients, respectively, on the Sexual Relationship Satisfaction domain, 71 vs 41% on the Confidence domain, 76 vs 49% on the Self-Esteem subscale, 60 vs 44% on the Overall Relationship Satisfaction subscale, and 75 vs 38% on the Overall score. With respect to the psychosocial factors addressed in the SEAR questionnaire, CRCs clearly, distinctly, and meaningfully highlighted the favourable profiles of responses to sildenafil compared with placebo. CRCs for patient-reported outcomes in urology can provide a clear, transparent, and meaningful visual depiction of efficacy data that can supplement and complement other analyses.

A Randomized Open‐Label Trial with a Crossover Comparison of Sexual Self‐Confidence and Other Treatment Outcomes Following Tadalafil Once a Day Vs. Tadalafil or Sildenafil On‐Demand in Men with Erectile Dysfunction

To compare Sexual Self-Confidence and other treatment outcomes following 8 weeks of treatment with tadalafil 5 mg once a day (OaD) vs. tadalafil 20 mg or sildenafil 100 mg as needed (pro re nata [PRN]) in patients with erectile dysfunction (ED). A randomized, open-label, crossover study in men ≥18 years of age with history of ED and satisfactory response to current oral phosphodiesterase 5 (PDE5) inhibitor PRN. Data were analyzed with a mixed effects model for crossover design. The primary outcome measure was the Sexual Self-Confidence domain of the Psychological and Interpersonal Relationship Scales (PAIRS) between tadalafil OaD and sildenafil PRN. SECONDARY OUTCOMES INCLUDED: Time Concerns and Spontaneity domains of PAIRS, and the Self-Esteem and Relationship (SEAR) scale. Men naive to tadalafil OaD were enrolled (N = 378), with 61-69% prior PDE5 inhibitor use. There were improvements in all PAIRS domains from baseline when comparing tadalafil OaD and PRN with sildenafil PRN (P < 0.001). The Sexual Self-Confidence domain improved from baseline and was 0.50 ± 0.78 following tadalafil OaD, 0.5 ± 0.72 for tadalafil PRN, and 0.39 ± 0.67 for sildenafil PRN. The difference in least-squares mean was 0.12 ± 0.04 (confidence interval [CI] = 0.04, 0.19; P = 0.001) between tadalafil OaD and sildenafil PRN and 0.01 ± 0.04 (CI = -0.06, 0.08; P = 0.872) between tadalafil OaD and tadalafil PRN. The Time Concerns domain score was lower with tadalafil OaD than tadalafil PRN (P < 0.001). There were no differences in SEAR scores between treatments. Tadalafil OaD and tadalafil PRN compared with sildenafil PRN demonstrated greater improvements in Sexual Self-Confidence, Time Concerns, and Spontaneity. There was no significant difference in Sexual Self-Confidence between tadalafil OaD and tadalafil PRN. Changes in SEAR, the erectile function domain of the International Index of Erectile Function, and the Erectile Dysfunction Inventory of Treatment Satisfaction scores from baseline to end point were similar.

A pilot study to evaluate the effects of vardenafil on sexual distress in men with obesity

There are no interventional studies on the impact of sexual distress (SD) in men with obesity. We investigated the effects of vardenafil (VAR) on SD in middle-aged (mean age 49 ± 8), healthy, obese men in the absence of premature ejaculation, ED or hypogonadism. After a 4-week run-in period, 20 men with high body mass index (BMI=40 ± 8) and SD at the Sexual Distress Esteem Questionnaire-Male (mean score 65 ± 20 AU) were randomized to receive either VAR 10 mg on demand (N=10) or matched-placebo (PLB, N=10). Primary endpoints were variations from baseline in the intravaginal ejaculatory latency time (IELT) measured by the stopwatch technique; secondary endpoints were variations from baseline in Self-Esteem and Relationship (SEAR) and Male Sexual Health Questionnaire-Ejaculatory domain (MSHQ-EjD) scores. VAR significantly improved IELT (P<0.0001), as well as SEAR (P<0.001) and MSHQ-EjD (P<0.005) scores, whereas no changes were observed after PLB. Interestingly, an inverse relationship between BMI and IELT was found in all the men studied (r(2)=0.37, P<0.001). SD in healthy obese men seems to be correlated mainly with inadequate ejaculatory control, especially in men with higher BMI. Our preliminary results suggest that treatment with VAR may improve ejaculatory control, thus ameliorating self-esteem and sexual performance in men with obesity.

The Psychosocial Impact of Penile Reconstructive Surgery for Congenital Penile Deviation

A variety of surgical techniques to correct congenital penile deviation (CPD) have been described. Although surgical outcomes have been reported, the impact of this treatment on sexual relationship, confidence, self-esteem, and sexual function has never been established. To assess the impact of surgical treatment for CPD on sexual relationship, confidence, self-esteem, and sexual function, employing validated instruments. The Self-Esteem and Relationship (SEAR) and International Index of Erectile Function (IIEF) questionnaires. Prospective, longitudinal, uncontrolled study of 32 men undergoing penile reconstructive surgery for CPD. Assessment of change in sexual relationship, confidence, self-esteem, and sexual function scores. Twenty (37.5%) patients had ventral and 12 (62.5%) had lateral curvature, mean magnitude was 37 +/- 12 degrees . Significant improvement in SEAR domains scores was observed in sexual relationship (82 vs. 40, P < 0.01), overall relationship (86 vs. 62, P < 0.01), and confidence (88 vs. 58, P < 0.001). While mean IIEF erectile function domain score was unchanged: 24 +/- 3.6 and 25 +/- 2.5, before and after surgery, respectively (P = 0.85), significant improvements were observed in the libido (8 vs. 5, P = 0.02) and satisfaction (22 vs. 15, P < 0.01) domains of the IIEF. Predictors of improvement in SEAR and IIEF scores were perceived complete straightening and penile length preservation. Penile reconstructive surgery for CPD is associated with significant improvements in overall relationship, sexual relationship, confidence, libido, and satisfaction, as reflected by higher scores in three of the four domains of the SEAR questionnaire and improvements in two of the four domains of the IIEF.

Quality of Erections in Men Treated with Flexible-Dose Sildenafil for Erectile Dysfunction: Multicenter Trial with a Double-Blind, Randomized, Placebo-Controlled Phase and an Open-Label Phase

Erectile dysfunction (ED) impacts erection hardness and compromises quality of life. Assess erection hardness and its correlation with sexual function, emotional well-being, and satisfaction (erection quality, intercourse, sex life, sexual relationship, and treatment). Men with ED were randomized to double-blind, flexible-dose sildenafil (25, 50, or 100 mg) or placebo (6 weeks) with open-label extension (6 weeks). Erection Hardness Score (EHS), Quality of Erection Questionnaire (QEQ), International Index of Erectile Function (IIEF), Self-Esteem And Relationship (SEAR) questionnaire, and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). A total of 307 men (mean [range] age, 45 [18-55] years) were randomized to sildenafil (N = 154) or placebo (N = 153). At the end of double-blind treatment, occasions with EHS 3 (hard enough for penetration but not completely hard) or 4 (completely hard) had increased by 40% +/- 3% for sildenafil vs. 11% +/- 3% for placebo (least squares mean +/- standard error; P < 0.0001); the estimated percentage of occasions with EHS 4 was 58% (95% CI, 52-65%) vs. 14% (95% CI, 10-19%) (odds ratio, 8.5; P < 0.0001). There was greater improvement in mean QEQ, IIEF, and SEAR scores (P < 0.0001), and more men were satisfied with sildenafil treatment (EDITS Index score >50: 90% vs. 49%). QEQ, IIEF, SEAR, and EDITS outcomes correlated positively with EHS 3 or 4, and with EHS 4 alone and were highest (no overlap of 95% CI vs. other EHS subgroups) in the subgroup with most frequent EHS of 4. In the group of men with ED treated with sildenafil, it was estimated that completely hard erections were achieved on 58% (95% CI, 52-65%) of occasions. Improvement in function, emotional well-being, and satisfaction was greatest in men with completely hard erections and correlated positively with other measures of hardness.

Comparison Between Sildenafil‐Treated Subjects with Erectile Dysfunction and Control Subjects on the Self‐Esteem And Relationship Questionnaire

Erectile dysfunction (ED) can negatively impact psychosocial measures of a patient's sexual life. To evaluate self-esteem, confidence, and relationships in men with ED, before and after treatment with sildenafil citrate (Viagra), with reference to controls without ED. Sildenafil-naïve patients with ED were enrolled in a 10-week, open-label, flexible-dose (25 mg, 50 mg, or 100 mg) trial of sildenafil. In a separate study, men without ED who did not take sildenafil also completed the Self-Esteem And Relationship (SEAR) questionnaire. In addition to traditional statistical testing, equivalency testing was applied to compare the ED group, before and after treatment, with the control group and to examine whether the ED group improved to normative ranges on the SEAR questionnaire after treatment (within half a standard deviation of the normative or control group mean). Baseline and end-of-treatment responses on psychosocial aspects of ED were measured with the validated SEAR. Mean SEAR scores between subjects with ED (N = 93, mean age 55.0 years) at baseline and control subjects without ED (N = 94, mean age 52.5 years) were statistically different from zero and not statistically equivalent. Conversely, mean SEAR scores between ED subjects after treatment and control subjects were statistically equivalent and not statistically different from zero. The results indicate that sildenafil is associated with normalization of relationships, confidence, and self-esteem in men with ED.