Sexual Self-Efficacy Scale—Erectile Functioning

Sexual Self-Efficacy Scale—Erectile Functioning‌‌‌

CATHERINE S. FICHTEN,1 SMBD-Jewish General Hospital

JILLIAN BUDD, Adaptech Research Network ILANA SPECTOR, SMBD-Jewish General Hospital RHONDA AMSEL, McGill University

LAURA CRETI, WILLIAM BRENDER, SALLY BAILES, AND EVA LIBMAN, SMBD-Jewish General Hospital

The Sexual Self-Efficacy Scale—Erectile Functioning (SSES-E) is a brief self-report measure of the cognitive dimension of erectile functioning and adjustment in men. It evaluates a man’s beliefs about his sexual and erectile competence in a variety of situations. The scale may be completed by a man to obtain self-ratings or by his partner to obtain corroboration. Self-efficacy refers to confidence in the belief that one can perform a certain task or behave adequately in a given situation (Bandura, 1982). Sexual self-efficacy is of great concern to most men and a topic of increasing interest with an aging population.

Description

The SSES-E is a 25-item self-report measure that follows Bandura, Adams, and Beyer’s (1977) format. Item content is based on questionnaires by Lobitz and Baker (1979) and Reynolds (1978). Respondents indicate which sexual activities they expect they can complete. For each, they rate their confidence level on a scale ranging from 10 to 100. To obtain both partners’ views about the male’s self-efficacy beliefs, the SSES-E can be completed by both the male sub- ject and his partner.

Response Mode and Timing

The respondent places a check mark in the “Can Do” column next to each sexual activity that he expects he could do if he tried it today. For each activity checked, he also selects a number from 10 to 100 indicating confidence in his ability to perform the activity. The reference scale labels a confidence rating of 10 as Quite Uncertain, a rating of 50–60 as Moderately Certain, and a rating of 100 as Quite Certain. Partners rate sexual functioning according to the same format. This takes 10 minutes.

Scoring

The SSES-E yields a self-efficacy strength score obtained by summing the values in the Confidence column and dividing by 25 (the number of activities rated). Any activity not checked in the Can Do column is presumed to have a 0 confidence (i.e., strength) rating. Some are reluctant to use the 10-point interval, so any continuous number recorded may be used in the Confidence column. Higher scores indicate greater confidence in the man’s erectile competence. In case of missing scores, prorating is possible. There must, however, be at least one response in either the Can Do or the Confidence column on items 14 to 25. To deal with missing data, if Can Do is checked and Confidence is left empty, mean score substitution can be used when this occurs fewer than three times. If it occurs more often, the test is invalid.

Reliability

To collect evidence for the reliability of the SSES-E, dysfunctional and control samples were examined. The dysfunctional sample consisted of 17 men presenting with sexual difficulties (13 with Erectile Disorder, 2 with Hypoactive Sexual Desire, 2 with Rapid Ejaculation) at the sex therapy service of a large metropolitan hospital (Libman, Rothenberg, Fichten, & Amsel, 1985). Nine men presented with their female sexual partners. The control group consisted of 15 married couples with nonproblem- aticsexual functioning, who were matched to the dysfunctional group on demographic variables: the entire sample was composed of middle-class Caucasians with a mean age of 34.

To determine internal consistency, standardized alpha coefficients were calculated for the dysfunctional and con-trol males and females separately. The following estimates were obtained: .92 for dysfunctional males and .94 for their female partners’ ratings of their male partners, .92 for control males and .86 for their female partners.

Test-retest reliability, using the control group, was calculated over a 1-month period. Results showed a reliability coefficient of .98 for males and .97 for females.

Validity

Concurrent validity estimates were reported in the original (Libman et al., 1985) study. Recently, Latini et al. (2002) correlated men’s SSES-E and Psychological Impact of Erectile Dysfunction Scale (PIED) scores. The SSES- E was significantly correlated (−.57 and −.51) with both PIED scales, suggesting that lower sexual self-efficacy about erectile functioning is associated with greater negative impact of erectile dysfunction. Convergent validity was also established by Swindle, Cameron, Lockhart, and Rosen (2004), who found a correlation of .67 between SSES-E and Psychological and Interpersonal Relationship Scales scores.

Predictive validity was shown by Kalogeropoulos (1991), who found that scores significantly improved in a sample of 53 males who had undergone vasoactive intracavernous pharmacotherapy for erectile dysfunction. Similarly, Latini, Penson, Wallace, Lubeck, and Lue’s (2006b) longitudinal study of therapy for erectile dysfunction showed that treatment had an important and significant effect on SSES-E scores. Godschalk et al. (2003) used low-dose human chorionic gonadotropin and placebo in the treatment of benign prostatic hyperplasia. In addition to significant improvement in urine flow in the active treatment sample, the authors also showed improved sexual self-efficacy after treatment relative to placebo subjects (p < .036).

The SSES-E has also demonstrated good criterion validity. For example, Latini, Penson, Wallace, Lubeck, and Lue (2006a) found that the SSES-E score was the best predictor of erectile dysfunction severity out of a large number of clinical and psychosocial predictors. Evidence for known- groups criterion validity has also been collected. In our initial sample of 17 dysfunctional men and 15 controls (Libman et al., 1985), dysfunctional men (M = 53.6, SD = 21.1) and their partners (M = 47.2, SD = 26.7) scored significantly (p < .001) lower on the SSES-E than did functional men (M = 88.0, SD = 10.0) and their partners (M = 89.5, SD = 10.4). Moreover, a stepwise discriminant analysis indicated that SSES-E scores were able to classify dysfunctional and nondysfunctional men with 88% accuracy. In addition, data indicate that older married men (age = 65+) had significantly lower self-efficacy scores (M = 54.10) than their middle-aged (age = 50–64) counterparts (M = 70.03; Libman et al., 1989). Also, men who under- went a transurethral prostatectomy were found to rate their postsurgery sexual self-efficacy lower (M = 59.3, SD = 20.3) than presurgery (M = 64.3, SD = 18.8) (Libman et al., 1989, 1991). A study by Latini et al. (2006a) found that men with mild (M = 74.7, SD = 9.31), moderate (M = 56.3, SD = 10.69), and severe erectile dysfunction (M = 34.3, SD = 18.38) differed significantly, p < .0001. The findings above were replicated in studies of men with erectile dysfunction who had illness known to affect erectile functioning. For example, Penson et al. found that men with erectile dys- function as well as prostate cancer (2003a) and diabetes (2003b) reported worse sexual self-efficacy than men with erectile dysfunction but no known underlying medical ill- ness (prostate cancer M = 37.7, no prostate cancer M = 50.6, p < .001; diabetes M =38.2, SD = 17.75, no diabetes M = 47.5, SD = 20.30, p =.063).

These results indicate that the SSES-E has excellent psychometric properties. The measure has good internal consistency and test-retest reliability as well as good concurrent, convergent, criterion, and predictive validity. Moreover, the measure has been successfully used in studies of psychological and medical interventions for men with erectile difficulties caused by known disease processes as well as erectile dysfunction of unknown etiology.

Other Information

GlaxoSmithKline (2009) had the measure, which was originally developed in English and French, translated into several languages (cf. Eremenco, 2003) and has been using it in its worldwide Levitra evaluation program. A companion measure, the Sexual Self-Efficacy Scale for Female Functioning (SSES-F), is available in this volume (Bailes et al., 2010).

Address correspondence to Catherine S. Fichten, Behavioural Psychotherapy and Research Unit, Institute of Community and Family Psychiatry, SMBD- Jewish General Hospital, 4333 Cote St. Catherine Rd., Montreal, Quebec, Canada H3T 1E4; e-mail: [email protected]

Sexual Self-Efficacy Scale for Erectile Functioning

NAME:

DATE:

The following form lists sexual activities that men engage in.

For male respondents only:

Under column I (Can Do), check () the activities you expect you could do if you were asked to do them today.

For only those activities you checked in column I, rate your degree of confidence in being able to perform them by selecting a number from 10 to 100 using the scale given below. Each activity is independent of the others. Write this number in column II (Confidence).

Remember, check () what you can do. Then, rate your confidence in being able to do each activity if you tried to do it today. Each activity is independent of the others.

For (female) partners only:

Under column I (Can Do), check () the activities you think your male partner could do if he were asked to do them today.

For only those activities you checked in column I, rate your degree of confidence that your male partner could do them by selecting a number from 10 to 100 using the scale given below. Write this number in column II (Confidence).

Remember, check () what you expect your male partner can do. Then rate your confidence in your partner’s ability to do each activity if he tried to do it today. Each activity is independent of the others.

I

II

10

20

30

40

50

60

70

80

90

100

Check if

Rate

Quite

Moderately

Quite

Female

Confidence

Uncertain

Certain

Certain

Can Do

10–100

1. Anticipate (think about) having intercourse without fear or anxiety.

2. Get an erection by masturbating when alone.

3. Get an erection during foreplay when both partners are clothed.

4. Get an erection during foreplay while both partners are nude.

5. Regain an erection if it is lost during foreplay.

6. Get an erection sufficient to begin intercourse.

7. Keep an erection during intercourse until orgasm is reached.

8. Regain an erection if it is lost during intercourse.

9. Get an erection sufficient for intercourse within a reasonable period of time.

10. Engage in intercourse for as long as desired without ejaculating.

11. Stimulate the partner to orgasm by means other than intercourse.

12. Feel sexually desirable to the partner.

13. Feel comfortable about one’s sexuality.

14. Enjoy a sexual encounter with the partner without having intercourse.

15. Anticipate a sexual encounter without feeling obliged to have intercourse.

16. Be interested in sex.

17. Initiate sexual activities.

18. Refuse a sexual advance by the partner.

19. Ask the partner to provide the type and amount of sexual stimulation needed.

20. Get at least a partial erection when with the partner.

21. Get a firm erection when with the partner.

22. Have an orgasm while the partner is stimulating the penis with hand or mouth.

23. Have an orgasm while penetrating (whether there is a firm erection or not).

24. Have an orgasm by masturbation when alone (whether there is a firm erection or not).

25. Get a morning erection.

NOM:

DATE:

Échelle d’efficacité sexuelle (Forme E)

Le questionnaire suivant donne la liste d’activités sexuelles dans lesquelles les hommes s’engagent.

Pour les hommes:

Cochez dans la colonne Peut le Faire, les activités que vous pensez être capable de faire si l’on vous demandait de les faire aujourd’hui.

Seulement pour les activités où vous avez coché Peut le Faire, évaluez votre degré de confiance dans le fait que vous pouvez les faire, en choisissant un nombre de 10 à 100, en utilisant l’échelle en bas de la page.

Écrivez les nombres dans la colonne Confiance. Rappelez-vous de cocher ce que pensez que vous pouvez faire. Évaluez ensuite votre Confiance dans le fait d’être capable de faire chaque activité si vous essayiez de le faire aujourd’hui. Chaque activité est indépendante des autres.

Pour les femmes:

Cochez dans la colonne Peut le Faire, les activités que vous pensez que votre partenaire pourrait faire, si on lui demandait de les faire aujourd’hui.

Seulement pour les activités où vous avez coché Peut le Faire, évaluez votre degré de confiance dans le fait que votre partenaire puisse les faire, en choisissant un nombre de 10 à 100, en utilisant l’échelle en bas de la page.

Écrivez les nombres dans la colonne Confiance. Rappelez-vous: Cochez ce que vous pensez que votre partenaire peut faire. Évaluez alors votre Confiance dans la capacité de votre partenaire de faire chaque activité, s’il essayait de les faire aujourd’hui. Chaque activité est indépendante des autres.

10

Tout à fait Incertain

20

30

40

50

Modérément Certain

60

70

80

90

100

Certain

I

Cochez (T) si l’Homme Peut le Faire

II

Évaluez votre Degré de Confiance

10–100

1. Anticiper (penser à) la pénétration sans peur ni anxiété.

2. Obtenir une érection en se masturbant seul.

3. Obtenir une érection pendant les caresses préliminaires quand les deux partenaires sont habillés.

4. Obtenir une érection pendant les caresses préliminaires quand les deux partenaires sont nus.

5. Regagner une érection si elle a été perdue pendant les caresses préliminaires.

6. Obtenir une érection suffisante pour tenter la pénétration.

7. Conserver une érection pendant la pénétration jusqu’à ce que l’orgasme soit atteint par l’homme.

8. Regagner une érection si elle est perdue durant la pénétration.

9. Obtenir une érection suffisante pour la pénétration dans un délai de temps raisonnable.

10. S’engager dans la pénétration pour aussi longtemps que désiré sans éjaculer.

11. Stimuler la partenaire jusqu’à l’orgasme de façon autre que par la pénétration.

12. Se sentir sexuellement désirable pour la partenaire.

13. Se sentir à l’aise au niveau sexuel.

14. Avoir du plaisir au cours d’une activité sexuelle avec la partenaire sans qu’il n’y ait de pénétration.

15. Anticiper une activité sexuelle sans se sentir obligé de faire la pénétration.

16. Être intéressé au sexe.

17. Initier les activités sexuelles.

18. Refuser les avances sexuelles de la partenaire.‌

19. Demander à la partenaire de procurer le type et la quantité de stimulation sexuelle désirée.

20. Obtenir au moins une érection partielle en présence de la partenaire durant les activités sexuelles.

21. Obtenir une érection ferme en présence de la partenaire durant les activités sexuelles.

22. Obtenir un orgasme avec la partenaire pendant qu’elle stimule le pénis avec ses mains ou sa bouche.

23. Obtenir un orgasme pendant la pénétration (que l’érection soit ferme ou non).

24. Obtenir un orgasme en se masturbant seul (que l’érection soit ferme ou non).

25. Obtenir une érection le matin au réveil.

References

Bailes, S., Creti, L., Fichten, C. S., Libman, E., Brender, W., & Amsel, R. (2010). Sexual Self-Efficacy Scale for Female Functioning. In T. D. Fisher, C. M. Davis, W. L. Yarber, & S. L. Davis (Eds.). Handbook of sexuality-related measures. New York: Routledge.

Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, 122–147.

Bandura, A., Adams, N. E., & Beyer, J. (1977). Cognitive processes mediating behavioral change. Journal of Personality and Social Psychology, 35, 125–139.

Eremenco, S. (2003). FACIT Multilingual Translations Project, Center on Outcomes, Research, and Education (CORE), Evanston Northwestern Healthcare, Evanston, IL. Available tel: 847-570-7313, [email protected] northwestern.edu

GlaxoSmithKline. (2009). BAY38-9456, 5/10/20mg, vs. placebo in erectile dysfunction—clinical trial. Retrieved June 1, 2009, from http:// clinicaltrials.gov/ct2/show/NCT00665054

Godschalk, M. F., Unice, K. A., Bergner, D., Katz, G., Mulligan, T., & McMichael, J. (2003). A trial study: The effect of low dose human cho- rionic gonadotropin on the symptoms of benign prostatic hyperplasia. Journal of Urology, 170, 1264–1269.

Kalogeropoulos, D. (1991). Vasoactive intracavernous pharmacotherapy for erectile dysfunction: Its effects on sexual, interpersonal, and psy- chological functioning. Unpublished doctoral dissertation, Concordia University, Montreal, Canada.

Latini, D. M., Penson, D. F., Colwell, H. H., Lubeck, D. P., Mehta, S. S., Henning, J. M., et al. (2002). Psychological impact of erectile dysfunction: Validation of a new health related quality of life measure for patients with erectile dysfunction. Journal of Urology, 168, 2086–2091.

Latini, D. M., Penson, D. F., Wallace, K. L., Lubeck, D. P., & Lue, T. F. (2006a). Clinical and psychosocial characteristics of men with erectile dysfunction: Baseline data from ExCEED. Journal of Sexual Medicine, 3, 1059–1067.

Latini, D. M, Penson, D. F., Wallace, K. L., Lubeck, D. P., & Lue, T. F. (2006b). Longitudinal differences in psychological outcomes for men with erectile dysfunction: Results from ExCEED. Journal of Sexual Medicine, 3, 1068–1076.

Libman, E., Fichten, C. S., Creti, L., Weinstein, N., Amsel, R., & Brender, W. (1989). Transurethral prostatectomy: Differential effects of age category and presurgery sexual functioning on post prostatectomy sexual adjustment. Journal of Behavioral Medicine, 12, 469–485.

Libman, E., Fichten, C. S., Rothenberg, P., Creti, L., Weinstein, N., Amsel, R., et al. (1991). Prostatectomy and inguinal hernia repair: A comparison of the sexual consequences. Journal of Sex and Marital Therapy, 17, 27–34.

Libman, E., Rothenberg, I., Fichten, C. S., & Amsel, R. (1985). The SSES- E: A measure of sexual self-efficacy in erectile functioning. Journal of Sex and Marital Therapy, 11, 233–244.

Lobitz, W. C., & Baker, E. C. (1979). Group treatment of single males with erectile dysfunction. Archives of Sexual Behavior, 8, 127–138.

Penson, D. F., Latini, D. M., Lubeck, D. P., Wallace, K. L., Henning, J. M., & Lue, T. F. (2003a). Do impotent men with diabetes have more severe erectile dysfunction and worse quality of life than the gen- eral population of impotent patients? Results from the Exploratory Comprehensive Evaluation of Erectile Dysfunction (ExCEED) data- base. Diabetes Care, 26, 1093–1099.

Penson, D. F., Latini, D. M., Lubeck, D. P., Wallace, K. L., Henning, J. M., & Lue, T. F. (2003b). Is quality of life different for men with erec- tile dysfunction and prostate cancer compared to men with erectile dysfunction due to other causes? Results from ExCEED data base. Journal of Urology, 169, 1458–1461.

Reynolds, B. S., (1978). Erectile Difficulty Questionnaire. Unpublished manuscript, Human Sexuality Program, University of California, Los Angeles.

Swindle, R. W., Cameron, A. E., Lockhart, D. C., & Rosen, R. C. (2004). The Psychological and Interpersonal Relationship Scales: Assessing psychological and relationship outcomes associated with erectile dysfunction and its treatment. Archives of Sexual Behavior, 33, 19–30.