Latent Structures of Male Sexual Functioning

ABSTRACT Introduction Strong debate has been brought out around the upcoming editions of the International Classification of Diseases, the World Health Organization, and the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association) regarding new criteria for sexual dysfunction. Although criteria for male sexual dysfunction have been supported by traditional models of sexual response, recent data suggest that male sexual functioning could be conceptualized differently, offering new directions for diagnostic and assessment tools. Aim The aim of this study was to test, through structural equation modeling, four conceptual alternative models of male sexual response. Main Outcome Measures A modified version of the International Index of Erectile Function was used, assessing sexual desire, erectile function, orgasmic function, and premature ejaculation. Methods A total of 1,558 Portuguese men participated in the study. Participants were divided into two groups according to the presence or absence of sexual difficulties. Results Findings suggested different factor solutions for men with and without sexual difficulties. Male sexual response of men with sexual difficulties was best characterized by a two-factor structure: (i) a general sexual function factor (including sexual desire, erectile function, and orgasmic function); and (ii) premature ejaculation; while a three-factor solution was the model that best fitted the data regarding men without sexual difficulties: (i) sexual desire; (ii) erectile and orgasmic function (which merged into a single dimension); and (iii) premature ejaculation. Discriminant validity between factors was strongly supported, suggesting that these dimensions measure distinct phenomena in both samples. Conclusions Results regarding sexually healthy men suggest that erectile function is structurally independent from sexual desire, and that ejaculatory control could be conceptualized as a different phenomenon in relation to the current orgasmic disorders. Additionally, findings related to sexually dysfunctional men suggest the existence of a general sexual distress disorder.