Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University.
Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
J Sex Med. 2021 Mar;18(3):440-447. doi: 10.1016/j.jsxm.2020.11.018. Epub 2020 Dec 29.
Patients with premature ejaculation (PE) are often diagnosed as having a comorbid erectile dysfunction (ED). When evaluating erectile function in PE patients with the popular International Index of Erectile Function-5 (IIEF-5, or Sexual Health Inventory for Men [SHIM]), question #5 (Q5) about sexual satisfaction in the intercourse often lowers the total score of the questionnaire, giving false-positive results for the presence of ED.
We aimed to compare SHIM with the other abridged form of IIEF, which is IIEF-EF, and to discriminate which tool has the best diagnostic accuracy in the evaluation of erectile function in PE patients.
The study was conducted from March 2019 to January 2020. A total of 189 heterosexual males with lifelong PE (117, 61.9%) or acquired PE (72, 38.1%) were included. They all compiled Premature Ejaculation Diagnostic Tool, IIEF-15, SHIM, and IIEF-EF and underwent a full clinical examination to evaluate their erectile function.
The scores of the 2 erectile function assessment questionnaires (SHIM and IIEF-EF) were compared in terms of their sensitivity and specificity in the diagnosis of ED in PE patients.
In terms of diagnosing ED in PE patients, the sensitivity of SHIM is 100% while the specificity is only 36%; meanwhile, the sensitivity of IIEF-EF is 100% but specificity is 77.2%. Further analysis demonstrates that decreasing cutoff of SHIM to 17.5 would provide an increased specificity of 82.5%, while sensitivity would lower to 96.0%. However, the highest area under the curve (0.966 vs 0.941) is given by the IIEF-EF with 100% sensitivity and 80.7% specificity at the cutoff of 24.5, which is one point lower than the usual cutoff value of 25.5.
Our study suggests that when evaluating erection function in PE patients, the cutoff of both SHIM and IIEF-EF should be amended.
STRENGTHS & LIMITATIONS: We proposed the solution for the bias of erectile function assessment in PE patients. However, other trials are needed to further validate in larger cohorts of PE patients.
We suggest that the cutoff of SHIM and IIEF-EF should be amended (SHIM at 17.5 and IIEF-EF at 24.5, respectively) when assessing erectile function among PE population. Xi Y, Colonnello E, Ma G, et al. Validity of Erectile Function Assessment Questionnaires in Premature Ejaculation Patients: A Comparative Study Between the Abridged Forms of the International Index of Erectile Function and Proposal for Optimal Cutoff Redefinition. J Sex Med 2021;18:440-447.
早泄（PE）患者常被诊断为合并勃起功能障碍（ED）。在使用国际勃起功能指数-5（IIEF-5，或男性性健康量表[SHIM]）评估 PE 患者的勃起功能时，第 5 个问题（Q5）关于性交时的性满意度常常降低问卷的总分，导致 ED 的存在出现假阳性结果。
我们旨在比较 SHIM 与其他缩短版的 IIEF，即 IIEF-EF，并区分这两种工具在评估 PE 患者勃起功能方面的诊断准确性。
本研究于 2019 年 3 月至 2020 年 1 月进行。共纳入 189 名患有终身性 PE（117 名，61.9%）或获得性 PE（72 名，38.1%）的异性恋男性。他们都填写了早泄诊断工具、IIEF-15、SHIM 和 IIEF-EF，并接受了全面的临床检查，以评估他们的勃起功能。
比较了 2 种勃起功能评估问卷（SHIM 和 IIEF-EF）的得分，以评估它们在 PE 患者 ED 诊断中的敏感性和特异性。
我们建议修改 SHIM 和 IIEF-EF 的截断值（SHIM 为 17.5，IIEF-EF 为 24.5），以评估 PE 患者的勃起功能。
当评估 PE 患者的勃起功能时，SHIM 的敏感性为 100%，特异性仅为 36%；而 IIEF-EF 的敏感性为 100%，特异性为 77.2%。进一步分析表明，将 SHIM 的截断值降低至 17.5 可将特异性提高至 82.5%，但敏感性将降至 96.0%。然而，截断值为 24.5 的 IIEF-EF 的曲线下面积最高（0.966 比 0.941），具有 100%的敏感性和 80.7%的特异性，比通常的 25.5 截断值低 1 分。
