• Erectile Dysfunction;
  • Couple Dysfunction;
  • Relational Domain;
  • Copule


Introduction.  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.

Aim.  The aim of this study is to identify a pathological threshold of SIEDY Scale 2.

Method.  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.

Main Outcome Measure.  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. Boddi V, Corona G, Fisher AD, Mannucci E, Ricca V, Sforza A, Forti G, and 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.