I am not aware of anything specifically designed for the Veteran population, either younger or older. On our VA SCI unit we ask all patients if they have "any questions or concerns about sexuality or sexual functioning that they would like to discuss" during admission or annual check-ups. That keeps it simple and basic, and is consistent with our PLISSIT model. It is not routinely asked in most other clinical areas to my knowledge, and should be.

I'm not aware of anything specific for Veterans either. For the most basic of assessments you might consider the short forms of the Sexual Health Inventory for Men and the Female Sexual Function Index, both developed by Ray Rosen. The shorter forms focus on arousal difficulties. The longer forms at least begin to get into desire, satisfaction, etc.

Thank you Kathleen and David. I have followed each of your leads and am further exploring the related literature. Cheers, Stacey

For men, morning erection due to urination; not only veterans.

I don't know of a measure specific to older Veterans. The Arizona Sexual Experience Scale (ASEX) is a very simple five item measure, originally designed for patients on psychotropic medications.

Thanks and Season's Greetings to all!

I am not aware of anything specifically designed for the Veteran population either. BUT I think the most common measure of erectile dysfunction in published studies is the International Index of Erectile Function (IIEF; a 15 question instrument) and the more condensed 5-question instrument measure, the IIEF-5. The IIEF meets psychometric criteria for test reliability and validity, has a high degree of sensitivity and specificity (Rosen et al, 2002). The simplified IIEF-5 version, proved to be a valid specific and sensitive scale for use in the clinical setting (Rhoden et al, 2002). I have attached a link which provides an example of the IIEF-5.

http://www.google.com.au/imgres?imgurl=http://www.scielo.br/img/revistas/abem/v52n9/a06fig03.jpg&imgrefurl=http://www.scielo.br/scielo.php%3Fscript%3Dsci_arttext%26pid%3DS0004-27302008000900006&usg=__vufOZ76K_RvCU9luOLy6-lmY4uI=&h=551&w=370&sz=105&hl=en&start=2&zoom=1&tbnid=7k2lqvDhXtPk1M:&tbnh=133&tbnw=89&ei=H3PjUJGpC-a3iQf-mYCoCQ&prev=/images%3Fq%3Diief-5%26hl%3Den%26sa%3DX%26rls%3Dcom.microsoft:*%26ie%3DUTF-8%26oe%3DUTF-8%26tbm%3Disch&itbs=1

Thank you for your thoughtful response Tracey, and for alerting me to the literature regarding screening for HRQOL in ageing men. The needs assessment tool that we are developing for general practice in Australia will be administered by nurses as part of a comprehensive needs assessment for older veterans. I suspect that we will need to keep the initial question/s "simple and basic" as Kathleen has suggested, and to recommend inclusion of tools such as the IIEF as part of further clinical assessment by a medical officer. I think we all agree that screening for sexual problems should occur. As a first step, we hope to provide an opportunity for older veterans to identify sexual function as a concern, if relevant, and to flag this for further discussion with their doctor. Further suggestions about how best to do this, and what questions to ask, are most welcome. Thanks to all for your contributions.

Keep in mind that physicians may not be the best professional to address issues of sexuality, as many have limited training in this area. At our Veterans Hospital, on our SCI unit, I, as the clinical nurse specialist, do the majority of our sexuality education and counseling, and our psychologists also work collaboratively on this with many of our Veterans. The physicians are supportive and refer many clients to me, but the nurses refer most to me when screening during annual outpatient check-ups and during admission assessments.

Thanks for sharing your experience Kathleen. We do need to ensure that clinicians are able to respond to identified needs and can access appropriate referral pathways. Given the advanced age of our target group, we will also need to be mindful of physiological and psychological factors that can contribute to sexual dysfunction as well as the side effects of drug and/or surgical treatments for conditions such as prostate cancer, hypertension, anxiety and mood disorders. This discussion has raised some important points which I look forward to sharing with our research group and DVA advisors. Thank you for your contributions.

HI Stacey, I am doing research involvig older men with prostate cancer and we are also considering the IIEF, but was unaware of the IIEF-5, which we will consider. The other option for this group which may apply (but perhaps not to your group) is the EORTC30 P25 prostate module which gives sexual interest and sexual function domain scores.

An article that may be of interest to readers is: Construct validity of the PROMIS(R) sexual function and satisfaction measures in patients with cancer

Flynn KE, Reeve BB, Lin L, Cyranowski JM, Bruner DW, Weinfurt KP

Health and Quality of Life Outcomes 2013, 11:40 (11 March 2013)

Thanks Stacey for that reference. So what have you decided to go with and what lead you to this decision? For example, was it the psychometric properties, responsiveness to change, ease of use, cost etc?

Thanks for your question Justin. We are piloting an adaptation of the Brief Sexual Symptom Checklist (Hatzichristou D, et al. J Sex Med 2010; 7:337-348). Essentially we are asking: 'Are you satisfied with your sexual function?'; 'If not, how long have you been dissatisfied with your sexual function?' and 'Would you like to talk about it with your healthcare provider?' Our decision was based on the demographics of the population who are enrolled in the Coordinated Veterans Care (CVC) Program. This population has a mean age of 85 years and are predominantly WWII veterans as well as war widows/widowers so acceptability was a major consideration. We are administering the questions as part of a comprehensive needs assessment and brevity was important. As always, comments are welcomed!

We ask "Would you like to speak to someone about your sexuality concerns?" rather than specifying the provider. Our providers don't do much if any sexuality counseling, while myself (clinical nurse specialist) and our psychologists often get referrals from the providers for their patients.