Advertisement

The Erectile Performance Anxiety Index: Scale Development and Psychometric Properties

      Abstract

      Introduction

      Erectile dysfunction is a highly publicized and prevalent condition with marked adverse effects on men's social, emotional, and quality of life. Although several instruments have emerged for assessing erectile dysfunction and its impact on men's quality of life, none of the existing instruments provide a specific assessment of men's erectile performance anxiety.

      Aim

      This article reports on the development and psychometric evaluation of the Erectile Performance Anxiety Index (EPAI)—a 10‐item self‐report scale designed to fill an important gap in the assessment of male erectile dysfunction.

      Methods

      A total of 207 men ranging in age from 18 to 79 took part in the study. All subjects completed an online battery consisting of the EPAI, along with measures of related sexual functioning, social anxiety, state anxiety, and depressive symptoms. A small subset of study participants (N = 42) completed the EPAI a second time for determining test–retest reliability.

      Main Outcome Measure

      Test–retest reliability was determined by Pearson's product–moment correlations. Internal reliability was assessed using Cronbach's alpha. Factor validity was evaluated by a maximum likelihood factor analysis with oblique rotation. Convergent and discriminant validity was assessed by comparing the strength of association between the EPAI and measures varying in their hypothesized shared variance with the construct of erectile performance anxiety.

      Results

      The EPAI demonstrated excellent internal consistency, with Cronbach's alpha = 0.93 and excellent test–retest reliability (r = 0.85) over an average period of 3.5 weeks. Results of an exploratory factor analysis revealed a one‐factor solution that accounted for 63% of the total variance. Preliminary evidence supports the convergent and discriminant validity of the EPAI.

      Conclusion

      Results support the use of the EPAI as a reliable, valid, and efficient instrument for the assessment of erectile performance anxiety. Potential research and clinical applications are discussed. Telch MJ and Pujols Y. The Erectile Performance Anxiety Index: Scale development and psychometric properties. J Sex Med 2013;10:3019–3028.

      Key Words

      To read this article in full you will need to make a payment
      ISSM Member Login
      Login with your ISSM username and password.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Renshaw D.C.
        Profile of 2376 patients treated at Loyola Sex Clinic between 1972 and 1987.
        Sex Marital Ther. 1988; 3: 111-117
        • Feldman H.A.
        • Goldstein I.
        • Hatzichristou D.G.
        • Krane R.J.
        • McKinlay J.B.
        Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study.
        J Urol. 1994; 151: 54-61
        • Laumann E.O.
        Sexual dysfunction in the United States: Prevalence and predictors.
        JAMA. 1999; 281: 537-544
        • Rosen R.C.
        Prevalence and risk factors of sexual dysfunction in men and women.
        Curr Psychiatry Rep. 2000; 2: 189-195
        • Althof S.E.
        Quality of life and erectile dysfunction.
        Urology. 2002; 59: 803-810
        • Jiann B.‐.P.
        • Su C.‐.C.
        • Tsai J.‐.Y.
        Is female sexual function related to the male partners' erectile function?.
        J Sex Med. 2013; 10: 420-429
        • Mannino D.M.
        • Klevens R.M.
        • Flanders W.D.
        Cigarette smoking: An independent risk factor for impotence?.
        Am J Epidemiol. 1994; 140: 1003-1008
        • Wein A.J.
        • Van Arsdalen K.N.
        Drug‐induced male sexual dysfunction.
        Urol Clin North Am. 1988; 15: 23-31
        • Martin S.
        • Atlantis E.
        • Wilson D.
        • Lange K.
        • Haren M.T.
        • Taylor A.
        • Wittert G.
        Clinical and biopsychosocial determinants of sexual dysfunction in middle‐aged and older Australian men.
        J Sex Med. 2012; 9: 2093-2103
        • Vlachopoulos C.
        • Terentes‐Printzios D.
        • Ioakeimidis N.
        • Aznaouridis K.
        • Rokkas K.
        • Synodinos A.
        • Christoforatou E.
        • Aggelis A.
        • Samentzas A.
        • Stefanadis C.
        Prediction of cardiovascular events and all cause mortality with erectile dysfunction: A systematic review and meta‐analysis of cohort studies.
        J Am Coll Cardiol. 2012; 59: E2074-74
        • Braun M.
        • Wassmer G.
        • Klotz T.
        • Reifenrath B.
        • Mathers M.
        • Engelmann U.
        Epidemiology of erectile dysfunction: Results of the “Cologne Male Survey”.
        Int J Impot Res. 2000; 12: 305-311
        • Zisman A.
        • Leibovici D.
        • Kleinmann J.
        • Siegel Y.I.
        • Lindner A.
        The impact of prostate biopsy on patient well‐being: A prospective study of pain, anxiety and erectile dysfunction.
        J Urol. 2001; 165: 445-454
        • Marceau L.
        • Kleinman K.
        • Goldstein I.
        • McKinlay J.
        Does bicycling contribute to the risk of erectile dysfunction? Results from the Massachusetts Male Aging Study (MMAS).
        Int J Impot Res. 2001; 13: 298-302
        • Araujo A.B.
        • Durante R.
        • Feldman H.A.
        • Goldstein I.
        • McKinlay J.B.
        The relationship between depressive symptoms and male erectile dysfunction: Cross‐sectional results from the Massachusetts Male Aging Study.
        Psychosom Med. 1998; 60: 458-465
        • Araujo A.B.
        • Johannes C.B.
        • Feldman H.A.
        • Derby C.A.
        • McKinlay J.B.
        Relation between psychosocial risk factors and incident erectile dysfunction: Prospective results from the Massachusetts Male Aging Study.
        Am J Epidemiol. 2000; 152: 533-541
        • Boddi V.
        • Corona G.
        • Fisher A.D.
        • Mannucci E.
        • Ricca V.
        • Sforza A.
        • Forti G.
        • Maggi M.
        “It takes two to tango”: The relational domain in a cohort of subjects with erectile dysfunction (ED).
        J Sex Med. 2012; 9: 3126-3136
        • Levy J.
        Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study.
        Br J Diabetes Vasc Dis. 2002; 2: 278-280
        • Fenichel O.
        The concept of trauma in contemporary psycho‐analytical theory.
        Int J Psychoanal. 1945; 26: 33-44
        • Wolpe J.
        Psychotherapy by reciprocal inhibition.
        Stanford University Press, Stanford, CA1958
        • Masters W.
        • Johnson V.
        Human sexual inadequacy.
        Little Brown, Boston, MA1970
        • Kaplan H.S.
        The new sex therapy: Active treatment of sexual dysfunction.
        Brunner/Mazel, Oxford1974
        • Beck J.G.
        • Barlow D.H.
        The effects of anxiety and attentional focus on sexual responding–II. Cognitive and affective patterns in erectile dysfunction.
        Behav Res Ther. 1986; 24: 19-26
        • Beck J.G.
        • Barlow D.H.
        The effects of anxiety and attentional focus on sexual responding–I. Physiological patterns in erectile dysfunction.
        Behav Res Ther. 1986; 24: 9-17
        • Abrahamson D.J.
        • Barlow D.H.
        • Beck J.G.
        • Sakheim D.K.
        • Kelly J.P.
        The effects of attentional focus and partner responsiveness on sexual responding: Replication and extension.
        Arch Sex Behav. 1985; 14: 361-371
        • Sakheim D.K.
        • Barlow D.H.
        • Beck J.G.
        • Abrahamson D.J.
        The effect of an increased awareness of erectile cues on sexual arousal.
        Behav Res Ther. 1984; 22: 151-158
        • Barlow D.H.
        Causes of sexual dysfunction: The role of anxiety and cognitive interference.
        J Consult Clin Psychol. 1986; 54: 140-148
        • National Institute of Health Consensus Development Panel on Impotence
        NIH Consensus Conference—Impotence.
        JAMA. 1993; 270: 83-90
        • Rosen R.C.
        • Riley A.
        • Wagner G.
        • Osterloh I.H.
        • Kirkpatrick J.
        • Mishra A.
        The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction.
        Urology. 1997; 49: 822-830
        • Rosen R.C.
        • Cappelleri J.C.
        • Gendrano 3rd, N.
        The International Index of Erectile Function (IIEF): A state‐of‐the‐science review.
        Int J Impot Res. 2002; 14: 226-244
        • Rosen R.C.
        • Cappelleri J.C.
        • Smith M.D.
        • Lipsky J.
        • Pena B.M.
        Development and evaluation of an abridged, 5‐item version of the International Index of Erectile Function (IIEF‐5) as a diagnostic tool for erectile dysfunction.
        Int J Impot Res. 1999; 11: 319-326
        • Rosen R.C.
        • Althof S.E.
        • Giuliano F.
        Research instruments for the diagnosis and treatment of patients with erectile dysfunction.
        Urology. 2006; 68: 6-16
        • Cappelleri J.C.
        • Althof S.E.
        • Siegel R.L.
        • Shpilsky A.
        • Bell S.S.
        • Duttagupta S.
        Development and validation of the Self‐Esteem And Relationship (SEAR) questionnaire in erectile dysfunction.
        Int J Impot Res. 2004; 16: 30-38
        • Althof S.E.
        • Corty E.W.
        • Levine S.B.
        • Levine F.
        • Burnett A.L.
        • McVary K.
        • Stecher V.
        • Seftel AD.
        EDITS: Development of questionnaires for evaluating satisfaction with treatments for erectile dysfunction.
        Urology. 1999; 53: 793-799
        • Latini D.M.
        • Penson D.F.
        • Colwell H.H.
        • Lubeck D.P.
        • Mehta S.S.
        • Henning J.M.
        • Lue T.F.
        Psychological impact of erectile dysfunction: Validation of a new health related quality of life measure for patients with erectile dysfunction.
        J Urol. 2002; 168: 2086-2091
        • Corona G.
        • Ricca V.
        • Bandini E.
        • Rastrelli G.
        • Casale H.
        • Jannini E.A.
        • Sforza A.
        • Forti G.
        • Mannucci E.
        • Maggi M.
        SIEDY scale 3, a new instrument to detect psychological component in subjects with erectile dysfunction.
        J Sex Med. 2012; 9: 2017-2026
        • Janda L.H.
        • O'Grady K.E.
        Development of a sex anxiety inventory.
        J Consult Clin Psychol. 1980; 48: 169-175
        • McCabe M.
        Sexual function scale.
        in: Davis C.M. Yarber W.L. Bauserman R. Schreer G. Davis S.L. Handbook of sexually‐related measures. Sage, Thousand Oaks, CA1998: 191-192
        • Salkovskis P.M.
        The importance of behaviour in the maintenance of anxiety and panic: A cognitive account.
        Behav Psychother. 1991; 19: 6-19
        • Telch M.J.
        • Lancaster C.L.
        Is there room for safety behaviors in exposure therapy for anxiety disorders.
        in: Neudeck P. Wittchen H.U. Exposure therapy: Rethinking the model—Refining the method. Springer, New York2012: 313-334
        • Helbig‐Lang S.
        • Petermann F.
        Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders.
        Clin Psychol Sci Pract. 2010; 17: 218-233
        • Telch M.J.
        • Lucas R.A.
        • Smits J.A.
        • Powers M.B.
        • Heimberg R.
        • Hart T.
        Appraisal of social concerns: A cognitive assessment instrument for social phobia.
        Depress Anxiety. 2004; 19: 217-224
        • Schultz L.T.
        • Heimberg R.G.
        • Rodebaugh T.L.
        • Schneier F.R.
        • Liebowitz M.R.
        • Telch M.J.
        The appraisal of social concerns scale: Psychometric validation with a clinical sample of patients with social anxiety disorder.
        Behav Ther. 2006; 37: 392-405
        • Marteau T.M.
        • Bekker H.
        The development of a six‐item short‐form of the state scale of the Spielberger State—Trait Anxiety Inventory (STAI).
        Br J Clin Psychol. 1992; 31: 301-306
        • Spielberger C.
        • Gorsuch R.L.
        • Luschene R.E.
        Test manual for the state‐trait anxiety inventory.
        Consulting Psychologists Press, Palo Alto, CA1970
        • Kohout F.J.
        • Berkman L.F.
        • Evans D.A.
        • Cornoni‐Huntley J.
        Two shorter forms of the CES‐D depression symptoms index.
        J Aging Health. 1993; 5: 179-193
        • Brown T.A.
        Confirmatory factor analysis for applied research.
        Guilford Press, New York, NY2006
        • Chen P.Y.
        • Popovich P.M.
        Correlation.
        Sage Publications, Inc, Thousand Oaks, CA2002