0022-5347/02/1685-2086/0 Vol.

168, 2086 –2091, November 2002

THE JOURNAL OF UROLOGY® Printed in U.S.A.
Copyright © 2002 by AMERICAN UROLOGICAL ASSOCIATION, INC.® DOI: 10.1097/01.ju.0000034365.57110.b7

PSYCHOLOGICAL IMPACT OF ERECTILE DYSFUNCTION: VALIDATION

OF A NEW HEALTH RELATED QUALITY OF LIFE MEASURE FOR
PATIENTS WITH ERECTILE DYSFUNCTION
DAVID M. LATINI,* DAVID F. PENSON,† HILARY H. COLWELL, DEBORAH P. LUBECK,*
SHILPA S. MEHTA,* JAMES M. HENNING* AND TOM F. LUE‡
From the Department of Urology and Urology Outcomes Research Group, University of California, San Francisco, San Francisco,
California, Departments of Urology, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle,
Washington, and TAP Pharmaceutical Products, Lake Forest, Illinois

ABSTRACT

Purpose: Male erectile dysfunction has a substantial impact on health related quality of life. We
examined the psychometric properties of 2 new scales created to measure the psychological
impact of erectile dysfunction.
Materials and Methods: Patients enrolled in a long-term study of men with erectile dysfunction
completed clinical and health related quality of life information at baseline and at 3 followup
points. The questionnaire incorporated a number of standard scales of psychosocial characteris-
tics as well as questions developed from comments made during focus groups of men with erectile
dysfunction and of their female partners. Principal components analysis was used to identify
underlying constructs in response to the new questions.
Results: A total of 168 men completed the baseline quality of life questionnaire. The principal
components analysis of the psychological impact of erectile dysfunction questions resulted in 2
new scales. Reliability was good with an internal consistency reliability of 0.91 for scale 1 and
0.72 for scale 2. Test-retest reliability was 0.76 and 0.66, respectively. Men reporting a greater
psychological impact of erectile dysfunction also reported greater impairment in functional
status, lower sexual self-efficacy, greater depression and anxiety at the last intercourse. Each
new scale significantly differentiated men with mild/moderate versus severe erectile dysfunction.
Conclusions: We developed 2 new scales to measure the psychological impact of erectile
dysfunction and they showed good reliability and validity. These new scales, named the
Psychological Impact of Erectile Dysfunction instrument, comprehensively capture
the psychological effect of erectile dysfunction on health related quality of life, which is not
adequately assessed by existing patient centered measures of erectile function.
KEY WORDS: penis; impotence; questionnaires; quality of life; psychology, medical

Erectile dysfunction has substantial impact on male qual-
ity of life. In addition to the impact on the sexual experience,
in many men erectile dysfunction creates psychological dis-
tress that affects their relationships with family and friends.1
In a study of a general measure of health related quality of
life men with erectile dysfunction reported significantly
worse results than normal respondents on measures of social
function, role limitations due to emotional problems and
emotional well-being.2 In another study men with erectile
dysfunction reported significantly lower physical and emo-
tional satisfaction, and lower general happiness than men in
the study without the condition.3
Unfortunately few available validated and reliable instru-
ments specifically measure the effect of erectile dysfunction
on health related quality of life. Most patient administered
questionnaires used for erectile dysfunction are measures of
symptoms and functional status or general psychological
Accepted for publication June 7, 2002.
Supported in part by TAP Pharmaceutical Products and Veterans
Affairs Puget Sound Health Care System, Seattle, Washington.
* Financial interest and/or other relationship with TAP
Pharmaceutical Products.
† Financial interest and/or other relationship with Pfizer, Boehr-
inger Ingelheim, Astra Zeneca and TAP Pharmaceutical
Products.
‡ Financial interest and/or other relationship with Bayer, Lilly,
ICOS, Pfizer, Pharmacia, TAP Pharmaceutical Products and
Upjohn.
2086
functioning.4 While these types of measures provide useful
information, they do not capture the wide impact of erectile
dysfunction on health related quality of life. Qualitative re-
search in men with the disease showed that an array of
emotional consequences of erectile dysfunction are not as-
sessed by current measures. Men with erectile dysfunction
have substantial damage to their self-image as males and as
sexual beings. They also report that erectile dysfunction im-
pacts not only the emotional intimacy of their primary rela-
tionship, but also daily interactions with women or other
potential partners.5, 6
To date only 2 instruments have specifically attempted to
assess the psychological effect of erectile dysfunction on
health related quality of life, namely the Quality of Life-Male
Erectile Dysfunction and Erectile Dysfunction Effect on
Quality of Life.7 Each has similar limitations. The most im-
portant limitation is that they provide a single score rather
than separate scores for subscales that measure the different
types of psychological impact of erectile dysfunction. In ad-
dition, 2 instruments word questions in the negative, which
assumes that erectile dysfunction is a problem in the respon-
dent and may bias results.
We developed a quality of life instrument that adequately
assesses the impact of erectile dysfunction on health related
quality of life, including subscales that measure different
facets of the psychological consequences of the condition.
This instrument, called the Psychological Impact of Erectile
 PSYCHOLOGICAL IMPACT OF ERECTILE DYSFUNCTION
Dysfunction (PIED), was developed as part of a larger longi-
tudinal study of quality of life in men with erectile dysfunc-
tion (see Appendix). We describe the process of item selec-
tion, data analysis and validation of the new scales.
METHODS
The Exploratory Comprehensive Evaluation of Erectile Dys-
function study. The Exploratory Comprehensive Evaluation of
Erectile Dysfunction data base is a longitudinal, observational
data base of prospectively collected data on outcomes in men
with erectile dysfunction. Participants were followed prospec-
tively for 12 months.
Participants: The study enrolled 207 men at 5 North American
academic medical centers and 1 Veterans Administration med-
ical center. Participants were men who were diagnosed with
primary or secondary erectile dysfunction, able to speak and
read English and had no sexual partners younger than age 18
years. Patients fulfilling study criteria were contacted by the
participating physician and asked to participate voluntarily in
the study. Participants received financial remuneration for par-
ticipating in the study. The human subjects review board at
each of the 6 study sites approved the study procedures.
Data Collection: Data were collected at a baseline visit and
at 3 followup points 3, 6 and 12 months after enrollment,
respectively. The baseline assessment done by the study phy-
sician included physical examination, erectile dysfunction,
medical and surgical history, body systems review and rele-
vant laboratory tests. Depending on the erectile dysfunction
and medical history participants received treatment for erec-
tile dysfunction (85%) or were scheduled for further assess-
ment after completing the baseline clinical information with
the physician.
After the baseline clinical assessment the participant was
asked to complete a health related quality of life question-
naire. The questionnaire included disease specific measures
of health related quality of life, including the ejaculation
domain of the Brief Male Sexual Function Inventory,8 Sexual
Self-Efficacy Scale9 and International Index of Erectile Func-
tion (IIEF).10 The questionnaire also included standard meas-
ures of depression (Beck Depression Inventory-Short Form11)
and anxiety (State-Trait Anxiety-Short Form12). A set of ex-
perimental questions was developed to address the psycho-
logical aspects of erectile dysfunction based on comments
made by patients with this disease and their partners who
participated in focus group discussions. These questions were
the basis of the PIED instrument described.
Followup health related quality of life questionnaires were
completed 3, 6 and 12 months after enrollment, and returned
by mail to the coordinating center for data entry. Followup
data collection instruments included the same health related
quality of life questions as at baseline with the addition of
questions on health resource use within the study period
irrespective of whether it was related to erectile dysfunction.
If participants revisited the urologist or used any other med-
ical services during the study period, relevant data from the
clinical visit was collected from the site.
Development of PIED scales. Item Identification: A study
staff member conducted 2 focus groups with 16 men with
erectile dysfunction recruited at 2 urology clinics as well as a
focus group of 9 women whose partners had erectile dysfunc-
tion, including some participants in the male focus groups.
Semistructured group interviews explored the impact of erec-
tile dysfunction on self-confidence, sexual satisfaction and
marital quality among other quality of life domains. Items
were constructed from comments made by focus group par-
ticipants using the same wording when possible.
Data Collection: Responses to the experimental set of ques-
tions were collected along with other health related quality of
life data at baseline, 3, 6 and 12 months, including 24 state-
ments that related to how erectile dysfunction may have
2087
impacted participants psychologically. Each statement had 5
possible responses with a score of 4 to 0, namely 4 —all of the
time, 3—most of the time, 2—some of the time, 1—a little of
the time and 0 —none of the time. Participants were asked to
indicate how often in the 4 weeks before questionnaire com-
pletion their emotions were described by each statement.
Data Analysis: Principal components analysis was done to
identify sets of items that were related to each other and
described different dimensions of the psychological impact of
erectile dysfunction. All 24 statements underwent the first
principal components analysis. Items that loaded at least 0.5
on the first component were further analyzed to determine
the internal reliability of the items as a possible scale. Items
were removed from the potential scale when they detracted
from the internal reliability of the scale. Items that were not
retained on the first scale were then submitted to a second
principal components analysis and the resulting scale was
pruned as described. This process was repeated until no
further scales with adequate internal reliability could be
identified.
Scales were created by summing items that loaded on a
particular component. Scale scores were created if at least
80% of the items loading on that scale were completed by a
respondent. For respondents who had at least 80% of the
items completed but were still missing some items a value for
the missing items was imputed using the mean score for the
nonmissing items on that scale. After the items were
summed the scale scores were transformed into T scores
(mean plus or minus SD 50 ⫾ 10).
Psychometric Analysis: Reliability (accuracy of meas-
urement) was determined by examining the internal consis-
tency of the new scales with Cronbach’s coefficient ␣.13
Coefficient ␣ scores are between 0 and 1 with 0.7 usually
used as the minimum desirable score.14 Another type of re-
liability relates to the stability of scores for the same person
tested at different time points, known as test-retest reliabil-
ity.15 The shortest interval available for calculating the test-
retest correlation in this study was 3 months, which was
longer than in many health related quality of life studies but
still provided useful information about the stability of scores
with time. The intraclass correlation coefficient is 0 to 1 with
a coefficient of at least 0.5 most desirable.
Validity or evidence to confirm the conclusions drawn from
the instrument also has more than 1 component. Discriminant
validity refers to the relationship of scale scores and some other
characteristic on which respondents are known to differ.16 It
was hypothesized that PIED scores would be positively associ-
ated with patient perceived disease severity (mild, moderate or
severe), meaning that men reporting more severe erectile dys-
function would also report greater psychological impairment. It
was also hypothesized that PIED scores would be negatively
associated with sexual self-efficacy, overall sexual satisfaction
(IIEF) and intercourse satisfaction (IIEF). Convergent validity
refers to the hypothesized relationship of scale scores and other
measures shown to be related in previous research. Based on
earlier research on erectile dysfunction it was hypothesized that
PIED scores would correlate more highly with depression and
anxiety at the last intercourse.
Variability refers to the extent to which the full range of
item responses and scale scores are reported in the data.
Optimal variability suggests patient responses at each end of
the scale as well as the middle. Scales that are skewed
positively or negatively tend to be less responsive to changes
in therapy or disease progression.17 Descriptive statistics on
the new scales were calculated and response variability was
examined.
RESULTS
Sample characteristics. A total of 168 men completed the base-
line health related quality of life questionnaire. Participants
2088 PSYCHOLOGICAL IMPACT OF ERECTILE DYSFUNCTION

were categorized with mild, moderate or severe erectile dys- tional life. Although some remaining items appeared concep-
function based on the baseline self-report. For analysis pur- tually similar, further examination of the remainder yielded
poses the small number of men with mild or moderate erectile no interpretable components with acceptable internal consis-
dysfunction were combined into 1 group and comparisons were tency.
made of the 55 with mild/moderate and the 113 with severe Variability. To examine the variability of PIED scales in
disease. Participants were primarily middle-aged, white and this sample we calculated the descriptive statistics for the
well educated with a mean age of 57.4 years and 74% were raw nonstandardized scores on each scale (table 2). Scores
married. No significant differences were observed in men with were fairly well distributed. No obvious skewness in response
mild/moderate and severe erectile dysfunction except for the was detected.
level of education. Men with severe erectile dysfunction re- Reliability. The reliability of the 2 new scales was evalu-
ported significantly higher levels of education (chi-square test ated by calculating the Cronbach coefficient ␣ for each scale
13, 5 df, p ⬍0.05). using data from all men at baseline and by calculating test-
Most participants reported that erectile dysfunction was retest reliability in a subsample of 144 men with data avail-
severe (67%), more than 1 year in duration (69%) and always able at baseline and 3-month followup. The 2 new scales
present (84%) (table 1). Not surprisingly those with more performed well. For the impact of erectile dysfunction on the
severe disease were significantly more likely to report that sexual experience test-retest reliability was 0.76. For the
disease was always present (chi-square test 28.2, 2 df, impact of erectile dysfunction on emotional life reliability
p ⬍0.0001). Many participants reported previous treatment was 0.66.
for erectile dysfunction, primarily oral therapy (52%) such as Validity. To examine the validity of PIED measures we
sildenafil citrate. calculated the correlations of PIED scores with measures of
Scale construction. Data on all 168 men with health related disease specific health related quality of life and psychologi-
quality of life data at baseline were used in the principal cal characteristics that have been shown in the literature to
components analysis. The majority of the items loaded on be related to erectile dysfunction (table 3). Correlations were
1 component that accounted for 33.9% of the variance. Inter- in the expected direction. PIED scales, on which higher
nal consistency of the items loading on the first component scores indicate a greater negative impact of erectile dysfunc-
was examined by calculating item intercorrelations and the tion, significantly correlated negatively (⫺0.23 to ⫺0.61)
Cronbach coefficient ␣. Items less closely related to the larger with all 7 disease specific measures of health related quality
group of items were discarded, which resulted in an 11 item of life, on which higher scores indicate more positive func-
scale with a coefficient ␣ of 0.91 describing the psychological tioning. On the 2 measures of psychological functioning that
impact of erectile dysfunction on the sexual experience. were shown to be related to erectile dysfunction in past
Higher scores represented a greater negative impact on the research PIED scores correlated positively, indicating that
patient sexual relationship. men reporting a greater psychological impact of erectile dys-
All items not loading on the sexual experience component function also reported more depression and more anxiety at
were included in second principal components analysis. The the last intercourse.
first component accounted for 21% of the variance and in- We hypothesized that PIED scale scores should differ sig-
cluded 5 items. The Cronbach coefficient ␣ for the scale was nificantly in men who reported mild or moderate and more
0.72 and the items had adequate intercorrelations. The scale severe erectile dysfunction. That hypothesis was supported
score of these 5 items was calculated per patient with higher (table 4). Significant differences were noted on each PIED
scores reflecting a greater negative impact on patient emo- scale. Scores were in the expected direction with significantly
higher scores in men reporting severe erectile dysfunction,
indicating more negative psychological impact of the disease
TABLE 1. Clinical characteristics of patients at baseline on sexual experiences and emotional life.
Characteristic Overall Mild/Moderate Severe
No. pts. 168 55 113 DISCUSSION
No. erectile dysfunction onset (%): In the past studies of the impact of erectile dysfunction on
New (within last 3 mos.) 9 (5) 2 (4) 7 (6)
Recently (greater than 3 mos. ago 43 (26) 15 (27) 28 (25) quality of life have focused primarily on functional status and
but less than 1 yr.) failed to capture the broader impact of this condition on
Long standing (greater than 1 yr.) 112 (67) 38 (69) 74 (65) patient daily existence. The primary reason has been the lack
Problematic since first sexual ac- 4 (2) 0 4 (4) of a patient centered instrument that adequately captures
tivity
No. erectile dysfunction frequency the effect of erectile dysfunction on patient emotional and
(%):* psychological health in addition to functional status. Using
Episodic 7 (4) 2 (4) 5 (4) data from a longitudinal observational study of 168 North
Intermittent 20 (12) 17 (31) 3 (3) American men with erectile dysfunction we report the devel-
Always 141 (84) 36 (65) 105 (93)
No. erectile dysfunction etiology opment and validation of a new erectile dysfunction specific
physician assessment (%): health related quality of life instrument that comprehen-
Psychogenic 14 (8) 6 (11) 8 (7)
Neurogenic 20 (12) 4 (7) 16 (14)
Vasculogenic 35 (21) 13 (24) 22 (19)
Penile/cavernous 13 (8) 6 (11) 7 (6) TABLE 2. Descriptive statistics of raw baseline scores on PIED
Hormonal 4 (2) 2 (4) 2 (2) scales
Multiple etiologies 81 (48) 23 (42) 58 (51)
No. erectile dysfunction therapy (%): Erectile Dysfunction Impact Scale
Current 42 (26) 18 (33) 24 (22) Sexual Experience Emotional Life
Previous* 87 (53) 21 (38) 66 (61)
No. therapy type (%):† No. pts. 165 162
Oral erectile 97 (52) 25 (52) 72 (52) Score:
Vacuum constriction devices 31 (17) 11 (23) 20 (14) Mean ⫾ SE 17.6 ⫾ 0.79 7.3 ⫾ 0.3
Intracavernous injection 36 (19) 6 (13) 30 (22) Range 0–44 0–18
Intraurethral suppository 10 (5) 0 10 (7) Median 18 7
Oral herbal 5 (3) 3 (6) 2 (1) % Pts. possible score:
Hormone supplementation 5 (3) 3 (6) 2 (1) Lowest 3 1.9
Psychosexual counseling 2 (1) 2 (1) 2 (1) Highest 3 1.2
* p ⬍0.01. Higher scores indicate greater negative psychological impact of erectile
† More than 1 type possible per patient. dysfunction.
 PSYCHOLOGICAL IMPACT OF ERECTILE DYSFUNCTION
TABLE 3. Internal scale consistency scores and interscale correlations for erectile dysfunction quality of life questionnaires
Sexual Experience
␣ ⫽ 0.91
Sexual Self-Efficacy Scale ⫺0.57
IIEF:
Erectile function ⫺0.4
Intercourse satisfaction ⫺0.36
Orgasmic function ⫺0.32
Sexual desire ⫺0.36
Overall satisfaction ⫺0.53
Brief Male Sexual Function Inventory ejaculation ⫺0.24
State-Trait Anxiety at last intercourse 0.61
Beck Depression Inventory 0.56
TABLE 4. Baseline scale scores according to patient reported
severity of erectile dysfunction
Erectile Dysfunction Impact Scale* Severe t Test
No. pts. 108
Mean sexual experience ⫾ SE 52.2 4.2
Mean emotional life ⫾ SE 52.1 4.1
p ⬍0.0001.
* Mild/moderate (mean 45.9) in 55 patients.
sively measures the psychological impact of erectile dysfunc-
tion, that is the PIED scales. When combined with existing
functional scales in erectile dysfunction such as the IIEF, the
PIED scales broadly capture the impact of erectile dysfunc-
tion on health related quality of life.
The new scales measure 2 dimensions not assessed by
other instruments, namely the impact of erectile dysfunction
on the sexual experience and on patient emotional life. While
other, more general scales of psychological functioning have
been used to measure constructs such as depression, the 2
new scales address the patient psychological state as he
perceives it to be impacted by erectile dysfunction. These
scales provide useful new tools for assessing disease specific
health related quality of life in men who present with erectile
dysfunction as a primary complaint or who present with
other conditions, such as prostate cancer or diabetes, which
frequently result in erectile dysfunction. The new scales are
relatively brief and easy to use, making them attractive not
only to researchers, but also to clinicians, who can apply the
new instrument to determine whether a given therapy for
erectile dysfunction is actually benefiting a patient.
Our results show that the PIED scales are reliable and
valid. Each scale was internally consistent. Test-retest reli-
ability was also good. The scales were valid and discrimi-
nated men with mild/moderate versus severe erectile dys-
function. The hypothesized relationships of the new scales to
existing measures of functional status and sexual self-
efficacy were confirmed since men reporting a greater psy-
chological impact of erectile dysfunction also reported greater
impairment in functional status and sexual self-efficacy.
Those with higher scores on the measures of depression and
anxiety at the last intercourse also reported a greater psy-
chological impact of erectile dysfunction.
Earlier instruments have attempted to capture the psycho-
social impact of erectile dysfunction on health related quality
of life. For example, Wagner et al developed the Quality of
Life-Male Erectile Dysfunction7 and MacDonagh et al re-
cently developed a similar instrument, namely the Erectile
Dysfunction Effect on Quality of Life.17 Each generates a
single summary score. The newly developed PIED scales
represent a significant advance of the previous instruments,
in that they capture the multidimensional nature of the
psychological consequences of erectile dysfunction by gener-
ating 2 subscale scores. While scores on the 2 PIED scales
correlated highly in the current sample, it is likely that some
men may be affected more in 1 area than in another. For
example, men in a committed relationship may experience a
2089
Emotional Life
p Value ␣ ⫽ 0.72 p Value
⬍0.0001 ⫺0.51 ⬍0.0001
⬍0.0001 ⫺0.34 ⬍0.0001
⬍0.0001 ⫺0.34 ⬍0.0001
⬍0.0001 ⫺0.23 ⬍0.01
⬍0.0001 ⫺0.31 ⬍0.0001
⬍0.0001 ⫺0.47 ⬍0.0001
⬍0.01 ⫺0.21 ⬍0.01
⬍0.0001 0.5 ⬍0.0001
⬍0.0001 0.6 ⬍0.0001
different effect of erectile dysfunction on health related qual-
ity of life than those without a regular partner. Men in the
former group have an established relationship in which in-
sertive sexual activity may be only a part, while those in the
latter group may have fewer opportunities for sexual rela-
tions or believe that they must prove themselves by achieving
erection with a new partner.18 Only a multidimensional in-
strument such as the PIED scales with its 2 subscales cap-
tures the different psychosocial impact of erectile dysfunction
in these 2 groups.
While the PIED scales are useful research measures, they
also have clinical value. The instrument is well received by
patients and easy to use in the clinical setting. For clinicians
the summary scores and responses to individual items may
provide useful discussion points with patients about the erec-
tile dysfunction experience. Particularly some PIED state-
ments may be an indication for referral to a mental health
professional for additional psycho-educational interventions.
PIED scales offer the clinician a method of assessing the
efficacy of erectile dysfunction therapy on a more comprehen-
sive level than the IIEF alone. In addition, the scales may be
useful for guiding additional intervention. Because of the
substantial correlation of PIED scales with measures of de-
pression and anxiety, it may be unnecessary to use separate
measures of those constructs unless they are one of the
primary outcomes of the research study or clinical treatment
administered. However, correlations with measures of sexual
function such as the IIEF were more modest, indicating that
measures of functional status should be used in addition to
the PIED scales.
While the new scales represent substantial enhancement
of our ability to measure health related quality of life in men
with erectile dysfunction, some limitations should be noted.
Recently published research confirms that men with erectile
dysfunction report substantial psychological distress, includ-
ing not only disruptions in intimate relationships, but also in
masculine self-concept and nonsexual relationships with
women.7 The PIED scales include questions that address
masculine confidence and nonsexual areas, such as negative
emotions related to the experience of having erectile dysfunc-
tion. A limitation of the current version of the instrument is
that it does not adequately capture some interpersonal dy-
namics described by Bokhour et al.5 Ongoing development
and refinement of the instrument is planned to address this
concern.
While the scales showed good convergent and discriminant
validity, no effort was made to assess criterion validity. An
approach to assessing criterion validity would have been to
compare scores on the PIED scales to physiological measures
of erectile functioning. No such objective measures of erectile
functioning were used. Instead the study relied on the
physician-patient assessment of erectile dysfunction severity
and on patient responses on the IIEF. Future research is
needed to confirm the criterion validity of the new instru-
ment.
2090 PSYCHOLOGICAL IMPACT OF ERECTILE DYSFUNCTION

CONCLUSIONS tioning or other erectile dysfunction specific health related

The measures in this study have been shown to be reliable
and valid scales for assessing disease specific health related
quality of life in men with erectile dysfunction. The 2 newly
developed scales address aspects of psychological functioning
not assessed by more general measures of psychological func-
quality of life measures. In addition to existing measures of
functional status, these new scales provide a more complete
picture of health related quality of life in men with erectile
dysfunction and may be useful to clinicians and researchers
alike.

APPENDIX: PSYCHOLOGICAL IMPACT OF ERECTILE DYSFUNCTION, VERSION 1.0

Over the past 4 weeks . . . (Please

check the response that fits best by
marking the box)
Most of Some A little None of
All of the
the of the of the the
time
time time time time
1. I am more irritable than I used 䊐 䊐 䊐 䊐 䊐
to be
2. At times, I have felt so devas- 䊐 䊐 䊐 䊐 䊐
tated by the performance of my
penis that I wanted to die
3. My erectile dysfunction makes 䊐 䊐 䊐 䊐 䊐
me feel like less of a man
4. I lack masculine confidence 䊐 䊐 䊐 䊐 䊐
5. I am easily frustrated by little 䊐 䊐 䊐 䊐 䊐
things
6. When I have trouble with my 䊐 䊐 䊐 䊐 䊐
erection, I feel disgusted by my
penis
7. I feel proud of my penis 䊐 䊐 䊐 䊐 䊐
8. My erectile dysfunction makes 䊐 䊐 䊐 䊐 䊐
me feel sexually unattractive
9. When I can’t have intercourse, 䊐 䊐 䊐 䊐 䊐
I don’t feel like having any sex
at all
10. Sex feels like it is not worth 䊐 䊐 䊐 䊐 䊐
the effort
11. I feel there’s something miss- 䊐 䊐 䊐 䊐 䊐
ing in my sex life when I can’t
have intercourse
12. I avoid sexual opportunities 䊐 䊐 䊐 䊐 䊐
13. I don’t quite believe my part- 䊐 䊐 䊐 䊐 䊐
ner(s) when they say they are
satisfied with my sexual per-
formance
14. I am afraid to touch my part- 䊐 䊐 䊐 䊐 䊐
ner in ways that will make her
want to have sex with me
15. I feel I could not sustain a new 䊐 䊐 䊐 䊐 䊐
relationship because of my
erectile dysfunction
16. My frustration over my erectile 䊐 䊐 䊐 䊐 䊐
dysfunction has a negative ef-
fect on my sexual relation-
ship(s)
Scoring instructions:
Scale 1) Psychological impact of erectile dysfunction on sexual experience. Score only if at least 8 of the 11 items
have been completed. Impute a value for missing items by assigning the mean value of the nonmissing items.
Calculate the sum of items 3, 4, 6, 8, 9, 10, 11, 12, 14, 15 and 16. Transform the summed score into a T score
(mean ⫾ SD 50 ⫾ 10). Higher scores indicate greater psychological impact.
Scale 2) Psychological impact of erectile dysfunction on emotional life. Reverse code item 7. Score only if at least 4
of the 5 items have been completed. Impute a value for missing items by assigning the mean value of the non-
missing items. Calculate the sum of items 1, 2, 4, 7 and 13. Transform the summed score into a T score (mean 50
⫾10). Higher scores indicate greater psychological impact.
PIED, Psychological Impact of Erectile Dysfunction, ©1999–2002 TAP Pharmaceutical Products Inc.
 PSYCHOLOGICAL IMPACT OF ERECTILE DYSFUNCTION
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3. Laumann, E. O., Paik, A. and Rosen, R. C.: Sexual dysfunction in
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4. Lenderking, W. R., Sweeney, S. L., Pashos, C. L. and Flanders,
S. C.: Measuring erectile dysfunction from the patient’s per-
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5. Bokhour, B. G., Clark, J. A., Inui, T. S., Silliman, R. A. and
Talcott, J. A.: Sexuality after treatment for early prostate
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