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Sexual function symptom scales should be used routinely to assess functional level (eg ability to respond, level of interest) and to determine the impact of therapy The most frequently used type of instrument is the self-administered questionnaire As with all psychometric instruments, the fundamental requirements for psychometric validity include reliability and validity Reliability refers to the consistency or replicability of data, while validity re ects the degree to which an instrument or scale measures what it intends or claims to measure Two essential indicators of validity for measures of sexual function are: sensitivity to diagnostic status (eg functional versus dysfunctional); and sensitivity to treatment change Both are crucial features of any scale that is designed to serve as a diagnostic and/or ef cacy measure in either clinical or research settings Validated symptom scales are available for the assessment of male sexual dysfunction, as well as couple and partner questionnaires, quality of life and well-being measures Most of the scales described in the table are well established and widely used in research or clinical settings In Table 22(on p27) we review measures of sexual function (in alphabetical order), that may be used in either men or women (eg CSFQ), or with men only (eg IIEF, IPE) Each measure is reviewed in

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As recommended by the 2nd International Consultation on Sexual Dysfunction [2] the sexual, medical and psychosocial history are the essential elements in the basic evaluation and should be obtained in all male patients presenting with complaints of sexual dysfunction (A sexual function checklist to be lled out in general practice or specialty settings is provided in Table 21 on p 26) The essential components of sexual function assessment in the male always include erectile response (onset, duration, progression, severity of the problem, nocturnal/morning erections, selfstimulatory and visually erotic-induced erections), sexual desire, ejaculation, orgasm, sexually related genital pain disorders and partner sexual function, if available Often, a dysfunction in one phase may precipitate a dysfunction in another For instance, men with erectile dysfunction may report a loss of sexual desire or the onset of premature ejaculation

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You are more likely to be able to influence inbound traffic from adjacent ASs than from distant ones For most enterprise connections, most adjacent ASs will be service providers you are paying for transit Your money makes them listen to your preferences Enterprises with BGP connections to other enterprises may not directly pay one another, but the fact that they have the connection indicates they have some economic motivation for talking to one another It is reasonable to assume that the peering arrangement can be negotiated to create a win-win topology for both sides It s far less likely that tier 1 providers will care very much about the preferences of other tier 1 providers customers When there is a need for controlled quality of service between major providers, the best strategy is usually to contract with one provider for a VPN and make that provider responsible for the interprovider economic incentives to make other providers care about your QoS requirement

Gauging the potential of renovating a building versus redeveloping the site is worth doing when you re buying an older property, or one in need of maintenance Most buildings have a useful lifetime after which it is more economical to demolish them and start over than renovate them Unless, that is, you enjoy renovating properties and making something new out of them (if that s your bag, see 15) We discuss the calculations required to assess the relative cost of buying as opposed to redevelopment in this chapter under cost-comparison appraisals Both renovations and redevelopment have their complications as well as benefits: Complications associated with renovations include the need to respect the existing structural elements of the building, potentially raising the cost of the project You may also need to satisfy municipal requirements with respect to permitting and zoning, or building code issues if the

2 relationship, the man s denial, or the woman s hurt/anger Partner participation may be in uenced by cultural and social expectations, as well as patient needs and preferences When psychosocial assessment reveals the presence of signi cant psychologic distress or relationship dif culties, in-depth psychosocial evaluation and one-to-one counseling may be recommended

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