title: "It takes two to tango": the relational domain in a cohort of subjects with erectile dysfunction (ED).
abstract: BACKGROUND
  The relational domain of erectile dysfunction (ED) is difficult to investigate in a clinical setting. We developed and validated SIEDY, a 13-item structured interview, that evaluates, besides the organic (Scale 1) and intra-psychic (Scale 3) domains, also the relational one (Scale 2). We previously established a pathological threshold for SIEDY Scale 1 and 3.
  
  
  OBJECTIVE
  The aim of this study is to identify a pathological threshold of SIEDY Scale 2.
  
  
  METHODS
  A nonselected, consecutive series of 2,992 subjects with ED was retrospectively evaluated. In a first consecutive series of 844 patients (Sample A, studied without systematically applying a psychometric test: Middlesex Hospital Questionnaire), a pathological threshold of SIEDY Scale 2 score was identified through receiver operating characteristic, using, as surrogate marker of impaired couple relationship, at least a positive answer to two standard questions on conflict within the couple and on the presence of extramarital affairs.
  
  
  METHODS
  Sensitivity and specificity, along with possible associations with biological and psychological correlates were verified in a further sample of 2,148 patients (Sample B).
  
  
  RESULTS
  In Sample A, a threshold of Scale 2 score ≥2 predicts couple impairment with a sensitivity of 53% and specificity of 66% and an overall accuracy of 62.0 ± 2.2% (P < 0.0001). When this threshold was verified in sample B, Scale 2 score ≥2 was associated with a higher risk of anxiety and depressive symptoms, higher prevalence of psychopathology, and higher Scale 3 scoring, even after adjusting for confounders. In the same sample, a Scale 2 score ≥2 was associated with a reduced intimacy during sexual intercourse and overall worse sexual functioning.
  
  
  CONCLUSIONS
  Until now, no instrument is available to quantify the marital domain of ED. The validation of a threshold of SIEDY Scale 2 score (≥2) represents an easy tool for the identification of ED patients with a relevant marital impairment.
authors.affiliation: Department of Physiopathology, Andrology Unit, Florence, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Boddi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corona
authors.forename: Alessandra Daphne
authors.initials: AD
authors.lastname: Fisher
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.forename: Valdo
authors.initials: V
authors.lastname: Ricca
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sforza
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000987:Antisocial Personality Disorder / Q000175:diagnosis; D001007:Anxiety / Q000175:diagnosis; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008393:Marriage; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult