Sexual Self-Efficacy Scale – Erectile Functioning

Abstract

The Sexual Self-Efficacy Scale—Erectile Functioning (SSES-E) is a brief, 25-item self-report measure designed to assess the cognitive dimension of erectile functioning and sexual adjustment in men. It specifically evaluates a man’s beliefs and confidence regarding his erectile competence across a variety of sexual situations. Developed following the methodological format established by Bandura, Adams, and Beyer (1977), the scale requires respondents to indicate which specific sexual activities they believe they “Can Do” and then rate their confidence level for each of those activities on a 10-to-100 scale. Uniquely, the SSES-E can be completed by the male subject to provide self-ratings, or by his sexual partner to offer corroborating perspectives on his perceived competence.

Keywords

Sexual Self-Efficacy Scale, SSES-E, Erectile Dysfunction, Self-Efficacy, Sexual Competence, Sexual Adjustment, Psychometric Measure, Bandura.

Authors

Catherine S. Fichten, Jillian Budd, Ilana Spector, Rhonda Amsel, Laura Creti, William Brender, Sally Bailes, Eva Libman

Purpose

The primary purpose of the SSES-E is to quantify the cognitive and subjective dimension of male sexual performance, focusing specifically on erectile competence. It serves as a clinical and research tool to gauge a man’s confidence that he can achieve and maintain an erection sufficient for sexual activity across various contexts.

By obtaining ratings from both the male subject and his partner, the scale provides a comprehensive view of the perceived sexual self-efficacy, which is highly relevant given that confidence is a major determinant of sexual performance, particularly in aging populations or those undergoing treatment for sexual difficulties.

Construct

The SSES-E measures Sexual Self-Efficacy related to erectile functioning. This construct is rooted in Albert Bandura’s (1982) social cognitive theory, which defines self-efficacy as the belief in one’s capability to organize and execute the courses of action required to manage prospective situations.

In the context of the SSES-E, the construct evaluates the strength of a man’s belief in his ability to successfully perform 25 specific sexual tasks, ranging from basic masturbation to maintaining an erection during intercourse and communicating sexual needs to a partner. Item content was derived from earlier work by Lobitz and Baker (1979) and Reynolds (1978).

Validity

The SSES-E has demonstrated strong evidence across multiple forms of validity, confirming its rigorous psychometric properties.

Concurrent Validity was established in the original 1985 study (Libman et al.). Later research (Latini et al., 2002) found significant negative correlations (–.57 and –.51) between SSES-E scores and the Psychological Impact of Erectile Dysfunction Scale (PIED), indicating that lower sexual confidence is strongly linked to a greater negative psychological impact of erectile dysfunction. Convergent validity was supported by Swindle et al. (2004), who reported a correlation of .67 between the SSES-E and the Psychological and Interpersonal Relationship Scales scores.

Evidence for Predictive Validity shows that SSES-E scores are sensitive to treatment effects. Scores significantly improved following vasoactive intracavernous pharmacotherapy (Kalogeropoulos, 1991) and in longitudinal studies of erectile dysfunction therapy (Latini et al., 2006b). Furthermore, the scale showed improvement following active treatment for benign prostatic hyperplasia compared to placebo (Godschalk et al., 2003). Criterion Validity studies found that the SSES-E score was the best predictor of erectile dysfunction severity (Latini et al., 2006a). Known-groups criterion validity was also excellent: the scale successfully differentiated dysfunctional men from control subjects with 88% accuracy (Libman et al., 1985). Scores also significantly differentiated men based on age (older men scored lower) and severity of ED (mild, moderate, severe differences were highly significant, p < .0001).

Reliability

The SSES-E exhibits high reliability across diverse samples of men and their partners.

Internal Consistency was assessed using standardized alpha coefficients in dysfunctional and control samples. Estimates were consistently high: .92 for dysfunctional males, .94 for their female partners’ ratings, .92 for control males, and .86 for their female partners. This suggests a strong correlation among the 25 items within the scale.

Test-retest Reliability, measured over a 1-month interval using the control group, was exceptionally high, yielding coefficients of .98 for males and .97 for females. These results confirm the stability and consistency of the measure over time.

Factor Analysis

The provided source material does not contain specific information regarding the factor structure or factor analysis results of the Sexual Self-Efficacy Scale—Erectile Functioning (SSES-E). The scale is typically treated as a unidimensional measure yielding a single strength score reflecting overall erectile competence confidence.

Instrument

Test Type: Self-report Questionnaire (Psychological/Behavioral)

Format: 25 items, dual-response format (Can Do checkbox + Confidence rating scale from 10 to 100)

Language Available: English, French, and several other languages through GlaxoSmithKline translation efforts (cf. Eremenco, 2003)

Population Group: Men experiencing sexual difficulties, particularly Erectile Dysfunction, and their sexual partners.

Age Group: Adult (Studies included samples with a mean age of 34, and comparison groups up to 65+)

Population Details: Has been validated in middle-class Caucasian samples, men with Erectile Disorder, Hypoactive Sexual Desire, Rapid Ejaculation, prostate cancer, diabetes, and post-surgical patients (e.g., transurethral prostatectomy).

Test Methodology: Respondents first check “Can Do” for activities they believe they could perform today. For only those activities checked, they rate their confidence level (self-efficacy strength score) on a scale from 10 (Quite Uncertain) to 100 (Quite Certain).

Keywords

Sexual Health, Penile Function, Confidence Score, Psychometric Properties, Quality of Life, Libman, Pharmaceutical Trials, Sexual Therapy.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected]

Correspondence Address: 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.

Permissions & Fee and Test Year

The scale was first published and validated in 1985 (Libman et al., 1985). The SSES-E has been widely utilized in clinical research, including the worldwide Levitra evaluation program sponsored by GlaxoSmithKline (2009). Information regarding current licensing fees or explicit permissions is not provided in the source material, but correspondence is directed to Catherine S. Fichten.

Reference’s

• 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, s-eremenco@ 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 chorionic 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 psychological 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 general population of impotent patients? Results from the Exploratory Comprehensive Evaluation of Erectile Dysfunction (ExCEED) database. 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 erectile 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.

Items of the Sexual Self-Efficacy Scale—Erectile Functioning

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

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.

Confidence Rating Scale:

• 10: Quite Uncertain
• 50–60: Moderately Certain
• 100: Quite Certain

SSES-E Items (English):

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.