The Validity of using a Single-Question Self-Report of Erectile Dysfunction as a Screening Tool among Men with Type 2 Diabetes Mellitus

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Mohammed Batais
Dr.Muhammad Hussain Mujammami
Dr.Khaled K. ldossari
Dr. Talal S. Alghamdi
Dr. Turki A. Binmoammar
Dr. Mashael M. Al-Enzi
Dr. Turky H. Almigbal


Erectile dysfunction; diabetes; sexual dysfunction; glycemic control; Saudi Arabia.


Background and objective
This study aimed to determine the validity of using a single-question self-report of erectile dysfunction (ED) as a screening tool among Saudi men with type 2 diabetes mellitus (T2DM).

Materials and methods
A cross-sectional study was conducted using a single-question self-report questionnaire to determine the association between the risk of ED and poor glycemic control among men with T2DM. The study was conducted in a hospital-based diabetes clinic in Riyadh, Saudi Arabia. Married adults (aged >18 years) suffering from T2DM for at least 1 year were included in the study. All statistical analy-ses were performed using SAS version 9.2 and R software (Foundation for Statistical Computing, Vienna, Austria).

With 86% response rate, 293 participants were included in this study. Over half (53.9%) of the partic-ipants were below 60 years of age. More than half (55.3%) were suffering from uncontrolled diabetes (i.e., HbA1c > 7%). There was significant correlation between the International Index of Erectile Function (IIEF) and self-reported question in terms of duration of T2DM (p < 0.001), type of treatment (p = 0.004), income of the participants (p = 0.005), age (p < 0.001), education level (p = 0.032), and occupation (p < 0.001). However, there was no significant correlation between IIEF and self-reported question in terms of body mass index (p = 743) and smoking. Regarding overall diagnostic accuracy of IIEF score to predict self-reported ED, receiver operating characteristic curve showed area under curve as 89.4%, which is sta-tistically significant.

Single-question self-report of ED is a valid and reliable tool to screen diabetic patients suffering from sexual problems. Such tool may help to identify ED in diabetic patients and warrant early management. 


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1. Rastrelli G, Maggi M. Erectile dysfunction in fit and healthy young men: Psychological or pathological? Transl Androl Urol 2017;6(1):79. https://doi. org/10.21037/tau.2016.09.06
2. Oyelade BO, Jemilohun AC, Aderibigbe SA. Prevalence of erectile dysfunction and possible risk factors among men of south-western Nigeria: A population-based study. Pan Afr Med J 2016;24(1).
3. Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: Longitudinal results from the Massachusetts Male Aging Study. J Urol 2000;163(2):460–3. S0022-5347(05)67900-1
4. Liu Q, Zhang Y, Wang J, Li S, Cheng Y, Guo J, et al. Erectile dysfunction and depression: A systematic review and meta-analysis. J Sex Med 2018; 15(8):1073–82. 05.016
5. Goldstein I, Goren A, Li V, Tang WY, Hassan TA. Erectile dysfunction prevalence, patient characteristics, and health outcomes globally. J Sex Med 2017;14(5):e298. 04.433
6. Gerbild H, Larsen CM, Graugaard C, Josefsson KA. Physical activity to improve erectile function: A systematic review of intervention studies. J Sex Med 2018;6(2):75–89. esxm.2018.02.001
7. McKinlay J. The worldwide prevalence and epidemiology of erectile dysfunction. Int J Impot Res 2000;12(S4):S6. 3900567
8. DeLay KJ, Haney N, Hellstrom WJ. Modifying risk factors in the management of erectile dysfunction: A review. World J Men Health 2016;34(2):89–100.
9. Köseoğlu N, Köseoğlu H, Ceylan E, Cimrin HA, Ozalevli S, Esen A. Erectile dysfunction prevalence and sexual function status in patients with chronic obstructive pulmonary disease. J Urol 2005;174(1):249– 52.
10. Shiri R, Häkkinen JT, Hakama M, Huhtala H, Auvinen A, Tammela TL, et al. Effect of lower uri-nary tract symptoms on the incidence of erectile dysfunction. J Urol 2005;174(1):205–9. https://doi. org/10.1097/01.ju.0000162042.90554.64
11. Binmoammar TA, Hassounah S, Alsaad S, Rawaf S, Majeed A. The impact of poor glycaemic control on the prevalence of erectile dysfunction in men with type 2 diabetes mellitus: A systematic review. JRSM Open 2016;7(3):2054270415622602. https://
12. Chao JK, Ma MC, Chao HC. Erectile dysfunction, hormone levels, inflammation in male patients with metabolic syndrome. J Men Health 2018;14(4): e25–37.
13. Kratzik CW, Schatzl G, Lunglmayr G, Rücklinger E, Huber J. The impact of age, body mass index and testosterone on erectile dysfunction. J Urol 2005;174(1): 240–3. 95483.51
14. Gökçe Mİ, Yaman Ö. Erectile dysfunction in the elderly male. Turk J Urol 2017;43(3):247. https://doi. org/10.5152/tud.2017.70482
15. Sanchez E, Pastuszak AW, Khera M. Erectile dys-function, metabolic syndrome, and cardiovascular risks: Facts and controversies. Transl Androl Urol 2017;6(1):28.
16. Kouidrat Y, Pizzol D, Cosco T, Thompson T, Carnaghi M, Bertoldo A, et al. High prevalence of erectile dysfunction in diabetes: A systematic review and meta-analysis of 145 studies. Diab Med 2017;34(9):1185–92. dme.13403
17. AlMogbel TA. Erectile dysfunction and other sex-ual activity dysfunctions among Saudi type 2 diabetic patients. Int J Health Sci 2014;8(4):347. https://
18. Malavige LS, Levy JC. Erectile dysfunction in diabetes mellitus. J Sex Med 2009;6(5):1232–47.
19. Seid A, Gerensea H, Tarko S, Zenebe Y, Mezemir R. Prevalence and determinants of erectile dysfunction among diabetic patients attending in hospi-tals of central and northwestern zone of Tigray, northern Ethiopia: A cross-sectional study. BMC Endoc Disord 2017;17(1):16. s12902-017-0167-5
20. McGuire H, Longson D, Adler A, Farmer A, Lewin I, Guideline Development Group. Management of type 2 diabetes in adults: Summary of updated NICE guidance. BMJ 2016;353:i1575. https://doi. org/10.1136/bmj.i1575
21. Pastuszak AW. Current diagnosis and management of erectile dysfunction. Curr Sex Health Rep 2014;6(3):164–76.
22. Chung CM, Lu MZ, Wong CY, Goh SG, Azhar MI, Lim YM, et al. The SAD–MEN questionnaire: A new and reliable questionnaire for assessing sex-ual dysfunction in Asians with diabetes. Diab Med 2016;33(5):674–80. dme.12864
23. O’Leary MP, Fowler FJ, Lenderking WR, Barber B, Sagnier PP, Guess HA, Barry MJ. A brief male sexual function inventory for urology. Urology 1995;46(5):697–706. S0090-4295(99)80304-5
24. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology 1997;49(6):822–30. S0090-4295(97)00238-0
25. Kleinman KP, Feldman HA, Johannes CB, Derby CA, McKinlay JB. A new surrogate variable for erectile dysfunction status in the Massachusetts Male Aging Study. J Clin Epidemiol 2000;53(1):71– 8.
26. Çayan S, Kendirci M, Yaman Ö, et al. Prevalence of erectile dysfunction in men over 40 years of age in Turkey: Results from the Turkish Society of Andrology Male Sexual Health Study Group. Turk J Urol 2017;43(2):122.
27. Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression: Two questions are as good as many. J Gen Intern Med 1997;12(7):439–45. https://doi. org/10.1046/j.1525-1497.1997.00076.x
28. Peralta RL, Fleming MF. Screening for intimate partner violence in a primary care setting: The validity of “feeling safe at home” and prevalence results. J Am Board Fam Pract 2003;16(6):525–32.
29. Eardley I. The incidence, prevalence, and natural history of erectile dysfunction. Sex Med Rev 2013;1(1):3–16.
30. O’donnell AB, Araujo AB, Goldstein I, McKinlay JB. The validity of a single-question self-report of erectile dysfunction: Results from the Massachusetts Male Aging Study. J Gen Intern Med 2005;20(6):515– 19.
31. Lo WH, Fu SN, Wong CKH, San Chen E. Prevalence, correlates, attitude and treatment seek-ing of erectile dysfunction among type 2 diabetic Chinese men attending primary care outpatient clinics. Asian J Androl 2014;16(5):755. https://doi. org/10.4103/1008-682X.127823
32. Almigbal TH. Erectile dysfunction in men with type 2 diabetes: Is it associated with poor glycemic control? J Mens Health 2019;15(1):e12–22. https://
33. Alwin Robert A, Abdulaziz Al Dawish M, Braham R, Musallam MA, Al Hayek AA, Al Kahtany NH. Type 2 diabetes mellitus in Saudi Arabia: Major challenges and possible solutions. Curr Diab Rev 2017;13(1):59–64. .2174/1573399812666160126142605
34. Aldossari KK, Aldiab A, Al-Zahrani JM, Al-Ghamdi SH, Abdelrazik M, Batais MA, et al. Prevalence of prediabetes, diabetes, and its associated risk factors among males in Saudi Arabia: A popu-lation-based survey. J Diab Res 2018;2018:2194604.
35. Al-Zahrani JM, Aldiab A, Aldossari KK, Al-Ghamdi S, Batais MA, Javad S, et al. Prevalence of prediabetes, diabetes and its predictors among females in Alkharj, Saudi Arabia: A cross-sectional study. Ann Glob Health 2019;85(1):109. https://doi. org/10.5334/aogh.2467
36. Meo SA. Prevalence and future prediction of type 2 diabetes mellitus in the Kingdom of Saudi Arabia: A systematic review of published studies. JPMA J Pak Med Assoc 2016;66(6):722–5.
37. Alramadan MJ, Magliano DJ, Almigbal TH, Batais MA, Afroz A, Alramadhan HJ, et al. Glycaemic control for people with type 2 diabetes in Saudi Arabia – An urgent need for a review of management plan. BMC Endocr Disord 2018;18(1):62.
38. Almigbal TH, Schattner P. The willingness of Saudi men with type 2 diabetes to discuss erectile dysfunction with their physicians and the factors that influence this. PLoS One 2018;13(7):e0201105.
39. Utomo E, Blok B, Pastoor H, Bangma CH, Korfage IJ. The measurement properties of the five-item International Index of Erectile Function (IIEF-5): A Dutch validation study. Andrology 2015;3(6): 1154–9.
40. Derby CA, Araujo A, Johannes C, Feldman HA, McKinlay JB. Measurement of erectile dysfunction in population-based studies: The use of a single question self-assessment in the Massachusetts Male Aging Study. Int J Impotence Res 2000;12(4):197.
41. Goyal A, Singh P, Ahuja A. Prevalence and severity of erectile dysfunction as assessed by IIEF-5 in North Indian type 2 diabetic males and its correlation with variables. J Clin Diagn Res JCDR 2013;7(12):2936.
42. Park J, Kwon J, Cho SY, Cho MC, Paick JS, Kim SW. Comparison of improving effects for diabetic erectile dysfunction according to the anti-glycemic agents: Phlorizin and insulin. World J Mens Health 2019 May;37(2):210–18. wjmh.180057
43. Song WH, Park J, Yoo S, Oh S, Cho SY, Cho MC, et al. Changes in the prevalence and risk factors of erectile dysfunction during a decade: The Korean Internet Sexuality Survey (KISS), a 10-year-in-terval web-based survey. World J Mens Health 2019 May;37(2):199–209. wjmh.180054
44. Prabhakaran DK, Nisha A, Varghese PJ. Prevalence and correlates of sexual dysfunction in male patients with alcohol dependence syndrome: A cross-sectional study. Indian J Psychiatry 2018;60(1):71. https://doi. org/10.4103/psychiatry.IndianJPsychiatry_42_17