International Journal of Impotence Research (2003) 15, 173–184

& 2003 Nature Publishing Group All rights reserved 0955-9930/03 $25.00
www.nature.com/ijir

Quality of Sexual Life Questionnaire (QVS): a reliable, sensitive

and reproducible instrument to assess quality of life in subjects
with erectile dysfunction
P Costa1*, B Arnould2, F Cour3, P Boyer3, A Marrel2, EO Jaudinot4 and A Solesse de Gendre4
1
Hôpital Gaston Doumergue, Service d’Urologie-Andrologie, Nı̂mes Cedex, France; 2Mapi Values, Lyon, France; 3Hôpital
Pitié Salpétrière, Paris, France; and 4Laboratoire Pfizer, Paris cedex, France

A French quality of life questionnaire specific to erectile dysfunction (ED), ‘QVS’ for ‘Questionnaire
de Vie Sexuelle’, has been developed. This paper describes its validation: item reduction and
reliability (internal consistency and reproducibility), construct validity and criterion validity
(clinical, discriminant and concurrent). The initial 40-item questionnaire was administered once to
316 ED and 117 control subjects, and twice (D0 and D7) to 104 ED and 29 control subjects. Item
reduction gave a 27-item questionnaire with three scales (Sexual Life, Skills and Psychosocial Well-
being) and four scores (one score for each scale and a Global Index). Psychometric analyses
demonstrated the reliability and the validity of the QVS. The questionnaire was able to discriminate
patients according to the presence or severity of ED. The Skills scale was the least sensitive.
Analysis of responsiveness to change over time still needs to be addressed to consider the
questionnaire as a fully validated instrument.
International Journal of Impotence Research (2003) 15, 173–184. doi:10.1038/sj.ijir.3900995

Keywords: erectile dysfunction (ED); quality of life (QOL); questionnaire; psychometric properties

Introduction ings may be limited by differences in methodologi-

Erectile dysfunction (ED) is defined by the National
Institute of Health (NIH) Consensus Panel on
Impotence as the ‘inability to attain or maintain
penile erection sufficient for satisfactory sexual
performance’.1 Although considered as a benign
disorder (not reducing life-expectancy), for many
men ED has specific psychosocial consequences
including depression, anxiety about sexual perfor-
mance, denial of symptoms, sexual avoidance or
relationship distress that finally impair their quality
of life (QOL).2–4 Moreover, even though an organic
component usually contributes to ED, psychological
aspects of self-confidence, anxiety or partner com-
munication and conflict are often important con-
tributing factors.1
Contemporary research has addressed the QOL
implications of ED for subjects and partners, using
different tools.5–21 However, the understanding,
validity and meaningfulness of the published find-
*Correspondence: Dr P Costa; Hôpital Gaston Doumergue,
Service Urologie, 5 rue Hoche, BP 26, 30029 Nimes Cedex
9, France.
E-mail: pierre.costa@chu-nimes.fr
Accepted 16 December 2002
cal approaches and in the characteristics of
instruments used for assessing QOL. Moreover,
instruments usually provide useful information for
diagnostic purposes and on treatment efficacy, but
fail to address subject-perceived psychosocial con-
cerns related to perception of ED.
A French expert committee has recently devel-
oped a new Quality of Sexual Life Questionnaire
(in French ‘Questionnaire de Vie Sexuelle’, QVS).
The strength and originality of this questionnaire
is that subjects were asked on perceived achieve-
ment, satisfaction and importance with regard
to each item measured. Moreover, QVS measures
the impact of ED on social life and well-being
in contrast with other questionnaires, which
usually focus on sexual function5–21 (Appendix 1).
Consequently, as the QVS is not only specific
to sexuality but also comprises a more general
part (social life, well-being), it can be used
in subjects without ED so as to compare
responses.
The objective of the present study was to test the
psychometric properties of this new questionnaire
in subjects suffering from ED or not, in order to
obtain a validated version of the questionnaire. Such
psychometric documentation is a prerequisite for
further use of the questionnaire as a scientific
assessment instrument.22,23
 Quality of sexual life questionnaire
P Costa et al
174
Subjects and methods
Subjects and study design
The study took place in France from August 1998 to
January 2000 and involved 83 investigators. Inves-
tigators (general practitioners, sexologists, androlo-
gists or urologists) were to verify presence or
absence of ED and to collect the sociodemographic
and clinical characteristics of the included subjects.
In all, three independent subjects samples were
recruited. The first sample comprised adult (418 y)
volunteer ED subjects, recruited during a clinical
trial. The second or reference sample consisted of
volunteer subjects without ED, age-matched to the
first sample. The third or reproducibility sample
consisted of adult volunteer subjects, with or with-
out ED, recruited in an observational study.
At baseline, all the subjects were to complete the
QVS and the International Index of Erectile Func-
tion (IIEF).12,13 On D7, sample-3 subjects were to
complete the QVS plus two items, one assessing
their global health status and one assessing the
impact of ED on their life, in order to check their
stability between the two visits. On D7, the
investigators were asked to check the stability of
the sample-3 subjects, using four questions.
All measures were taken to confer perfect patient
anonymity.
Questionnaires
The Quality of Sexual Life Questionnaire. The
pilot version of the QVS was developed after a
literature review, interviews with subjects and
expert input. It was constituted of 40 items: a global
question on the future (item 14) and 39 questions
corresponding to 13 items, each being rated accord-
ing to three sets of responses: (1) achievement, (2)
satisfaction and (3) importance.
For example, as regards the quality of ejaculation,
the following responses were to be rated by the
subjects: (1) ‘You think things are going: very badly,
fairly badly, neither well nor badly, fairly well, or
very well; (2) You are: very dissatisfied, somewhat
dissatisfied, indifferent, somewhat satisfied, or very
satisfied; (3) In your life you consider this to be:
unimportant, somewhat important, very important,
or extremely important’. Scale scores ranged from 0
(poor quality of life) to 100 (good quality of life).
The International Index of Erectile Function,
IIEF. The IIEF is a 15-item, self-administered
questionnaire scale developed in 10 languages,
including French, as an ED diagnosis tool for easy
use by physicians (mainly for clinical trials). It
International Journal of Impotence Research
explores five domains: erectile function (six items),
orgasmic function (two items), sexual desire (two
items), intercourse satisfaction (three items) and
overall sexual satisfaction (2 items).12,13 For each
scale, scores with lower values indicated greater
dysfunction.
Measurement properties
Data from the three samples were extracted when
appropriate according to the type of analysis
required. Briefly, quality of completion of the
questionnaires and psychometric properties were
analysed on data collected in subjects with ED
(samples 1 F clinical trial F and 3 F reproduci-
bility) except discriminant validity, which was
assessed on all the available data (samples 1, 2 F
reference F and 3) and reproducibility which was
assessed in the stable subjects of the reproducibility
sample. The feasibility of assessing QOL using a
self-administered questionnaire was evaluated by
the quality of completion of the questionnaire in the
target population. Quality of completion was as-
sessed by the percentage of fully completed ques-
tionnaires, the number of questionnaires with more
than 50% of missing data and the mean number of
missing data per questionnaire.
Factorial analysis using the principal component
method with Varimax rotation was performed in
order to study relations among items and to define
the operational version of the QVS.
Confirmation of the hypothesised scale structure
was performed using multitrait analysis24 (study of
item-scale relations through item-convergent, i.e.
correlation coefficients higher than 0.40 and
through item-divergent validity, i.e. percentage
of scaling success close to or at 100%25). The
reliability of the multiitem scales was examined
by the internal consistency Cronbach’s alpha
coefficient (minimum recommended value of the
coefficient is 0.7026).
Floor and ceiling effect measurements were also
performed to ensure that the score had the ability to
cover the full range of severity for the considered
scale and allowed identification of the subjects at
the extremes of the scale. A percentage lower than
20% at floor or ceiling was expected.
As regards clinical validity, the hypothesis was
that the more severe the subject’s condition, the
worse the QOL score. Subgroups of subjects suffer-
ing from ED were compared according to clinical
severity levels using item 3 (ability to penetrate your
partner) and item 4 (ability to maintain your
erection after you had penetrated your partner) of
the IIEF.
Concurrent validity was analysed through the
relations of QVS-specific scales to the IIEF scales
(Spearman’s correlation coefficients).

The reproducibility of the questionnaire was
tested using QOL results obtained on D0 and D7
(test–retest procedure) in the reproducibility sam-
ple. The aim was to check the stability of the scores
in clinically stable subjects. This was assessed using
intraclass (ICC) and concordance class (CCC) corre-
lation coefficients. The recommended minimum
value for the coefficients is 0.70–0.80.27,28 Assess-
ment of subject’s change was performed by the
investigator (four questions completed on D7), by
the subject himself (two items completed on D7) and
by the combination of the previous two criteria.
The ability of the QVS to discriminate between
subjects with and without ED was also explored
using all available data (samples 1–3) and matched
subjects with and without ED (samples 1 and 2).
Statistics
Statistical analyses were carried out by Mapi Values
(Lyon, France) using SAS software release 6.12
(Statistical Analysis System Institute, CARY, NC,
USA) and Multitrait Analysis Program (MAP-R for
Windows).
Sociodemographic characteristics and clinical
data were described for each sample of subjects.
As data were not always normally distributed,
nonparametric tests (Kruskal–Wallis test, Mann–
Whitney Wilcoxon test or Wilcoxon signed rank test
for paired test comparing a change to 0) were used to
test the relations. The significance level was set at
0.05.
As regards missing data in the questionnaires, if
their number was lower than half of the number of
the items of the score, they were replaced by means
of nonmissing values. Otherwise, the score was not
calculated.
Results
Subject characteristics
In all, 566 subjects entered the study: 316 subjects in
the clinical trial sample (sample 1), 117 in the
reference sample (sample 2) and 133 (104 and 29
with and without ED, respectively) in the reprodu-
cibility sample (sample 3).
In sample 1, subjects with ED were aged 55.3 y
(between 24 and 80 y), usually employed full-time
(55.7%) in managerial positions (44.6%). They were
suffering from ED usually of psychogenic (43%)
origin, for 4.3 y (s.d.: 75.0). In total, 42.4% of the
subjects had received at least one previous ED
treatment and 89.6% experienced at least one
chronic pathology, mainly genitourinary (50.9%),
gastrointestinal (37.5%), cardiovascular (36.0%), or
endocrine or metabolic (31.5%) disorders.
Quality of sexual life questionnaire
P Costa et al
175
In sample 2, subjects without ED were aged 54.5 y
(between 24 and 76 y), usually employed at full- or
part-time (62.4%) in managerial positions (44.4%).
In total, 54.7% experienced at least one chronic
pathology, mainly hypertension (37.5%), hyperlipi-
daemia (26.6%) or prostate disorder (23.4%).
In sample 3, subjects with ED were aged 57.7 y
(between 30 and 76 y) and usually retired (50.5%).
When employed, they usually had a managerial
position (26%). They had been suffering from ED
usually of mixed (50.0%) origin, for 3.3 y (s.d.:
73.60). In total, 41.4% had received at least one
previous ED treatment and 82.7% experienced at
least one chronic pathology, mainly prostate dis-
order (37.2%) or hypertension (27.9%).
In sample 3, subjects without ED were aged 43.1 y
(between 21 and 62 y). They were usually employed
full- or part-time (75.9%) in managerial positions
(27.59%). Four subjects (13.8%) experienced at least
one chronic pathology: noninsulin-dependent dia-
betes (two subjects) or hypertension (two subjects).
Quality of completion of the questionnaires
On D0, 73.0% of the subjects in sample 1 and 52.0%
in sample 3 fully completed the QVS; in sample 3,
60.2% did so 7 days later. The mean number (7s.d.)
of missing data per subject was 1.06 (73.02) in
sample 1 and 1.57 (7 2.57) on D0 and 1.38 (7 2.72)
on D7 in sample 3. Only one QVS questionnaire had
more than 50% of missing data (sample 1). Whatever
the sample or the day of completion, the item with
the highest incidence of missing data was that
related to work (item 11, ‘concerning your relation-
ships at work’).
On D0, 92.0% of the subject in sample 1 and
82.4% in sample 3 fully completed the IIEF. The
mean number of missing data per subject was 0.15
(7 0.63) for sample 1 and 0.61 (7 1.42) for sample 3.
No subject had more than 50% of missing data.
Item reduction and QVS factorial structure
The first step of the QOL analysis was item
reduction and determination of scoring rules in
order to obtain the questionnaire that was to be
subjected to psychometric validation (operational
questionnaire). The questionnaire structure was
assessed using principal component analysis (PCA)
with Varimax rotation and a free number of factors.
All the data issued from the 280 subjects with ED
having fully completed the QVS were used. The
variables included in the PCA were the 40 items of
the initial QVS.
The Achievement and Satisfaction items
always pertained to a common factor and Achieve-
ment items had slightly better properties than the
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 Quality of sexual life questionnaire
P Costa et al
176
satisfaction items regarding floor and ceiling effects.
Therefore, the Satisfaction items were excluded
from the operational structure of the QVS. After
PCA, analysis of the scale–scale correlations con-
firmed that the structure could be summarised
in three scales so as to calculate three scores:
Sexual Life (eight items), Skills (13 items) and
Psychosocial Well-being (six items). In addition,
one Global QOL Index was generated grouping
items from Sexual Life and items from Psychosocial
Well-being.
The operational version of the QVS was thus
constituted of 27 items (Appendix 2): 13 questions
with two sets of responses (on Achievement and
Importance) and the global item.
Distribution of scores and internal consistency of
QVS scales
Table 1 presents baseline QVS and IIEF scores for all
samples. As regards QVS, all the scores (except the
Skills scale score) were lower in ED subjects than in
subjects without ED, indicating that ED subjects had
lower QOL than subjects without ED. The difference
was particularly important for the Sexual Life score
and the Global Index: scores being lower than 50 in
subjects with ED and higher than 75 in subjects
without ED. As regards IIEF, all the scores were
lower in ED subjects than in subjects without ED,
confirming the presence of ED.29
The operational QVS version was analysed
using the data of 284 subjects with ED (samples 1
and 3) and having completed the questionnaire
without missing data. Results are summarised in
Table 2. Briefly, the analyses revealed (a) that all
item-scale correlation coefficients were above 0.40,
indicating good convergent validity; (b) that the
scaling success was very good, varying between 91.7
and 100% and (c) that the internal consistency was
satisfactory, all the Cronbach alpha coefficients
exceeding the minimum recommended reliability
standard (ie, 0.70). Moreover, neither relevant (ie:

20%) floor nor ceiling effects were observed
(Table 2).

Table 1 QVS and IIEF scores at baseline in the three samples of subjects

Sample 1 Sample 2 Sample 3

Clinical trial Reference Reproducibility

Demographic characteristic N=316 N=117 N=104 N=29

Clinical characteristic With ED Without ED With ED Without ED

QVS: mean 7 s.d.

Sexual Life (SL) 36.69719.59 78.22714.37 39.15720.37 85.49710.35
Skills (SK) 56.71717.33 54.80719.20 55.39720.97 65.04719.62
Psychosocial Well-being (WB) 61.55715.74 76.36711.72 62.59717.31 77.26712.35
Global Index (GI) 47.27715.68 77.40711.55 49.07716.51 81.9679.79

IIEF: mean 7 s.d.

Erectile function 12.3377.30 F 12.3377.61 28.8671.43
Orgasmic function 5.8573.50 F 5.2073.51 9.8670.76
Sexual desire 6.7671.83 F 5.6872.21 7.9370.86
Intercourse satisfaction 6.3073.98 F 5.9473.95 12.8671.90
Overall satisfaction 4.5872.61 F 4.6472.51 9.5471.00

Scores varied from 0, poor quality of life to 100, good quality of life for the QVS and from 0, bad function to 10 (orgasmic function, sexual
desire and overall satisfaction), to 15 (intercourse satisfaction) or to 30 (erectile function), good function for the IIEF.

Table 2 QVS construct validity summary and internal consistency in subjects with erectile dysfunction

Scales

Sexual Life Skills Psychosocial Well-being

Number of items 8 13 6
Range of Spearman correlation coefficients 0.50– 0.71 0.41– 0.79 0.41– 0.66
Item convergent validitya 8/8 13/13 6/6
Item discriminant validity (scaling success)b 100% 100% 91.7%
Internal consistency reliabilityc 0.87 0.91 0.78
Floor effect (% at floor) 3.9 0.0 0.4
Ceiling effect (% at ceiling) 0.0 1.4 0.0

a
Number of items with correlation coefficient to their own scale Z0.40 vs the total number of item in the scale.
b
Percentage of cases in which the items of the scale are more correlated to their own scale than the other scales.
c
Cronbach’s alpha coefficient.

International Journal of Impotence Research


Clinical and concurrent validity
The Global Index, the Psychosocial Well-being and
the Sexual Life scales significantly discriminated
subjects according to clinical severity as assessed by
items 3 and 4 of the IIEF (Spearman correlation
coefficients, P ¼ 0.0001), while the Skills scale did
not (P ¼ 0.2472 for IIEF item 3 and P ¼ 0.8836 for
IIEF item 4). The Sexual Life and the Global Index
were highly correlated with the IIEF items 3 and 4
(Spearman correlation coefficients 40.40), whereas
the Psychosocial Well-being scale was only moder-
ately correlated (Spearman correlation coefficients
about 0.20).
Clinical validity results are shown in Figures 1
and 2: the greater dysfunction, the lower the QVS
scores for all the scales except the Skills scale. As
regards the Skills scale, subjects with severe
dysfunction (never or almost never, or a few times)
had higher scores than subjects with moderate
dysfunction (sometimes or most of the time). These
results were confirmed by the statistical analyses
that showed that the difference in the distribution of
the scores according to the response choice for items
3 and 4 of the IIEF was significant (Kruskal–Wallis
test, Po0.05) for all the scales except for the Skills
scale (Kruskal–Wallis test, P ¼ 0.5446 for item 3 and
0.1165 for item 4).
The analyses of the relations between the QVS
and the IIEF scales showed that the IIEF dimensions
were moderately to highly correlated with the
Sexual Life scale (Spearman correlation coefficients
between 0.26 and 0.61, P ¼ 0.0001); moderately to
100
80
0.0001*
60
score
40
20
0
SL
never or almost never (n=100) a few time (n=68)
Figure 1 QVS scores according to the severity of the ED assessed by means of IIEF item 3 (When you attempted sexual intercourse, how
often were you able to penetrate your partner?) Missing data and non-concerned patients were excluded from the graph. * Kruskal–Wallis
test, P-value. SL: Sexual Life; SK: Skills; WB: Psychosocial Well-being; GI: Global Index.
Quality of sexual life questionnaire
P Costa et al
177
highly correlated with the Global Index (Spearman
correlation coefficients between 0.25 and 0.60,
P ¼ 0.0001); moderately correlated with the Psycho-
social Well-being scale (Spearman correlation coef-
ficients between 0.17 and 0.36, Po0.05) and slightly
correlated with the Skills scale (Spearman correla-
tion coefficients between 0.05 and 0.21, P40.05).
Reproducibility
Subject’s change was assessed by the investigator (four
questions on D7), by the subject (two questions
administered on D7) or both by the investigator and
the subject. When stability was assessed both by the
investigator and the subject, high intraclass correlation
coefficients (40.70) were found for the three scales
(Sexual Life: 0.79; Skills: 0.87; Psychosocial Well-
being: 0.74) and the Global Index (0.81), indicating
that the test–retest reproducibility of the QVS was
good in subjects with ED. Similar results were
obtained with the other two definitions of stability.
Discriminative power as between subjects with and
without ED
The relation between the QVS scores and the
presence/absence of ED was studied using data from
all the samples (N ¼ 555 available data). There was a
highly significant difference (Wilcoxon–Mann–
Whitney, P ¼ 0.0001) at baseline between subjects
with and without ED for the Sexual Life and the
IIEF: item 3
0.5446* 0.0001* 0.0001*
SK WB GI
QVS scales
sometimes (n=77) most times (n=51) always or almost always (n=48)
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 Quality of sexual life questionnaire
178
100
80
0.0001*
60
score
40
20
0
SL
never or almost never (n=123)
Figure 2 QVS scores according to the severity of the ED assessed by means of IIEF item 4 (During sexual intercourse, how often were
you able to maintain your erection after you had penetrated your partner?) Missing data and non-concerned patients were excluded from
the graph. *Kruskal–Wallis test, P-value. SL: Sexual Life; SK: Skills; WB: Psychosocial Well-being; GI: Global Index.
Psychosocial Well-being as well as for the Global
Index. No significant difference between subjects
with and without ED was observed for the Skills
scale (Wilcoxon–Mann–Whitney, P ¼ 0.8251).
QVS scores were compared between subjects with
and without ED using the two age-matched samples.
The distribution of QOL scores varied according
to the presence or absence of ED and there was a
highly significant difference between the two groups
for all the scales (Wilcoxon–Mann–Whitney test,
P ¼ 0.0001) except for the Skills scale (P ¼ 0.4251).
As seen in Figure 3, subjects with ED had lower
Sexual Life and Psychosocial Well-being scores and
Global Index than did subjects without ED, indicat-
ing a lower QOL.
Discussion
The objective of the present study was to validate a
French questionnaire, which may be used to assess
the QOL of subjects suffering from ED. The valida-
tion process included item reduction based on the
content and psychometric properties of the ques-
tionnaire, as well as comparison with the IIEF.
Moreover, as QVS is not only specific to sexuality
but also comprises a more general part (social-life,
well being), comparison of responses in subjects
with and without ED was performed.
International Journal of Impotence Research
P Costa et al
IIEF: item 4
0.0048* 0.0001*
0.1165 *
SK WB GI
QVS scales
a few time (n=77) sometimes (n=72) most times (n=35) always or almost always (n=37)
The initial questionnaire included 40 items, that
is, a global item and 13 items combined with three
sets of responses. The subjects were asked to rate
their perceived achievement, satisfaction and im-
portance with regard to each item. This particularity
was the main specificity of the QVS, and was
consistent with the classification of sexuality into
sexual interest, sexual ability and sexual activity.30
The principal component and multitrait analyses
showed that the importance rating of the items
measured one concept different from that measured
by the achievement and satisfaction ratings which in
turn, always measured the same concept. Thus, the
13 satisfaction ratings of the items were removed
from the initial questionnaire; indeed, as achieve-
ment and satisfaction ratings were redundant, the
selection of achievement-rating items does not
result in a loss of information or validity. The
operational questionnaire was thus constituted of 27
items. The items were divided into three scales:
Sexual Life, Skills and Psychosocial Well-being.
This enabled four scores to be calculated: one score
per scale and one Global Index grouping items from
Sexual Life and Psychological Well-being. Whatever
the scale, scores ranged from 0 (poor quality of life)
to 100 (good quality of life). While achievement-
rating items were split between the Sexual Life and
Psychosocial Well-being scales, the importance-
rating items were grouped in the Skills scale, which
should therefore be renamed ‘importance scale’.

100
0.0001*
80
60
Score
40
20
0
SL
Subjects with ED (n = 311)
Figure 3 QVS scores according to the presence of ED in two age-matched samples. *Kruskal–Wallis test, P-value. SL: Sexual Life; SK:
Skills; WB: Psychosocial Well-being; GI: Global Index.
The Skills scale is probably the most interesting.
The information it provides differs from that
generated by the other scales. For the Global Index,
the Sexual Life and Psychosocial Well-being scales,
concurrent validity with the IIEF scales, clinical
validity regarding the response choice to the items 3
and 4 of the IIEF, and discriminative power as
between subjects with and without ED were satis-
factory. As regards the Skills scale, no significant
difference was observed between subjects with and
without ED, no significant correlation was observed
between the severity of the disease (items 3 and 4 of
the IIEF) and the Skills score, and no significant
correlation was observed between the Skills scale
and the IIEF scales. In this sense, the Skills scale
provides additional information about the impor-
tance of the disorder perceived by the patients,
which appeared to be driven by nonclinical factors.
The Skills rating could be proposed for use as a
measure of the expectation level of the patients, but
cannot be and is not integrated in a QOL dimension
or index.
The psychometric analysis showed the QVS to be
reliable. The questionnaire proved reproducible and
discriminative. The discriminative power was
tested in the whole population and in the two age-
matched samples, as ED was known to be strongly
related to age, with about a two- or three-fold
increase in the prevalence of moderate to severe
ED between the ages of 40 and 70 years.2 After
adjustment for age, a higher probability of ED was
associated with certain treated medical conditions
such as heart disease, hypertension or diabetes. This
result was confirmed in our samples: 89.6 and
Quality of sexual life questionnaire
P Costa et al
179
0.4251* 0.0001*
0.0001*
SK WB GI
QVS scales
Subjects without ED (n = 114)
54.7% of the subjects experienced at least one
chronic pathology in the sample with and without
ED, respectively.
Although ED can be measured physiologically, it
has been proposed that it can be assessed by subject
self-report in real-life settings. The IIEF was devel-
oped to address the need for a self-report measure of
both erectile function and sexual function that can
be used by physicians in clinical settings.31 It has
been proved to be a valid and reliable instrument,
with high sensitivity and specificity for detecting
real treatment effects or lack of treatment effect in
patients with ED, whatever the aetiology. The QVS,
which represents the perception of the patient as
regards the impact of ED on various domains of his
QOL, and in particular on social life, well-being and
self-esteem, appears to be a complementary tool.
After assessment of responsiveness to change over
time, its use in clinical trials, could be associated or
not with the IIEF.
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 Quality of sexual life questionnaire
P Costa et al
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Appendix 2: QVS questionnaire and &2 Plutôt mal
scoring method &3 Ni bien, ni mal
&4 Plutôt bien
&5 Très bien
French version of the questionnaire. Les questions
suivantes portent sur votre vie sexuelle. Pour Cela tient dans votre vie, une place:
chaque question, veuillez cocher une seule case. &1 Sans importance
Nous vous remercions de remplir ce questionnaire &2 Assez importante
seul, dans un endroit calme si possible. &3 Très importante
Prenez tout le temps qu’il vous sera nécessaire. Il &4 Extrêmement importante
n’y a pas de réponse juste ou fausse. Si vous ne
savez pas très bien comment répondre, choisissez la 5. Concernant la satisfaction de votre partenaire
réponse la plus proche de votre situation. lors de vos relations sexuelles,
Vous trouvez que cela va:
SEXUALITE &1 Très mal
1. Concernant le plaisir que vous pouvez avoir &2 Plutôt mal
dans votre sexualité, &3 Ni bien, ni mal
Vous trouvez que cela va: &4 Plutôt bien
&1 Très mal &5 Très bien
&2 Plutôt mal
&3 Ni bien, ni mal Cela tient dans votre vie, une place:
&4 Plutôt bien &1 Sans importance
&5 Très bien &2 Assez importante
Cela tient dans votre vie, une place: &3 Très importante
&1 Sans importance &4 Extrêmement importante
&2 Assez importante
6. Concernant votre désir sexuel,
&3 Très importante
Vous trouvez que cela va:
&4 Extrêmement importante
&1 Très mal
2. Concernant la confiance que vous avez avant &2 Plutôt mal
d’aborder une activité sexuelle, &3 Ni bien, ni mal
Vous trouvez que cela va: &4 Plutôt bien
&1 Très mal &5 Très bien
&2 Plutôt mal
&3 Ni bien, ni mal Cela tient dans votre vie, une place:
&4 Plutôt bien &1 Sans importance
&5 Très bien &2 Assez importante
&3 Très importante
Cela tient dans votre vie, une place: &4 Extrêmement importante
&1 Sans importance
&2 Assez importante 7. Concernant l’intensité de votre orgasme,
&3 Très importante Vous trouvez que cela va:
&4 Extrêmement importante &1 Très mal
&2 Plutôt mal
3. Concernant votre sentiment de virilité, &3 Ni bien, ni mal
Vous trouvez que cela va: &4 Plutôt bien
&1 Très mal &5 Très bien
&2 Plutôt mal
&3 Ni bien, ni mal Cela tient dans votre vie, une place:
&4 Plutôt bien &1 Sans importance
&5 Très bien &2 Assez importante
Cela tient dans votre vie, une place: &3 Très importante
&1 Sans importance &4 Extrêmement importante
&2 Assez importante
8. Concernant la qualité de votre éjaculation,
&3 Très importante
Vous trouvez que cela va:
&4 Extrêmement importante
&1 Très mal
4. Concernant votre sentiment d’être sexuellement &2 Plutôt mal
normal, &3 Ni bien, ni mal
Vous trouvez que cela va: &4 Plutôt bien
&1 Très mal &5 Très bien

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Cela tient dans votre vie, une place: Cela tient dans votre vie, une place:
&1 Sans importance &1 Sans importance
&2 Assez importante &2 Assez importante
&3 Très importante &3 Très importante
&4 Extrêmement importante &4 Extrêmement importante
VIE SOCIALE 13. Concernant votre caractère,
9. Concernant la manière dont se passent vos Vous trouvez que cela va:
relations avec les gens, &1 Très mal
Vous trouvez que cela va: &2 Plutôt mal
&1 Très mal &3 Ni bien, ni mal
&2 Plutôt mal &4 Plutôt bien
&3 Ni bien, ni mal &5 Très bien
&4 Plutôt bien
&5 Très bien Cela tient dans votre vie, une place:
&1 Sans importance
Cela tient dans votre vie, une place: &2 Assez importante
&1 Sans importance &3 Très importante
&2 Assez importante &4 Extrêmement importante
&3 Très importante GLOBAL
&4 Extrêmement importante 14. Si vous deviez vivre ainsi le reste de votre vie,
vous en seriez:
10. Concernant la manière dont se passent vos
&1 Très insatisfait
relations avec votre famille,
&2 Plutôt insatisfait
Vous trouvez que cela va:
&3 Indifférent
&1 Très mal
&4 Plutôt satisfait
&2 Plutôt mal
&5 Très satisfait
&3 Ni bien, ni mal
&4 Plutôt bien
&5 Très bien English version of the questionnaire

Cela tient dans votre vie, une place:

&1 Sans importance The following questions ask about your sexual
&2 Assez importante life. Please indicate your answer by ticking
&3 Très importante one box. Please take your time to fill in the
&4 Extrêmement importante questionnaire and answer the questions alone in a
quiet place.
11. Concernant la manière dont se passent vos There are no right or wrong answers. If you do not
relations professionnelles, know how to answer, please choose the response
Vous trouvez que cela va: that best corresponds to your situation.
&1 Très mal
&2 Plutôt mal SEXUALITY
&3 Ni bien, ni mal 1. Concerning the pleasure you can reach in your
&4 Plutôt bien sexuality,
&5 Très bien You think things are going:
&1 Very badly
Cela tient dans votre vie, une place: &2 Fairly badly
&1 Sans importance &3 Neither well nor badly
&2 Assez importante &4 Fairly well
&3 Très importante &5 Very well
&4 Extrêmement importante
In your life you consider this to be:
BIEN ETRE &1 Unimportant
12. Concernant l’opinion que vous avez de vous- &2 Somewhat important
même, &3 Very important
Vous trouvez que cela va: &4 Extremely important
&1 Très mal
&2 Plutôt mal 2. Concerning how you feel before starting a sexual
&3 Ni bien, ni mal activity,
&4 Plutôt bien You think things are going:
&5 Très bien &1 Very badly

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&2 Fairly badly In your life you consider this to be:
&3 Neither well nor badly &1 Unimportant
&4 Fairly well &2 Somewhat important
&5 Very well &3 Very important
&4 Extremely important
In your life you consider this to be:
&1 Unimportant 7. Concerning the intensity of your orgasms,
&2 Somewhat important You think things are going:
&3 Very important &1 Very badly
&4 Extremely important &2 Fairly badly
&3 Neither well nor badly
3. Concerning your feeling of manliness, &4 Fairly well
You think things are going: &5 Very well
&1 Very badly
&2 Fairly badly In your life you consider this to be:
&3 Neither well nor badly &1 Unimportant
&4 Fairly well &2 Somewhat important
&5 Very well &3 Very important
&4 Extremely important
In your life you consider this to be:
8. Concerning the quality of your ejaculation,
&1 Unimportant
You think things are going:
&2 Somewhat important
&1 Very badly
&3 Very important
&2 Fairly badly
&4 Extremely important
&3 Neither well nor badly
4. Concerning how sexually normal you feel, &4 Fairly well
&5 Very well
You think things are going:
&1 Very badly In your life you consider this to be:
&2 Fairly badly &1 Unimportant
&3 Neither well nor badly &2 Somewhat important
&4 Fairly well &3 Very important
&5 Very well &4 Extremely important
In your life you consider this to be: SOCIAL LIFE
&1 Unimportant 9. Your relationships with other people,
&2 Somewhat important You think things are going:
&3 Very important &1 Very badly
&4 Extremely important &2 Fairly badly
&3 Neither well nor badly
5. Concerning yours partner’s satisfaction during &4 Fairly well
sexual relations, &5 Very well
You think things are going:
&1 Very badly In your life you consider this to be:
&2 Fairly badly &1 Unimportant
&3 Neither well nor badly &2 Somewhat important
&4 Fairly well &3 Very important
&5 Very well &4 Extremely important

In your life you consider this to be: 10. Concerning your relationships with your
&1 Unimportant family,
&2 Somewhat important You think things are going:
&3 Very important &1 Very badly
&4 Extremely important &2 Fairly badly
&3 Neither well nor badly
6. Concerning your sexual desire, &4 Fairly well
You think things are going: &5 Very well
&1 Very badly In your life you consider this to be:
&2 Fairly badly &1 Unimportant
&3 Neither well nor badly &2 Somewhat important
&4 Fairly well &3 Very important
&5 Very well &4 Extremely important

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11. Concerning your professional relationships, Scoring method
You think things are going:
&1 Very badly
&2 Fairly badly Sexual Life score (eight items): The raw score
&3 Neither well nor badly is the sum of answers to set: ‘you think things
&4 Fairly well are goingy’ of items: 1, 2, 3, 4, 5, 6, 7 and 8.
&5 Very well If the number of items without any answer
is 43, the score cannot be calculated. If the
In your life you consider this to be: number of items without any answer is r3,
&1 Unimportant the missing value is replaced by the mean
&2 Somewhat important score of the items which are completed.
&3 Very important Minimal (Min) score is 8, maximum (Max) score
&4 Extremely important is 40.
WELL-BEING Final score ¼ [(raw scoreMin)/(MaxMin)]*100.
12. Concerning how you feel about yourself, Skills score (13 items): The raw score is the sum of
You think things are going: answers to set: ‘in your life you consider this to
&1 Very badly bey’ of all items except item 14.
&2 Fairly badly If the number of items without any answer is 46,
&3 Neither well nor badly the score cannot be calculated. If the number of
&4 Fairly well items without any answer is r6, the missing
&5 Very well value is replaced by the mean score of the items
that are completed. Minimal score is 13, maximum
In your life you consider this to be: score is 52.
&1 Unimportant Final score ¼ [(raw scoreMin)/(MaxMin)]*100.
&2 Somewhat important Psychosocial Well-being score (six items): The raw
&3 Very important score is the sum of answers to set: ‘you think things
&4 Extremely important are goingy’ of items: 9, 10, 11, 12, 13 and 14. If the
number of items without any answer is 42, the
13. Concerning your mood, score cannot be calculated. If the number of items
You think things are going: without any answer is r2, the missing value is
&1 Very badly replaced by the mean score of the items that are
&2 Fairly badly completed. Minimal score is 6, maximum score is
&3 Neither well nor badly 30.
&4 Fairly well Final score ¼ [(raw scoreMin)/(MaxMin)]*100.
&5 Very well Global QOL Index (14 items): The raw score is the
sum of items from the Sexual Life score and
In your life you consider this to be: Psychosocial Well-being score. If the number of
&1 Unimportant items without any answer is 46, the score cannot be
&2 Somewhat important calculated. If the number of items without any
&3 Very important answer is r6, the missing value is replaced by the
&4 Extremely important mean score of the items that are completed. Minimal
GLOBAL score is 14, maximum score is 70.
14. If you were to live that way for the rest of your Final score ¼ [(raw scoreMin)/(MaxMin)]*100.
life, how satisfied would you be:
&1 Very dissatisfied
&2 Somewhat dissatisfied
&3 Indifferent
&4 Somewhat satisfied
&5 Very satisfied
Note: No linguistic validation was performed to
obtain the English version of the QVS presented in
this publication. As such, the version cannot be
considered as a validated tool and therefore cannot
be used.

International Journal of Impotence Research