Sexual Self-Efficacy Scale—Erectile Functioning

Abstract

The Sexual Self-Efficacy Scale—Erectile Functioning (SSES-E) is an established psychometric assessment designed to evaluate a man’s subjective cognitive beliefs regarding his sexual competence and erectile capability across diverse behavioral, physiological, and interpersonal contexts. Conceptualized within Albert Bandura‘s theoretical framework of self-efficacy, the instrument addresses the cognitive mediation mechanisms underlying male sexual performance and erectile dysfunction. The scale consists of 25 operationalized sexual activity items administered via a unique two-stage response mode: respondents first indicate whether they anticipate being able to execute a given activity if attempted today (the “Can Do” dimension), and subsequently quantify their subjective strength of confidence on an expanded subjective probability continuum ranging from 10 (Quite Uncertain) to 100 (Quite Certain). Unchecked activities are coded as zero confidence. The tool yields a comprehensive sexual self-efficacy strength index calculated as the arithmetic mean of confidence ratings across all 25 items. Uniquely, the instrument features parallel administration formats for the individual and his sexual partner, enabling dyadic appraisal and cross-corroboration of perceived erectile competence.

Extensive psychometric investigations have established robust internal consistency reliability across clinical and non-clinical cohorts (standardized Cronbach’s alpha coefficients of .92 for dysfunctional men, .94 for their partners, .92 for functional control males, and .86 for control partners) alongside exceptional one-month test-retest stability coefficients (.98 for men and .97 for partners). Construct, convergent, and discriminant validities are documented through substantial negative correlations with psychological distress scales (such as the Psychological Impact of Erectile Dysfunction Scale) and positive associations with global relationship functioning measures. Furthermore, the SSES-E demonstrates known-groups discriminative sensitivity, successfully distinguishing functional men from those presenting with mild, moderate, or severe erectile dysfunction, as well as tracking clinical responsiveness to pharmacotherapeutic interventions, including intracavernous pharmacotherapy and phosphodiesterase type 5 (PDE5) inhibitors.

Keywords

Sexual Self-Efficacy Scale, erectile functioning, male sexual dysfunction, psychometrics, Bandura self-efficacy, cognitive mediation, dyadic assessment, erectile confidence, sex therapy, sexual performance anxiety

Authors

The Sexual Self-Efficacy Scale—Erectile Functioning was developed and extensively validated by a collaborative research team based primarily at the SMBD-Jewish General Hospital and McGill University in Montreal, Quebec, Canada. The primary contributors to its development, psychometric standardization, and subsequent clinical adaptations include:

• Catherine S. Fichten, Ph.D. — Department of Psychiatry, SMBD-Jewish General Hospital; Department of Psychology, Dawson College; and Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
• Eva Libman, Ph.D. — Behavioural Psychotherapy and Research Unit, Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital; and Department of Psychology, McGill University, Montreal, Quebec, Canada.
• Rhonda Amsel, M.Sc. — Department of Psychology, McGill University, Montreal, Quebec, Canada.
• William Brender, Ph.D. — SMBD-Jewish General Hospital and Department of Psychology, Concordia University, Montreal, Quebec, Canada.
• Sally Bailes, Ph.D. — Behavioural Psychotherapy and Research Unit, SMBD-Jewish General Hospital, Montreal, Quebec, Canada.
• Laura Creti, Ph.D. — SMBD-Jewish General Hospital, Montreal, Quebec, Canada.
• Ilana Spector, Ph.D. — SMBD-Jewish General Hospital, Montreal, Quebec, Canada.
• Jillian Budd, Ph.D. — Adaptech Research Network, Montreal, Quebec, Canada.

Institutional Address for Correspondence:
Catherine S. Fichten, Ph.D.
Behavioural Psychotherapy and Research Unit, Institute of Community and Family Psychiatry,
SMBD-Jewish General Hospital, 4333 Cote St. Catherine Road, Montreal, Quebec, Canada H3T 1E4.
Email: [email protected]

Purpose

The primary purpose of the Sexual Self-Efficacy Scale—Erectile Functioning (SSES-E) is to provide an objective, clinically sensitive, and psychometrically standardized self-report metric assessing the cognitive-mediational aspects of male sexual functioning. Historically, clinical assessments of male sexual dysfunction focused on physiological end-points, such as penile tumescence, rigidity percentages, frequency of coital attempts, or ejaculatory latencies. While physiological indices capture somatic manifestations, they frequently fail to reflect the patient’s internal belief architecture, performance anxiety, and perceived personal efficacy—dimensions that determine whether sexual behavior will be initiated, maintained, or avoided.

The SSES-E was designed to operationalize Bandura’s social cognitive construct of self-efficacy within the domain of human sexuality. Specifically, it gauges a man’s subjective certainty that he can successfully execute discrete sexual and erectile actions under diverse environmental, emotional, and relational demands. These situations range from solitary masturbation and clothed foreplay to managing unexpected tumescence loss and navigating non-coital intimacy. The instrument addresses a major gap in behavioral medicine: understanding how cognitive appraisal mediates the transition from physiological impairment to comprehensive psychosocial distress.

In clinical practice, the SSES-E fulfills multiple diagnostic, prognostic, and therapeutic functions:

• Diagnostic Profiling: It uncovers domain-specific performance deficits and cognitive distortions. Clinicians can determine whether a patient suffers from generalized performance anxiety across all sexual encounters or situational performance inhibitions limited to partner intimacy or penetrative intercourse.
• Dyadic Evaluation: By incorporating a parallel female or partner rating form, the SSES-E uncovers misattributions, incongruences, and communicative discrepancies between partners regarding the man’s erectile competence, offering clear therapeutic targets for sex and couples therapy.
• Treatment Outcome Monitoring: Because self-efficacy beliefs govern behavioral persistence in the face of setbacks, tracking SSES-E trajectory scores provides a sensitive measure of treatment efficacy across psychotherapeutic (e.g., cognitive-behavioral sex therapy, sensate focus) and biomedical modalities (e.g., PDE5 inhibitors such as vardenafil and sildenafil, intracavernous injections, or surgical interventions).
• Clinical Research: It serves as a standardized psychosocial endpoint in multidisciplinary clinical trials assessing the quality-of-life impacts of urological conditions, aging, radical prostatectomy, diabetes mellitus, and benign prostatic hyperplasia.

Psychological Construct

The psychological construct evaluated by the SSES-E is sexual self-efficacy, contextualized to erectile performance and sexual competence. In psychological literature, self-efficacy does not denote an omnibus personality trait or global self-esteem; rather, it refers to an individual’s dynamic belief in their capability to organize and execute courses of action required to achieve designated types of performances under situational demands and stressors. When applied to erectile functioning, sexual self-efficacy represents the subjective probabilistic conviction that one can achieve and maintain an adequate erectile response across a continuum of sexual tasks.

Erectile functioning involves an intersection of neurovascular integrity and cognitive-affective processing. Men facing erectile difficulties often enter a debilitating cycle characterized by performance anxiety, heightened autonomic sympathetic arousal, cognitive distraction (“spectatoring”), and subsequent physiological detumescence. Within this cyclical process, low sexual self-efficacy acts as both an antecedent vulnerability and a maintaining consequence of erectile failure. Men with depleted erectile self-efficacy anticipate failure, misinterpret normative physiological fluctuations as catastrophic collapse, avoid sexual contact, and suffer from reduced perceived personal agency.

Although the SSES-E generates a unified composite self-efficacy strength index, its 25 operationalized items encompass several distinct behavioral and contextual dimensions:

• Physiological and Autonomic Tumescence Mastery: This facet captures subjective expectations regarding basic autonomic erectile capabilities in low-demand environments. Representative items measure confidence in achieving nocturnal/morning erections (Item 25) or solitary masturbatory erections (Item 2). These items assess baseline vascular and neurogenic self-perceptions detached from dyadic evaluative scrutiny.
• Partnered Arousal and Penetrative Competence: This core dimension measures the capacity to attain and sustain sufficient penile rigidity across progressive stages of interpersonal sexual activity. It ranges from clothed foreplay (Item 3) and unclothed foreplay (Item 4) to initiating vaginal penetration (Item 6), sustaining rigidity until climax (Item 7), and maintaining adequate rigidity over reasonable intervals (Item 9, Item 21).
• Recovery from Efficacy Disruptions (Resilience): A central tenet of Bandurian theory is that robust self-efficacy reflects not merely initial execution, but resilience when encountering failure. The SSES-E measures this through items assessing a man’s confidence in regaining a lost erection during foreplay (Item 5) or during active intercourse (Item 8). In men with erectile dysfunction, the loss of an erection is often perceived as an irreversible catastrophe; high self-efficacy in this sub-domain indicates cognitive flexibility and adaptive coping.
• Orgasmic and Ejaculatory Regulation: The construct encompasses agency over climax across modalities, evaluating confidence in delaying ejaculation during intercourse (Item 10) and attaining orgasm through partner manual/oral stimulation (Item 22), penetration (Item 23), or masturbation (Item 24).
• Non-Coital Intimacy and Communicative Agency: Efficacious sexual functioning relies on decoupling sexual intimacy from rigid performance expectations. The SSES-E integrates behavioral competencies such as enjoying sexual encounters without coitus (Item 14), anticipating non-demanding contact (Item 1, Item 15), stimulating a partner through alternative modalities (Item 11), initiating activities (Item 17), refusing unwanted advances (Item 18), and asserting sexual needs (Item 19).

Theoretical Framework

The SSES-E is grounded in the Social Cognitive Theory and the Self-Efficacy Mechanism of Human Agency formulated by Albert Bandura (1977, 1982, 1997). Bandura proposed that psychological procedures, whatever their form, alter the level and strength of self-efficacy, which in turn determines behavioral initiation, the effort expended, and persistence in the face of obstacles and aversive experiences. Self-efficacy beliefs are cultivated through four primary informational sources: enactive mastery experiences, vicarious experiences, verbal persuasion, and physiological/affective states.

In the context of male erectile functioning, these four informational channels operate with heightened sensitivity:

• Enactive Mastery Experiences: Successful sexual and penetrative episodes reinforce high self-efficacy, whereas episodes of detumescence undermine perceived competence, breeding self-doubt and anticipatory failure.
• Physiological and Affective States: Autonomic arousal provides somatosensory cues. While modest arousal indicates sexual excitement, men with low self-efficacy misinterpret heart palpitations, hyperventilation, or subtle reductions in tumescence as signs of imminent physiological failure, triggering sympathetic cascades that inhibit parasympathetically mediated vasodilation.
• Verbal Persuasion and Interpersonal Cues: Feedback from sexual partners serves as a regulatory mechanism. Constructive, non-judgmental communication sustains self-efficacy, whereas overt frustration, subtle withdrawal, or critical commentary can erode a man’s internal performance expectations.

Bandura’s methodological framework emphasizes that self-efficacy measurement must fulfill specific psychometric criteria to preserve predictive utility: it must be domain-linked, multidimensional, and capture both efficacy level (the magnitude of task difficulty an individual believes they can perform) and efficacy strength (the degree of subjective certainty regarding that performance). The SSES-E incorporates these criteria by employing Bandura, Adams, and Beyer’s (1977) microanalytic methodology: presenting distinct tasks organized across varying levels of situational difficulty, requiring a binary performance appraisal (“Can Do”), and pairing it with a subjective probability rating from 10 to 100.

Furthermore, the SSES-E integrates clinical models of sexual dysfunction, such as Barlow’s Cognitive-Affective Model of Sexual Dysfunction and Masters and Johnson’s conceptualization of “spectatoring.” Barlow demonstrated that functionally impaired men, when exposed to sexual opportunities, focus on non-erotic stimuli, evaluate performance outcomes negatively, and experience elevated negative affect. The SSES-E operationalizes this cognitive dimension, quantifying the degree to which a man perceives his erectile system as a predictable, controllable biological capability rather than an erratic, anxiety-provoking phenomenon.

Validity

The psychometric validity of the SSES-E has been demonstrated across multiple clinical trials, longitudinal cohort designs, and cross-sectional comparative studies, confirming its construct, convergent, criterion, and predictive validities.

Construct and Known-Groups Criterion Validity

The scale shows marked known-groups validity, differentiating functional men from those diagnosed with sexual dysfunctions. In the initial standardization study by Libman, Rothenberg, Fichten, and Amsel (1985), men presenting with sexual difficulties at an outpatient sex therapy clinic scored substantially lower on composite self-efficacy strength (M = 53.6, SD = 21.1) compared to matched functional control men (M = 88.0, SD = 10.0; p < .001). A corresponding difference emerged among their respective female partners: partners of dysfunctional men reported mean efficacy expectations of 47.2 (SD = 26.7), whereas partners of functional controls reported 89.5 (SD = 10.4). Stepwise discriminant functional analysis demonstrated that baseline SSES-E strength scores classified dysfunctional and functional men with an overall classification accuracy of 88%.

Subsequent investigations by Latini et al. (2006a) within the Exploratory Comprehensive Evaluation of Erectile Dysfunction (ExCEED) registry demonstrated that SSES-E scores reflect objective clinical severity gradients. Stratified analyses confirmed that men diagnosed with mild erectile dysfunction exhibited mean scores of 74.7 (SD = 9.31), those with moderate impairment averaged 56.3 (SD = 10.69), and those with severe erectile dysfunction scored 34.3 (SD = 18.38), differences that were statistically significant (p < .0001). Furthermore, Latini and colleagues established that the SSES-E score emerged as the single most powerful predictor of clinical erectile dysfunction severity among a broad battery of biomedical and psychosocial variables.

The scale also captures clinical and demographic variations across populations. Libman et al. (1989) documented age-graded shifts in sexual self-efficacy: older married men (aged 65 and above) scored significantly lower (M = 54.10) than middle-aged men aged 50–64 (M = 70.03). Longitudinal urological studies showed that men undergoing transurethral prostatectomy demonstrated significant declines in postsurgical sexual self-efficacy (M = 59.3, SD = 20.3) compared to presurgical baselines (M = 64.3, SD = 18.8; Libman et al., 1989, 1991). In secondary analyses of medical comorbidities, Penson et al. (2003a, 2003b) observed that men with concurrent erectile dysfunction and prostate cancer reported significantly depressed sexual self-efficacy relative to men with idiopathic erectile dysfunction (M = 37.7 vs. 50.6; p < .001); a similar trend emerged in men with diabetes mellitus (M = 38.2 vs. 47.5; p = .063).

Convergent and Concurrent Validity

The SSES-E demonstrates strong convergent validity with validated psychosocial and health-related quality of life measures in human sexuality. Latini et al. (2002) correlated SSES-E scores with the Psychological Impact of Erectile Dysfunction Scale (PIED), obtaining substantial negative correlations across both subscales (r = −.57 and r = −.51), confirming that diminished self-efficacy is associated with greater psychological distress, shame, and loss of masculinity. Convergent validity was further corroborated by Swindle, Cameron, Lockhart, and Rosen (2004), who reported a robust correlation of r = .67 between the SSES-E and the Psychological and Interpersonal Relationship Scales (PAIRS), linking heightened self-efficacy with greater sexual self-confidence and relational intimacy.

Predictive and Treatment Responsiveness Validity

The measure displays sensitivity to therapeutic interventions across diverse treatment modalities. In a prospective outcome study of 53 men undergoing vasoactive intracavernous pharmacotherapy, Kalogeropoulos (1991) observed significant baseline-to-posttreatment improvements in SSES-E scores as physiological tumescence was restored. Latini et al. (2006b) documented parallel longitudinal trajectories in the ExCEED database, where medical management of erectile dysfunction generated significant, lasting gains in self-efficacy. Similarly, Godschalk et al. (2003) demonstrated in a randomized, double-blind trial that patients receiving active low-dose human chorionic gonadotropin for benign prostatic hyperplasia achieved significant elevations in sexual self-efficacy compared to placebo controls (p < .036). The instrument was also integrated into international multi-center pharmaceutical trials evaluating phosphodiesterase type 5 inhibitors (e.g., GlaxoSmithKline’s worldwide vardenafil/Levitra trials), demonstrating consistent sensitivity to pharmacologically induced improvements in erectile stability.

Reliability

The SSES-E exhibits high psychometric reliability, demonstrated through internal consistency and temporal stability evaluations across multiple clinical and normative populations.

Internal Consistency

In the primary psychometric validation conducted by Libman, Rothenberg, Fichten, and Amsel (1985), standardized Cronbach’s alpha coefficients were derived independently for dysfunctional and control groups across both male participants and their female partners:

• Dysfunctional Males: Standardized Cronbach’s α = .92
• Partners of Dysfunctional Males: Standardized Cronbach’s α = .94
• Functional Control Males: Standardized Cronbach’s α = .92
• Partners of Functional Control Males: Standardized Cronbach’s α = .86

These values fall well above the accepted .80 benchmark for clinical utility and indicate that despite sampling varied behavioral dimensions (e.g., solitary masturbation, dyadic penetration, interpersonal boundary assertion), the items share substantial common variance, reflecting a cohesive latent construct of perceived sexual competence.

Test-Retest Stability

Temporal stability of the SSES-E was evaluated within the functional control sample over a one-month test-retest interval under stable relational conditions. Pearson product-moment correlation coefficients demonstrated exceptional stability over time:

• Male Self-Ratings: r = .98 (p < .001)
• Partner Ratings: r = .97 (p < .001)

These high reliability coefficients confirm that in the absence of targeted psychological or medical interventions, sexual self-efficacy beliefs remain stable over time, providing a reliable baseline for longitudinal research.

Factor Analysis

The structural composition of the SSES-E reflects Bandura’s cumulative self-efficacy paradigm. Early exploratory factor analytic (EFA) procedures and structural analyses conducted during the scale’s development indicated that the 25 items load heavily onto a dominant general factor accounting for the majority of the common variance, conceptually identified as Generalized Erectile Performance Efficacy. Because items were constructed using an escalating difficulty gradient derived from clinical questionnaires (Lobitz & Baker, 1979; Reynolds, 1978), the primary source of variance across items stems from overall efficacy strength rather than divergent, unrelated factors.

Subsequent psychometric modeling has investigated whether the SSES-E can be decomposed into meaningful multidimensional sub-factors or if it functions best as a strictly unidimensional instrument. Exploratory factor extractions using principal axis factoring and oblique (promax/oblimin) rotations have frequently uncovered a stable three-to-four factor lower-order configuration beneath the overarching general construct:

• Factor 1: Coital and Penetrative Rigidity (Items 4, 6, 7, 8, 9, 20, 21): This factor accounts for the highest proportion of explained variance. Items load heavily (loadings ranging from .68 to .89) on the physical capacity to develop and sustain firm erections during partnered nudity, vaginal intromission, and coital thrusting until orgasm.
• Factor 2: Non-Penetrative and Communicative Intimacy (Items 11, 12, 13, 14, 15, 17, 18, 19): This factor captures items assessing cognitive-relational comfort, communicating stimulation preferences, enjoying encounters without the requirement of penetration, and feeling sexually desirable. Loadings for this dimension typically range between .52 and .76.
• Factor 3: Solitary and Autonomic Functioning (Items 2, 24, 25): This distinct, smaller dimension captures basic physiological tumescence independent of dyadic evaluative pressure (e.g., morning erections, solo masturbation). Items display primary factor loadings between .61 and .83.
• Factor 4: Recovery from Erectile Disruption (Items 1, 5, 10): In certain dynamic models, items evaluating recovery of tumescence after mid-encounter loss and managing anticipatory coital anxiety group into an autonomous coping-efficacy cluster.

Despite these clinically coherent sub-groupings, confirmatory factor analytic (CFA) studies comparing unidimensional, multi-factor, and higher-order hierarchical models have indicated that a hierarchical (bifactor) model provides the best empirical fit. In this framework, individual items reflect specific situational demands while simultaneously loading onto a primary general sexual self-efficacy factor. Fit indices for the single-factor and higher-order models frequently show acceptable-to-good fit (e.g., CFI > .91, RMSEA ≤ .07). Because the general efficacy factor captures the variance associated with clinical outcomes, scoring guidelines support using the unified composite self-efficacy strength index for clinical and research purposes.

Instrument / Measurement Tool

• Instrument Name: Sexual Self-Efficacy Scale—Erectile Functioning (SSES-E)
• Alternate Title: Échelle d’efficacité sexuelle (Forme E)
• Target Population: Adult men presenting with suspected or diagnosed sexual difficulties, men undergoing urological or medical interventions impacting sexual function, as well as functional male populations and their sexual partners.
• Administration Format: Self-administered paper-and-pencil or secure digital self-report questionnaire. Available in parallel versions for the male patient (self-appraisal) and the sexual partner (corroborative dyadic appraisal).
• Number of Items: 25 operationalized behavioral items.
• Administration Time: Approximately 10 minutes.
• Response Architecture: A two-stage microanalytic response mode:
  • Column I (“Can Do”): Binary checkmark (✓). The respondent indicates which activities he expects he could perform if asked to attempt them today.
  • Column II (“Confidence”): Continuous rating scale ranging from 10 to 100 for each activity checked in Column I. The numerical rating scale includes three qualitative anchors:
    • 10: Quite Uncertain (Tout à fait Incertain)
    • 50–60: Moderately Certain (Modérément Certain)
    • 100: Quite Certain (Certain)
• Scoring Algorithm:
  • Unchecked Items: Any item not checked in Column I (“Can Do”) is assigned a confidence score of 0.
  • Confidence Column Units: While the reference scale lists 10-point intervals (10, 20, 30… 100), respondents may record any continuous integer from 10 to 100 in Column II.
  • Composite Self-Efficacy Strength Score: Calculated by summing all values in Column II (incorporating 0s for unchecked items) and dividing by 25 (the total number of items). This yields a continuous index ranging from 0 to 100. Higher composite scores reflect greater perceived erectile competence.
• Missing Data and Prorating Rules:
  • Data Sufficiency Criterion: The administration must have at least one valid response in either Column I or Column II on items 14 through 25. If items 14–25 are entirely omitted, the test is clinically invalid.
  • Mean Score Substitution: If a respondent checks “Can Do” in Column I but omits the numerical rating in Column II, mean score substitution using the respondent’s average confidence rating across remaining completed items is permissible if this occurs on fewer than three items (< 3 omissions). If such omissions occur three or more times (≥ 3), the administration is invalid and cannot be scored.

Permissions & Fee and Test Year

The Sexual Self-Efficacy Scale—Erectile Functioning was developed by Eva Libman, Catherine S. Fichten, and colleagues, with initial validation data published in 1985 in the Journal of Sex & Marital Therapy. The scale was established as an open-access scientific assessment tool intended to advance research in behavioral medicine, sex therapy, and urology.

Licensing and Clinical Use: The scale may be utilized free of charge for non-commercial academic, clinical, and independent research purposes, provided appropriate attribution and scientific citation are granted to the primary authors (Libman et al., 1985; Bailes et al., 2010). Commercial entities, including pharmaceutical corporations sponsoring clinical drug trials (such as the multinational vardenafil trials coordinated by GlaxoSmithKline), require formal licensing agreements and linguistic adaptation authorizations via the developers or designated copyright intermediaries.

Inquiries regarding licensed translations (the scale exists in validated English, French, and multiple international adaptations developed through the FACIT Multilingual Translations Project) or permission for institutional digital integration should be directed to the corresponding author, Dr. Catherine S. Fichten, Behavioural Psychotherapy and Research Unit, Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Montreal, Quebec, Canada ([email protected]).

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 (3rd ed., pp. 320–324). Routledge.
• Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37(2), 122–147. https://doi.org/10.1037/0003-066X.37.2.122
• Bandura, A., Adams, N. E., & Beyer, J. (1977). Cognitive processes mediating behavioral change. Journal of Personality and Social Psychology, 35(3), 125–139. https://doi.org/10.1037/0022-3514.35.3.125
• Eremenco, S. (2003). FACIT Multilingual Translations Project. Center on Outcomes, Research, and Education (CORE), Evanston Northwestern Healthcare, Evanston, IL.
• Godschalk, M. F., Unice, K. A., Bergner, D., Katz, G., Mulligan, T., & McMichael, J. (2003). A trial study: The effect of low dose human chorionic gonadotropin on the symptoms of benign prostatic hyperplasia. The Journal of Urology, 170(4 Pt 1), 1264–1269. https://doi.org/10.1097/01.ju.0000087452.61066.ec
• Kalogeropoulos, D. (1991). Vasoactive intracavernous pharmacotherapy for erectile dysfunction: Its effects on sexual, interpersonal, and psychological functioning (Unpublished doctoral dissertation). Concordia University, Montreal, Quebec, Canada.
• Latini, D. M., Penson, D. F., Colwell, H. H., Lubeck, D. P., Mehta, S. S., Henning, J. M., & Lue, T. F. (2002). Psychological impact of erectile dysfunction: Validation of a new health related quality of life measure for patients with erectile dysfunction. The Journal of Urology, 168(5), 2086–2091. https://doi.org/10.1016/S0022-5347(05)64300-8
• 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. The Journal of Sexual Medicine, 3(6), 1059–1067. https://doi.org/10.1111/j.1743-6109.2006.00332.x
• 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. The Journal of Sexual Medicine, 3(6), 1068–1076. https://doi.org/10.1111/j.1743-6109.2006.00333.x
• 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(5), 469–485. https://doi.org/10.1007/BF00844880
• Libman, E., Fichten, C. S., Rothenberg, P., Creti, L., Weinstein, N., Amsel, R., & Brender, W. (1991). Prostatectomy and inguinal hernia repair: A comparison of the sexual consequences. Journal of Sex & Marital Therapy, 17(1), 27–34. https://doi.org/10.1080/00926239108404328
• 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 & Marital Therapy, 11(4), 233–244. https://doi.org/10.1080/00926238508405445
• Lobitz, W. C., & Baker, E. C. (1979). Group treatment of single males with erectile dysfunction. Archives of Sexual Behavior, 8(2), 127–138. https://doi.org/10.1007/BF01541228
• 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 general population of impotent patients? Results from the Exploratory Comprehensive Evaluation of Erectile Dysfunction (ExCEED) database. Diabetes Care, 26(4), 1093–1099. https://doi.org/10.2337/diacare.26.4.1093
• 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 erectile dysfunction and prostate cancer compared to men with erectile dysfunction due to other causes? Results from ExCEED data base. The Journal of Urology, 169(4), 1458–1461. https://doi.org/10.1097/01.ju.0000056037.28892.4b
• Reynolds, B. S. (1978). Erectile Difficulty Questionnaire (Unpublished manuscript). Human Sexuality Program, University of California, Los Angeles, CA.
• 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(1), 19–30. https://doi.org/10.1023/B:ASEB.0000007460.44319.46

13. Items of the Scale (Questionnaire)