Individual and Partner Correlates of Sexual Satisfaction and Relationship Happiness in Midlife Couples: Dyadic Analysis of the International Survey of Relationships.

The current research reports a dyadic analysis of sexual satisfaction, relationship happiness, and correlates of these couple outcomes in a large multinational dataset consisting of 1,009 midlife heterosexual couples (2,018 individuals) recruited in Japan, Brazil, Germany, Spain, and the United States (Heiman et al., 2011). Actor-Partner Interdependence Models (Kenny, Kashy, & Cook, 2006) identified correlates of sexual satisfaction that included individuals' reports of good health; frequent kissing, cuddling, and caressing; frequent recent sexual activity; attaching importance to one's own and one's partner's orgasm; better sexual functioning; and greater relationship happiness. Even after controlling for individual-level effects, partners' reports of good health; frequent kissing, cuddling, and caressing; frequent recent sexual activity; attaching importance to one's own and one's partner's orgasm; better sexual functioning; and greater relationship happiness contributed significantly to predicting and understanding individuals' sexual satisfaction. Correlates of relationship happiness included individuals' reports of good health; frequent kissing, cuddling, and caressing; frequent recent sexual activity; attaching importance to one's own and one's partner's orgasm; better sexual functioning; and greater sexual satisfaction, and once again, even after controlling for individual-level effects, partners' reports of each of these correlates contributed significantly to predicting and understanding individuals' relationship happiness. Interactions of individual and partner effects with participant gender are also reported. Current results demonstrate empirically that the partner "matters" to an individual's sexual satisfaction and relationship happiness and indicate that a comprehensive understanding of factors contributing to these couple outcomes requires a couple-level research strategy. Partner effects, even when controlling for individual effects, were consistently observed, and explanation of sexual satisfaction and relationship happiness always depended on identifying and understanding mutual and concurrent individual and partner influences.

Correlates of PDE5i use among subjects with erectile dysfunction in two population-based surveys.

INTRODUCTION: Erectile dysfunction (ED) is thought to affect some 150 million men worldwide, but many men with ED symptoms do not seek treatment. Existing surveys suggest that men with severe ED and who report support from their partners are more likely to receive treatment than were others. Less is known, however, concerning the influence of sociomedical factors such as income and body composition on receipt of treatment. AIM: The aim of this study was to determine the importance of socioeconomic status, comorbidities, and body composition on receipt of treatment for ED symptoms. METHODS: We used data on 638 men enrolled in the Boston Area Community Health (BACH) survey reporting ED symptoms and/or treatment for ED as evidenced by phosphodiesterase type 5 inhibitor (PDE5i) use. Logistic regression was employed to assess the relative strength of association between receipt of treatment and socioeconomic factors, body mass index, and medical factors. A replication of these results was then provided via a parallel model using the 2004 follow-up of the Men's Attitudes to Life Events and Sexuality (MALES). MAIN OUTCOME MEASURE: In BACH, ED was deemed present if a subject scored 16 points or fewer on the five-item International Index of Erectile Function or reported PDE5i use. In MALES, presence of ED was indicated by use of a validated single question querying ED severity. RESULTS: Controlling for age, body composition and other factors, increased household income, availability of a sexual partner, and provider diagnosis of high blood pressure were positively associated with treatment seeking via the use of PDE5i therapy in BACH. Results on data available in MALES produced similar results for household income and partner availability. CONCLUSION: These data provide evidence that financial disadvantage may present a barrier to treatment of ED, an increasingly important sentinel marker of the cardiovascular and overall health among aging men.

Sexual satisfaction and relationship happiness in midlife and older couples in five countries.

Sexuality research focuses almost exclusively on individuals rather than couples, though ongoing relationships are very important for most people and cultures. The present study was the first to examine sexual and relationship parameters of middle-aged and older couples in committed relationships of 1-51 years duration. Survey research was conducted in Brazil, Germany, Japan, Spain, and the U.S. targeting 200 men aged 40-70 and their female partners in each country, with 1,009 couples in the final sample. Key demographic, health, physical intimacy, sexual behavior, sexual function, and sexual history variables were used to model relationship happiness and sexual satisfaction. The median ages were 55 for men and 52 for women; median relationship duration was 25 years. Relationship satisfaction in men depended on health, physical intimacy, and sexual functioning, while in women only sexual functioning predicted relationship satisfaction. Models predicting sexual satisfaction included significant physical intimacy and sexual functioning for both genders and, for men, more frequent recent sexual activity and fewer lifetime partners. Longer relationship duration predicted greater relationship happiness and sexual satisfaction for men. However, women in relationships of 20 to 40 years were significantly less likely than men to report relationship happiness. Compared to men, women showed lower sexual satisfaction early in the relationship and greater sexual satisfaction later. Within the long-term committed relationship context, there were significant gender differences in correlates of sexual and relationship satisfaction, with sexual functioning a common predictor of both types of satisfaction and physical intimacy a more consistent and salient predictor for men.

Female Assessment of Male Erectile dysfunction detection scale (FAME): development and validation.

INTRODUCTION: Although erectile dysfunction (ED) affects both members of the couple, no tools exist for the detection of ED by the female partner. AIM: The aim of this study was to develop a scale for the detection of ED, as assessed by the female partner. METHODS: Development and validation of the Female Assessment of Male Erectile dysfunction detection scale (FAME) consisted of five stages: (i) two focus group discussions conducted among female partners of ED sufferers; (ii) item construction; (iii) initial content validation to document face validity and reduce number of items; (iv) final selection of items and investigation of concurrent validity and reliability, sensitivity and specificity of the scale in 83 Spanish-speaking couples; and (v) multicenter study conducted in a group of 106 English-speaking couples. Concurrent validity was assessed using Spearman's rho correlation coefficients between FAME and clinical diagnosis, the Sexual Health Inventory for Men (SHIM), and the erectile function domain of the International Index of Erectile Function (IIEF-EF). Reliability was tested using Cronbach's alpha, and sensitivity and specificity was investigated using clinical diagnosis as the gold standard criterion. MAIN OUTCOME MEASURES: Validity, reliability, specificity, and sensitivity of the FAME scale when correlated with SHIM, IIEF-EF, and clinical diagnosis. RESULTS: Qualitative analysis yielded 44 clues; 21 items demonstrated statistical significance as the best discriminating items using a t-test for independent samples. A final scale of six items was tested for validity, reliability, specificity, and sensitivity. FAME correlated significantly with clinical diagnosis (0.791, P < 0.001), the SHIM (0.788, P < 0.001), and the IIEF-EF (0.777, P < 0.001). Additional support for discriminant validity was obtained with receiver operating characteristics analysis. Cronbach's alpha was 0.941. Sensitivity was 96.1% and specificity 86.0%. CONCLUSIONS: Accurate detection of ED in men by the female partner is possible. In this study, FAME demonstrated concurrent validity and very good reliability, as well as excellent sensitivity and specificity.

Erectile dysfunction and constructs of masculinity and quality of life in the multinational Men's Attitudes to Life Events and Sexuality (MALES) study.

INTRODUCTION: The Men's Attitudes to Life Events and Sexuality (MALES) study assessed the prevalence and correlates of erectile dysfunction, and examined men's attitudes and behavior in relation to this dysfunction. AIM: To report on the attitudes of men, with and without self-reported erectile dysfunction, concerning masculine identity and quality of life. METHODS: The MALES Phase I study included 27,839 randomly selected men (aged 20-75 years) from eight countries (United States, United Kingdom, Germany, France, Italy, Spain, Mexico, and Brazil) who responded to a standardized computer-assisted telephone interview. MAIN OUTCOME MEASURE: Perceptions of masculinity and quality of life in men with and without erectile dysfunction. RESULTS: Men's perceptions of masculinity differed substantially from stereotypes in the literature. Men reported that being seen as honorable, self-reliant, and respected by friends were important determinants of self-perceived masculinity. In contrast, factors stereotypically associated with masculinity, such as being physically attractive, sexually active, and successful with women, were deemed to be less important to men's sense of masculinity. These findings appeared consistently across all nationalities and all age groups studied. For quality of life, factors that men deemed of significant importance included good health, harmonious family life, and a good relationship with their wife/partner. Such factors had significantly greater importance to quality of life than concerns such as having a good job, having a nice home, living life to the full, or having a satisfying sex life. Of note, rankings of constructs of masculinity and quality of life did not meaningfully differ in men with or without erectile dysfunction, and men with erectile dysfunction who did or did not seek treatment for their sexual dysfunction. CONCLUSIONS: The present findings highlight the significance of partnered relationships and interpersonal factors in the management of erectile dysfunction, and empirically challenge a number of widely held stereotypes concerning men, masculinity, sex, and quality of life.

Sexual experience of female partners of men with erectile dysfunction: the female experience of men's attitudes to life events and sexuality (FEMALES) study.

INTRODUCTION: Much research has explored the experience of erectile dysfunction (ED) among men with ED, but far less attention has been paid to the perceptions and sexual experiences of the female partners of men with ED. AIM: The objective of this study was to characterize the attitudes, beliefs, and sexual experience of female partners of men with erectile difficulties. METHODS: Female partners of men with ED who had participated in the Men's Attitudes to Life Events and Sexuality (MALES) study were recruited for this research via mail or Internet, after their male partners consented to this contact. Female partners of men with ED (N = 293) responded to questionnaire measures assessing their frequency of sexual activity and the nature of their sexual experience, both before and after the development of their partner's ED, and in relation to their partner's use of phosphodiesterase type 5 (PDE5) inhibitors. RESULTS: Women reported engaging in sexual activity significantly less frequently after their partner developed ED in comparison with before (P < 0.001). Moreover, significantly fewer women experienced sexual desire, arousal, or orgasm "almost always" or "most times," and significantly fewer women reported satisfaction with their sexual relationship after their partner developed ED, compared with before (P < 0.001). Decreases in female sexual satisfaction and frequency of orgasm were significantly related to the male partner's self-reported severity of ED (P < 0.01). The proportion of women who experienced sexual desire, arousal, and orgasm "almost always" or "most times" was significantly higher in the group whose partners were currently using a PDE5 inhibitor (P < 0.05). CONCLUSION: Erectile dysfunction has significant adverse effects on the female partner's sexual experience. Women with partners who were currently using PDE5 inhibitors had a more satisfying sexual experience than those whose partners did not use a PDE5 inhibitor.

The multinational Men's Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population.

OBJECTIVE: The aims of the Men's Attitudes to Life Events and Sexuality (MALES) study were to identify prevalence of erectile dysfunction (ED) and related health issues in the general male population in Europe, North and South America, and to examine the attitudes and behavior of men in relation to these health issues. RESEARCH DESIGN AND METHODS: Phase I of the MALES study involved 27839 men aged 20-75 years who were interviewed in eight countries (United States, United Kingdom, Germany,France, Italy, Spain, Mexico, and Brazil) using a standardized questionnaire. Phase II of the MALES study involved 2912 men who were recruited from the sub-sample of Phase I MALES participants who reported ED together with additional men with ED recruited from other sources. MAIN OUTCOME MEASURE: Prevalence of ED and associated attitudes. RESULTS: The overall prevalence of ED in the MALES sample was 16%. ED prevalence varied markedly by country, however, from a high of 22%of men in the US reporting ED to a low of 10% in Spain. The prevalence of self-reported ED increased with increasing age. Men with co-morbid medical conditions and risk factors, including cardiovascular disease, hypertension, dyslipidemia,and depression all reported higher prevalence of ED. Men with ED also reported increased prevalence rates of these co-morbid conditions. MALES Phase II data indicated that among men who reported ED, 58% had actively sought medical attention for their condition; however, only 16% of men with ED were currently being treated with oral PDE-5 therapy. CONCLUSIONS: The MALES study confirms the high prevalence rates of ED and its association with co-morbid medical conditions, such as diabetes and depression, reported in other large-scale, epidemiological studies. Despite the advent of oral phosphodiesterase inhibitors, only 58% of ED sufferers consult a physician about their problem, and only 16% of men with self-reported ED maintain their use of oral therapy.