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To the Editor: In the study by Dr Esposito and colleagues,¹ the authors used the modified version of the International Index of Erectile Function (IIEF-5)² to determine outcome. However, we are not given intercourse attempt or success rates, which may be a more robust measure of treatment outcome, success, or efficacy.³ It is difficult to assess the clinical significance of the reported outcomes without intercourse data—a 4-point change in the IIEF-5 score may have only a modest clinical impact. The marital or partner status is not discussed, which has a major impact on erectile dysfunction treatment success.⁴ Finally, the mild increase in IIEF-5 score from 13.9 to 17 in the intervention group rather than to normal levels (>22) may be attributable to the majority of the treated men still having a significantly elevated body mass index (31.2) at the end of the treatment.

Allen D. Seftel, MD
adseftel@aol.com
Cleveland VA Medical Center
Cleveland, Ohio

1. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291:2978-2984. FREE FULL TEXT 2. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:319-326. FULL TEXT | ISI | PUBMED 3. Seftel AD, Wilson SK, Knapp PM, Shin J, Wang WC, Ahuja S. The efficacy and safety of tadalafil in United States and Puerto Rican men with erectile dysfunction. J Urol. 2004;172:652-657. PUBMED 4. Montorsi F, Althof SE. Partner responses to sildenafil citrate (Viagra) treatment of erectile dysfunction. Urology. 2004;63:762-767. PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292:2466.

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