Effective oral therapy for erectile dysfunction (ED) has been available since 1998. ED has a widely accepted definition; the NIH Consensus Development Panel on Impotence (1993) defined it as an “inability to achieve or maintain an erection sufficient for satisfactory sexual performance”. What constitutes “effective” treatment is far less well-defined. To grant a product licence for a new medication, regulatory authorities require that randomised, placebo-controlled trials demonstrate its superiority in improving quantitative outcome measures, usually event diaries (e.g., the Sexual Encounter Profile [SEP]) or validated questionnaire instruments (e.g., the International Index of Erectile Function [IIEF]). However, does observing changes in SEP diary event counts and IIEF domain scores equate to the restoration of “satisfactory sexual performance”? Sex and sexual performance are complex, subjective, cognitive experiences, and, whilst SEP and IIEF data may correlate to some extent with the experience of “better sex,” there are many other factors involved that are not assessed by the current “gold standard” instruments preferred by researchers and regulators.
In these four papers, the authors set out a more holistic view of satisfactory sexual performance, both for the man and his partner. They review the evidence from a wide range of qualitative and quantitative studies, and consider contemporary expert opinion. Erection hardness, the focus of the traditional instruments SEP and IIEF, is important. However, improvements in partner satisfaction and personal psychological well-being are also key features of satisfactory sexual performance and are, to some extent, dependent on the former. Consequently, clinicians should assess treatment outcome in more holistic terms, considering the effect of treatment on partner and patient satisfaction and well-being, rather than just on the restoration of erections adequate for penetration and intercourse.
This supplement was funded by an educational grant from Pfizer Inc.
Dr John Dean has undertaken consultancy work for, received hospitality from, and/or participated in sponsored clinical trials for the following companies: Abbott, Auxilium, Bayer, Boehringer-Ingleheim, GSK, Ipsen, Johnson & Johnson, Lilly-ICOS, Pfizer, Proctor & Gamble, Schering, and Schering-Plough.
Professor Alessandra Graziottin has served on speaker bureaus for the following organisations: Janssen-Cilag, Novo Nordisk, Pfizer, Procter & Gamble, Rottapharm, Schering, Solvay, and Theramex; on advisory boards for Bayer, Boehringer-Ingelheim, Pfizer, Rottapharm, Organon, and Valeas; and as a consultant to Epitech Lab, Fater, Procter & Gamble, Rottapharm, and Theramex.
Professor Jeremy Heaton has served as a consultant and speaker for Pfizer Inc.
Ann Tailor has served as an advisor to GlaxoSmithKline/Bayer's “Strike Up A Conversation” Campaign 2004.
-  NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA. 1993;270:83-90
a The Prostate Centre, 32 Wimpole Street, London W1G 8GT, United Kingdom
b Vocational Training Department of General Practice, Julius Center for Health Sciences and Primary Care, The Netherlands
c Center of Gynecology and Medical Sexology, H. San Raffaele Resnati, Milano, Italy; Specialty School in Obstetrics–Gynecology, University of Florence, Italy
d 2nd Department of Urology and Center for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Greece
e Queen's University, Kingston, Canada
f European Sexual Dysfunction Alliance 1998–2005, Spain
g Sexual Dysfunction Alliance 1996–2005, United Kingdom
© 2006 European Association of Urology, Published by Elsevier B.V.