Brief Sexual Function Inventory (BSFI) Test For LUTS Assessment

How does the Brief Sexual Function Inventory (BSFI) test for LUTS assessment work?

This is a health tool that evaluates male sexual function by taking into account several functional domains and providing a score that can be correlated with sexual dysfunction and the existence of lower urinary tract symptoms (LUTS).

The original study begins with the following indication: “Lets define sexual drive as a feeling that may include wanting to have a sexual experience (masturbation or intercourse) thinking about having sex or felling frustrated due to lack of sex.”

This Brief Sexual Function Inventory (BSFI) test for LUTS assessment comprises of 11 items that cover 5 aspects of male functioning with observations focusing on the last month in the patient’s life:

■ sexual drive (two items):

- frequency of experiencing sexual drive;

- rating the sexual drive level.

■ erection (three items):

- frequency of partial or full sexual erections during stimulation;

- frequency of the ability to have sexual intercourse;

- difficulty in obtaining an erection.

■ ejaculation (two items):

- degree of difficulty ejaculating while being sexually stimulated;

- considering the amount of semen ejaculated.

■ perceptions of problems in each area (three items):

- to what extent is lack of sex drive considered to be a problem;

- to what extent is the ability to keep an erection a problem;

- to what extent is ejaculation considered a problem.

■ overall satisfaction (one item).

Each of the items is rated on a 5 point scale, with different weights given to each answer choice. Most scales start from 0 whilst the first one starts from 1. Answers closer to the right end of the scale, closer to zero, tend to suggest symptom severity while answers closer to the other end reveal less limitation due to LUTS or other conditions.

The assessment needs to be administered by an objective observer and usually last between 5 and 10 minutes.

The original study has gone through two serial validation studies and the original items have been refined.

Although psychometric performance was rated as satisfactory, criticism concentrates on the fact that

self-assessments of ejaculate volume are problematic.

Another finding was that the increasingly reduced sexual function in the first four components was related to age as well, however the overall satisfaction degree was less associated with age.

One of the subsequent studies to use BFSI worked with a population of men with benign prostatic hyperplasia (BPH) who also experienced lower urinary tract symptoms in order to correlate the sexual dysfunction with the urinary symptoms. The International Prostate Symptom Score (IPSS) was employed as well as the BFSI.

LUTS guidelines

This is defined as a group of symptoms, also known as prostatism, mainly affecting older men. There are two main areas of focus, the filling or irritative symptoms and the voiding or obstructive symptoms. These include:

■ Increased frequency and/or urgency of urination;

■ Painful urination;

■ Excessive passage of urine during night time;

■ Incomplete voiding;

■ Poor stream (unimproved by straining);

■ Terminal dribbling;

■ Hesitancy;

■ Overflow incontinence.

The most common causes include BPH, urinary tract infections, chronic prostatitis, urinary stones, bladder or prostate malignancy or several neurological diseases.

Diagnostic means often include laboratory PSA (prostate specific antigen), urinalysis, ultrasound and also scores such as the IPSS and clinical examinations.

While less severe cases are first recommended certain lifestyle adjustements such as changing the voiding position, more severe cases include medication with alpha-1 blockade and anti-androgens or surgical methods.

References

1) O'Leary MP, Fowler FJ, Lenderking WR, Barber B, Sagnier PP, Guess HA, Barry MJ. (1995) A brief male sexual function inventory for urology. Urology; 46(5):697-706.

2) Shao Q, Song J, Guo YW, Lu WC, Du LD. (2005) Evaluation of sexual function in men with symptomatic benign prostatic hyperplasia. Zhonghua Nan Ke Xue; 11(7):505-7.

3) Mykletun A, Dahl AA, O'Leary MP, Fosså SD. (2006) Assessment of male sexual function by the Brief Sexual Function Inventory. BJU Int; 97(2):316-23.