Accepted Manuscript

Title: Sexual Satisfaction: an Opportunity to Explore Overall Health in Men

Author: Borja García Gómez, Eduard García Cruz, Giorgio Bozzini, Juan Justo
Quintas, Esther García Rojo, Manuel Alonso Isa, Javier Romero Otero

PII: S0090-4295(17)30697-0
DOI: http://dx.doi.org/doi: 10.1016/j.urology.2017.06.031
Reference: URL 20529

To appear in: Urology

Received date: 6-3-2017

Accepted date: 20-6-2017

Please cite this article as: Borja García Gómez, Eduard García Cruz, Giorgio Bozzini, Juan Justo
Quintas, Esther García Rojo, Manuel Alonso Isa, Javier Romero Otero, Sexual Satisfaction: an
Opportunity to Explore Overall Health in Men, Urology (2017), http://dx.doi.org/doi:
10.1016/j.urology.2017.06.031.

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Sexual satisfaction: An opportunity to explore overall health in men

AUTHORS:

Borja García Gómez, 12 de Octubre University Hospital, Madrid, Spain.

Eduard García Cruz, Clínic University Hospital, Barcelona, Spain.

Giorgio Bozzini, IRCCS Policlinico san Donato, Milano, Italy.

Juan Justo Quintas, 12 de Octubre University Hospital, Madrid, Spain.

Esther García Rojo, 12 de Octubre University Hospital, Madrid, Spain.

Manuel Alonso Isa, 12 de Octubre University Hospital, Madrid, Spain.

Corresponding author: Javier Romero Otero, 12 de Octubre University Hospital,

Cordoba Avenue, 28041, Madrid, Spain.
jromerootero@hotmail.com

ABSTRACT

Objective

The primary aim was to evaluate the use of sexual dissatisfaction as a marker of poor

overall health. Secondary objectives were to assess the effect of age on this measure and

the utility of the Brief Sexual Symptom Checklist (BSSC) for general practitioners

(GPs) and patients.

Material and Methods

Multicenter, cross-sectional study conducted in Spain among men aged ≥50 years

presenting with mood disorders and/or cardiovascular comorbidities (hypertension,

dyslipidemia or diabetes) visiting a GP for any reason. A group of men without these

comorbidities was also analyzed.

Main outcome measures

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Page 1 of 22
Prevalence of sexual dissatisfaction, based on the comorbidities analyzed (type, number

or their absence) and problems with sexual function in dissatisfied men (overall and in

men aged < 60 or ≥ 60 years).

Results

718 men aged 61.7 ± 7.1 years who presented the analyzed comorbidities participated,

69.8% of whom were sexually dissatisfied. Men without comorbidities (n = 144) were

younger and had lower prevalence of sexual dissatisfaction (54.2%; P = 0.001). Sexual

dissatisfaction increased with age. Having these comorbidities (especially mood

disorders) significantly increased the likelihood of sexual dissatisfaction after adjusting

for age. Erection problems and lack of interest in sex were the most reported problems,

independently of the presence of comorbidities. Differences in the prevalence of these

problems were found in men with/without comorbidities after splitting the population

into two age groups. GPs and dissatisfied patients found the BSSC useful and easy to

use.

Conclusions

Assessment of sexual satisfaction and related sexual problems using the BSSC could

help in approaching men’s overall health. Further research is needed.

KEY WORDS (MeSH):

Sexual dysfunction; Sexual satisfaction; Comorbidity; Men’s health

INTRODUCTION

Sexual dysfunction severely affects quality of life, well-being and satisfaction.(1) Some

sexual dysfunctions are a result of undiagnosed conditions (organic/medical factors

and/or multiple psychological or interpersonal factors)(1), and therefore sexual health

assessment may not only benefit well-being and longevity, but may also be a useful tool

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Page 2 of 22
that could help to reduce morbidity and mortality.(2, 3) Given its relevance, sexual

problem identification has been regarded as a routine and necessary aspect of medical

care.(1, 4) Involvement of the General Practitioner (GP) in sexual health is of especial

relevance as this is the first point of contact in many health care systems.

A wide variety of instruments, mainly brief self-report inventories, have been developed

for the purpose of identifying and assessing sexual problems in men.(5, 6) In this sense,

the main focus has been on erectile dysfunction (ED), whose relationship with the

presence of comorbidities has been extensively analyzed.(7-11) In fact, ED is nowadays a

recognized indicator of men’s overall health(12, 13), and as such it offers a unique

opportunity to undergo medical examination.(7) The Sexual Health Inventory for Men

(SHIM) is the self-reported questionnaire for ED screening that is most commonly used

both in research and in the clinical practice.(14, 15) However, this tool might not be useful

for this purpose in every cultural environment if it lacks proper validation. This is the

case of Spain, where it has been reported that the SHIM is not routinely used in the

clinical practice. The reasons include the use of direct and technical language which

may not always be appropriate at every socio-cultural level, thus limiting its theoretical

self-checklist capability(16). Other alternatives have been proposed. For instance,

Moncada et al. demonstrated that the Fugl-Meyer Life Satisfaction Questionnaire

(LISAT-8) and a composite variable made up of three of the items analyzed (sexual life

was one of them), could be used as a valid screening tool for ED in everyday clinical

practice.(16)

In 2004, the International Consultation on Sexual Medicine (ICSM) endorsed a

screening checklist, suitable for use in the Primary Care settings, known as the Brief

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Sexual Symptom Checklist (BSSC).(3) This questionnaire is simple and quick-to-answer

(less than 1 min), and addresses the presence of sexual problems by initially assessing

the patient’s level of sexual satisfaction with a single question. Precisely, sexual

satisfaction is considered to be the main outcome measure in the assessment of the

sexual health(1). According to this questionnaire sexual dissatisfaction would be an

indicator of poor sexual health, thus opening the door to further investigation of

problems that involve sexual functioning. However, it is unknown whether sexual

dissatisfaction, as assessed by this screening tool, would also be associated to poorer

overall health.

We performed an exploratory analysis of prevalence of sexual dissatisfaction as

assessed by the BSSC among patients with comorbidities known to be common in men

with sexual dysfunctions, such as cardiovascular risk factors/conditions (hypertension,

dyslipidemia, diabetes) or mood disorders, including depression, with the aim of

evaluating the use of "sexual dissatisfaction" as a marker of poor overall health. As

secondary objectives, we explored the feasibility and acceptability of the tool and

satisfaction with it, its ability to prompt discussion between the patient and the GP, and

the relationship of "sexual dissatisfaction" with the previously described comorbidities.

METHODS

Between April and September 2014, we conducted a multicenter, cross-sectional,

single-visit study in the offices of General Practitioners (GPs) of the Spanish National

Health System, in consecutive men visiting the GP for any medical reason. The

inclusion criteria included being ≥50 years old; having mood disorders and/or any of the

following cardiovascular comorbidities: hypertension, dyslipidemia (high cholesterol or

hypertriglyceridemia) or diabetes; being able to answer self-report questionnaires and

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Page 4 of 22
signing an informed consented form. Exclusion criteria were: being on treatment for

ED; having a poor functional status as assessed by the Eastern Cooperative Oncology

Group [ECOG] scale of performance status (ECOG ≤ 1)(17); and previous major pelvic

surgery (i.e. radical prostatectomy). The presence of comorbidities was roughly

determined on the basis of drug treatment intake, given that participants were regular

patients whose medical history was well known. A control group of men with the same

inclusion and exclusion criteria, but without the aforementioned comorbidities was also

selected. An independent Ethics Committee approved the study protocol. All

information was centralized in a co-ordination center.

Data collection

Data collected included age, ECOG status and presence of any of the comorbidities

analyzed. Men were asked to answer the BSSC,(1) a questionnaire consisting of four

questions (see Table 4). The first one assesses sexual satisfaction. Men reporting sexual

dissatisfaction are asked to continue answering the questionnaire, which presents a

number of problems with sexual function to be selected, asks the patient for how long

he has felt sexually dissatisfied, which is the most bothersome problem among those

reported and ends by evaluating willingness to talk about sexual problems with the

physician.(1) The BSSC was translated into Spanish by the Clinical Research

Organization responsible for the study. The utility of the BSSC was assessed in GPs and

in dissatisfied patients by means of 2 questions investigating the complexity in

completing the questionnaire and its usefulness for assessing the sexual health of

patients (for GPs) / in discussing sexual problems with the GP (for patients). A 5-point

Likert scale ranging from “very poor” to “good” was used. Answers were grouped for

ease of analysis. Dissatisfied patients were also asked whether they would have spoken

5
Page 5 of 22
with the GP about their sexual dissatisfaction/ sexual dysfunctions had it not been for

the BSSC.

Statistical analysis

Percentages were used for categorical variables and mean scores ± standard deviation

(SD), median scores, and ranges for normal and non-normal distributed quantitative

variables, respectively. The Kolmogorov-Smirnov test was used to assess the normality

of distributions. Categorical variables were compared using the Chi-square or the

Fisher’s exact tests, while Student’s t-test (or the Mann-Whitney U-test when normality

was not assumed) was used for quantitative variable analysis. Trend analyses using

ANOVA or TauC Kendall test were also performed. Further analysis of the relationship

between presence of comorbidities and sexual dissatisfaction was undertaken in both

populations as a whole. Logistic regression analyses were used to calculate odds ratios

(OR) and 95% confidence intervals (CI) for sexual dissatisfaction according to the

presence and type of comorbidities (independent variables). Given the relationship

between age, prevalence of comorbidities and sexual satisfaction, ORs were age-

adjusted to eliminate the confounding effect. The relationship between presence of

comorbidities, sexual dissatisfaction and age was further analyzed in order to ascertain

differences in the discrimination value of the BSSC in older vs. younger patients (51-60

and ≥ 60 years old). Receiver Operating Characteristic (ROC) curve predictive analysis

identified the age of 60 years as the cut-off value with a higher predictive, although

weak, power on sexual satisfaction (Area under the curve = 0.541; P = 0.021). SPSSv12

statistical software package was used. Two-sided statistical significance was set at P <

0.05.

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Page 6 of 22
The main outcome measures were the prevalence of sexual dissatisfaction according to

the presence of the comorbidities analyzed (type and number of comorbidities) or their

absence and the main problems with sexual function reported by dissatisfied men. This

relationship was investigated in men aged 51-60 and ≥ 60 years in order to ascertain

potential differences according to age.

RESULTS

Study population

A total of 718 men with the selected comorbidities and 144 without these comorbidities

who met all inclusion criteria and none of the exclusion criteria were recruited in 104

GP offices throughout Spain. Baseline characteristics of these patients, including

prevalence of the different comorbidities are shown in Table 1. Hypertension was the

most common comorbidity (68.0%) followed by dyslipidemia (52.4%). The most

frequent combinations were hypertension + hyperlipidemia (34.9%) and hypertension +

diabetes (22.1%).

Sexual dissatisfaction

Prevalence of sexual dissatisfaction was 69.8% in men in the group with comorbidities.

A significant trend towards greater sexual dissatisfaction as the number of comorbidities

increased was observed, with prevalence of sexual dissatisfaction being as high as

79.0% among men with ≥3 comorbidities vs. 73% or 63.6% among men with 2 or 1

comorbidities, respectively (P = 0.001). Prevalence of sexual dissatisfaction was greater

among men presenting mood disorders (alone or with CV comorbidities) vs. those

presenting only CV comorbidities. Men without comorbidities were younger (59 ± 5.9

vs. 61.7 ± 7.1; P <0.0001) and had better functional status (98.6 vs. 89.4 had a ECOG

7
Page 7 of 22
PS 0; P = 0.0004) than men with comorbidities. Prevalence of sexual dissatisfaction was

significantly lower (54.2%; P = 0.001).

“Erection problems” was the most reported problem in men with and without

comorbidities followed by “Little or no interest in sex”. Presenting mood disorders

increased the number of problems with sexual function and the prevalence of “Little or

no interest in sex” (alone or with cardiovascular comorbidities) vs. those presenting

only cardiovascular comorbidities (Table 2). No differences were found between men

with and without comorbidities regarding the time since perception of the sexual

dissatisfaction or the number or main type of problems leading to sexual dissatisfaction.

Sexual dissatisfaction, comorbidities and age

Prevalence of sexual dissatisfaction increased with age, from 57.4% in men aged 55

years or younger to 70.9 in men aged 65 years or older (P for linear trend = 0.001).

Age-adjusted logistic regression models showed that the presence of comorbidities was

an independent risk of sexual dissatisfaction: OR (95% CI) 1.826 (1.263-2.641); P =

0.001. Presenting any cardiovascular comorbidity + mood disorders showed the higher

risk for sexual dissatisfaction (OR [95% CI] 4.825 [2.456-9.477]; P < 0.0001) compared

to presenting only mood disorder (OR [95% CI] 2.890 [1.323-6.316]; P = 0.008) or

presenting only cardiovascular comorbidities (OR [95% CI] 1.563 [1.073-2.276]; P =

0.020).

When splitting the whole population into two groups according to age (60 years old),

patients aged ≥ 60 years presented a higher prevalence of comorbidities vs. their

younger counterparts (87.8% vs. 77.8%, respectively; P = 0.001), especially

8
Page 8 of 22
cardiovascular ones ± mood disorders (84.8% vs. 70.4%; P = 0.001). Prevalence of

mood disorders was higher in men aged < 60 years (7.5% vs. 3.0%; P = 0.002).

Prevalence of sexual dissatisfaction and of “Erection problems” was higher among men

with comorbidities in both age groups. The prevalence of having “Little or no interest in

sex” was significantly higher in men with comorbidities only in men aged ≥ 60 years

(Table 3), and it was significantly higher compared to men with comorbidities aged <

60 years (P = 0.0001).

Utility and easiness of use of the BSSC

GPs considered the BSSC relatively easy to complete (96.1% considered it “not

complicated” or “a little bit or normal”) and 62.9% considered it “quite” or “very

useful” for assessing the sexual health of their patients.

Dissatisfied patients reported a high willingness to talk about their sexual dissatisfaction

/ sexual dysfunctions with their doctor, independently of the presence of comorbidities

(Table 2). A high proportion of these patients (56.6%) reported that they would not have

approached their sexual problems had it not been for the BSSC. They considered the

BSSC relatively easy to complete (96.4% considered it “not complicated” or “a little bit

or normal”) and 57.3% considered it quite or very useful for opening a conversation

about their sexual problems with their GPs (Table 4).

DISCUSSION

Our exploratory analysis among men visiting a GP for any reason revealed a

relationship between self-reported sexual dissatisfaction and the presence of

comorbidities that are known to be associated to sexual dysfunction, with presence of

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Page 9 of 22
any type of these comorbidities nearly doubling the likelihood of sexual dissatisfaction.

Moreover, we also found that the combination of cardiovascular comorbidities and

mood disorders had a much higher effect on sexual dissatisfaction than having

cardiovascular comorbidities (three times greater) or mood disorders (two times greater)

alone.

Until now, sexual health has been mostly assessed through the presence of sexual

dysfunctions. Although both sexual dysfunction and sexual dissatisfaction are self-

reported conditions, the latter is a complex self-perceived construct that goes beyond the

simple concept of sexual functioning to integrate different aspects of life such as

relationship and interpersonal satisfaction, physical health, psychological well-being

and different aspects related to sexual life itself (i.e., sexual assertiveness and openness,

importance of sexuality in life etc).(18, 19) Not in vain, according to the ICSM, “sexual

dysfunction exists only when satisfaction arising from the integrated components of

sexual function, e.g., sexual desire, arousal, and orgasm or climax, is reduced or

absent”.(1) Assessing sexual satisfaction provides therefore a broader approach to sexual

and overall heath within a patient-centered framework.(1)

Though the research on sexual satisfaction has increased in recent years, it is still

considered to be in its preliminary steps(20). Besides, there is a lack of a common

definition of sexual satisfaction on the questionnaires assessing it and the indicators

used are not consistent.(21) It is worth noting that the BSSC assesses sexual

dissatisfaction by means of a single question and that we were able to find differences in

the prevalence and type of comorbidity with this simple assessment. The association

between the presence of comorbidities and poorer sexual satisfaction has been described

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Page 10 of 22
in several studies, and the relationship between sexual dissatisfaction and comorbidities

is predictable and meaningful.(18) However, to our knowledge, the approach used in this

study draws for the first time on sexual dissatisfaction to find comorbidities that are

commonly associated to sexual dysfunction. Our findings are in line with those of a

study conducted in Spain among 7384 sexually active people where it was shown that

one of the most conditioning factors influencing sexual satisfaction in men was self-

perceived health status.(22) A recent study undertaken in Brazil, Germany, Japan, Spain

and the U.S. has also identified the individual’s report of good health as a factor

influencing sexual satisfaction.(23)

We found that of the problems listed in the BSSC questionnaire, “Little or no interest in

sex” and “Erection problems” were by far the most frequent problems reported by

dissatisfied men, independently of the presence of the comorbidities analyzed. Having

mood disorders (alone or in combination with cardiovascular comorbidities) increased

the self-perception of having more problems with sexual function and had a significant

effect on the prevalence of “Little or no interest in sex”. However, we found no

differences in the prevalence of any of these problems between men with and those

without the analyzed comorbidities. This result may support the lack of a necessary link

between the presence of sexual dysfunction and sexual dissatisfaction, as has been

pointed out by other authors.(24-26) However, given the important relationship between

the comorbidities analyzed and the presence of ED, we cannot rule out a possible

selection bias favoring the participation of men with sexual dysfunctions in the two

groups both by the physicians and by men having an interest or being attracted by the

subject of study.

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The prevalence of sexual dissatisfaction increased with age in our series, which was

associated to increasing loss of interest in sex. The association between sexual

dissatisfaction and the presence of comorbidities remained in men younger and older

than the age of 60 and we were able to detect differences in the presence of “erection

problems” based on the presence of comorbidities in both groups, although the low

number of men without comorbidities, especially in the group of men ≥ 60 year old may

have affected the power of the statistical analysis. Men with comorbidities showed a

significantly higher prevalence of “Little or no interest in sex” with respect to those

without comorbidities only in men aged ≥ 60 years, which may be a reflection of the

effect of the comorbidities on sexual function and other aspects of life and well-being

beyond that of the presence of mood disorders, whose prevalence was lower than in

their younger counterparts.

The differences observed in sexual dissatisfaction in men with and without

comorbidities (54.2% of men with no comorbidities were sexually dissatisfied

compared to 69.8% of men with comorbidities -table 2-) are relative and it limits the

clinical utility of the BSSC. Nevertheless, we can state that the relationship between the

sexual dissatisfaction and presence of comorbidities was confirmed, but the overlap in

prevalence of comorbidities in sexually dissatisfied and satisfied patients, renders the

specificity, sensitivity, and clinical utility of the measure of sexual dissatisfaction for

surfacing comorbidities uncertain.

Sexually dissatisfied men expressed having a willingness to talk about their sexual

problems with their doctors, which would open a door to explore their overall health.

Both physicians and dissatisfied men found the questionnaire quite easy to complete,

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and useful to start a conversation about the sexual problems. However, we found some

mistakes in the completion of the questionnaires and some questions that were not well

understood (e.g. the most bothersome problems were the same as the reported problems

with sexual functioning), which supports the need to adapt the translation for better

understanding and to provide a brief explanation on how to complete it.

Our study has several limitations that may affect the interpretation of the results, some

of which have already been commented upon. We only focused on comorbidities

strongly related to sexual dysfunctions, however, there are many others that have shown

a relationship. It is possible that these latter comorbidities were not uniformly

distributed in the groups analyzed (with and without comorbidities / younger and older

than 60 years of age). The presence of the comorbidities analyzed was made on the

basis of treatment intake. It is well known that many of the treatments for hypertension,

dyslipidemia or depression have an impact on erectile function, one of the pillars of

men’s sexual function.(27, 28) A more accurate analysis should remove the effect of the

treatment intake. We were not able to detect differences in the prevalence of erection

problems or in the interest for sex, as it would have been expected. However, we were

able to detect them when the population was split into two age groups. Although the

different ratios for men with comorbidities and those without in the overall (5:1) and

both age groups (5:1.5 for < 60 years and 5:0.7 for ≥ 60 years) may have accounted for

this effect, it is likely that a selection bias could provide a better explanation. As the

main focus of the BSSC is screening for sexual dysfunctions, it does not explore the

existence of problems with sexual function in sexually satisfied men. Such an

evaluation would provide valuable information regarding the relationship between

sexual dysfunctions and sexual satisfaction and provide further information about the

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Page 13 of 22
screening properties of the BSSC both from a sexual and from a general health point of

view.

CONCLUSIONS

The utility of the BSSC and its acceptability to patients as a segue to discussion of

sexual problems was excellent. The assessment of sexual satisfaction and related sexual

problems by means of the BSSC seems to be useful as an approach to men’s overall

health, although the specificity, sensitivity, and clinical utility of the measure of sexual

dissatisfaction for surfacing comorbidities remains uncertain. This finding encourages

future studies to evaluate the psychometric properties of this simple tool for overall

health assessment.

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Table 1. Characteristics of the population with selected comorbidities included

in the study

Population with
comorbidities*
(N = 719)
Age, years, mean (SD) 61.7 (7.1)

ECOG PS, n (%)a

0 641 (89.4)

1 76 (10.6)

Comorbidity type

CV risk factors 582 (81.1)

CV risk factors + MD/D 93 (13.0)

Mood disorders 43 (6.0)

Comorbidity, n (%)a

Hypertension 488 (68.0)

Mood disorders 136 (18.9)

Dyslipidemia 376 (52.4)

Diabetes 253 (35.2)

Number of comorbidities*a

1 324 (45.1)

2 270 (37.6)

3 107 (14.9)

4 17 (2.4)

Only one comorbidity, n (%)a

Hypertension 151 (21.0)

Mood disorders 43 (6.0)

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Page 17 of 22
 Dyslipidemia 74 (10.3)

Diabetes 56 (7.8)

More frequent combinations

Hypertension + dyslipidemia 250 (34.8)

Hypertension + diabetes 159 (22.1)

Dyslipidemia + diabetes 129 (18.0)

Hypertension + Mood 67 (9.3)

disorders 96 (13.4)

Hypertension + dyslipidemia

+ diabetes

SD: standard deviation; ECOG PS: ECOG performance status.

*Analyzed comorbidities included hypertension, dyslipidemia, diabetes and
mood disorders/ depression.
a
Missing values: an = 1

18
Page 18 of 22
Table 2. Results of the BSSC according to the presence/absence of comorbidities and the type of comorbidities.

With Without P Only CV With CV + Only MD/D P

comorbiditie comorbiditie value co MD/D (n = 43), value
s (n = 718), s (n = 144), morbidities (n = 93), n (%)
n (%) n (%) (n = 582), n (%)
n (%)
Sexually dissatisfied, n (%) 501 (69.8) 78 (54.2) 0.001 388 (66.7) 80 (86.6) 33 (76.7) 0.001

Time, months, median (IQR)*a 36 (12-60) 24 (12-60) 0.125 34 (12-58) 36 (14-60) 37 (14-61) 0.256

Number of problems, n (%)*

1 272 (55.4) 49 (62.8) 224 (57.7) 33 (41.3) 15 (45.3)

0.352 0.007
2 175 (35.0) 18 (23.1) 128 (33.0) 38 (47.5) 9 (27.3)

≥3 53 (10.6) 11 (14.1) 25 (9.0) 9 (11.5) 9 (27.3)

Problems with sexual function, n (%)*

- Little or no interest in sex 164 (32.7) 22 (28.2) 0.426 107 (27.6) 38 (47.5) 19 (57.6) <0.001

- Erection problems. 397 (79.2) 57 (73.1) 0.218 308 (79.4) 65 (81.3) 24 (72.7) 0.429

- Ejaculating too early during sexual activity 77 (15.4) 10 (12.8) 0.556 60 (15.5) 11 (13.8) 6 (8.2) 0.870

- Taking too long, not being able to ejaculate

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 or have an orgasm 117 (23.4) 17 (21.8) 0.761 88 (22.7) 17 (21.3) 12 (36.4) 0.317

- Pain during sexual intercourse 6 (1.2) 3 (3.8) 0.079 6 (1.3) 0 0 0.216

- Penile curvature during erection 17 (3.4) 3 (3.8) 0.929 14 (3.6) 3 (3.8) 0 0.737

- Other 15 (3.0) 7 (9.0) 0.010 12 (3.1) 3 (3.8) 0 0.056

Willingness to talk about it with the doctor

- Yes, n (%)*b 418 (92.9) 63 (92.6) 0.942 328 (94.3) 63 (88.7) 27 (87.1) 0.124

MD/D: Mood disorders/depression; IQR: Interquartile range

*Values for patients reporting sexual dissatisfaction (first raw).
Missing values: an = 121; bn =9

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Table 3. Relationship between sexual satisfaction, comorbidities and age
Men < 60 years old Men ≥ 60 years old

With Without P value With Without P value

comorbidities comorbidities comorbidities comorbidities
(N = 302) (N = 86) (N = 416) (N = 58)
Sexual dissatisfaction 201 (66.6) 44 (51.2) 0.001 300 (72.1) 34 (58.6) 0.035

Main problems with sexual

function, n (%)*

- Little or no interest in sex 51 (16.9) 15 (17.4) 0.904 117 (28.1) 81 (13.8) 0.020

- Erection problems 169 (56.0) 36 (41.9) 0.021 244 (58.7) 23 (39.7) 0.006

*Values for patients reporting sexual dissatisfaction (first raw).

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Table 4. Utility and easiness of use of the BSSC for GPs and dissatisfied
patients
N (%) No A little bit Quite or

or normal very

General practitioners (GPs)a

Do you think that the BSSC was

difficult to complete? 488 338 32 (3.7)

(56.8) (39.3)

Was the BSSC useful to assess

the sexual health of your 46 (5.4) 273 540

patients? (31.8) (62.9)

Dissatisfied patientsb

Do you think that the BSSC was

difficult to complete? 304 253 21 (3.6)

(52.6) (43.8)

Was the BSSC useful to

approach your sexual problems 42 (7.3) 205 331

with your GP? (35.5) (57.3)

BSSC: Brief Sexual Symptom Checklist

Missing values: an= 3; bn= 1

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