Erectile performance anxiety is a key psychosexual determinant of erectile function and treatment response (1). Despite its clinical relevance, no validated Turkish instrument existed to assess this construct. This study aimed to adapt the Erectile Performance Anxiety Index (EPAI) (2) into Turkish (EPAI-TR) and evaluate its psychometric properties in a non-clinical adult male population.

This methodological validation study followed standardized forward–backward translation, expert review, and a pilot test (n=20). Data were collected online from 225 sexually active, Turkish-speaking men aged ≥18 years. A subsample of 55 participants completed the EPAI-TR after 2–4 weeks to examine temporal stability.
Given its factor-analytic design, the sample size exceeded the recommended subject-to-item ratio (≥20:1), providing adequate statistical power for ordinal CFA. Analyses used polychoric correlations, WLSMV estimation, EFA/CFA, Cronbach’s alpha, McDonald’s omega, composite reliability, AVE, and HTMT.

EPAI-TR total scores ranged from 10 to 39 (M = 15.75 ± 6.33), showing positive skewness consistent with a non-clinical sample. In the test–retest subsample, the mean score was 17.36 ± 7.24. CFA supported a two-factor structure representing cognitive–control and emotional–reactive components. Model fit indices were acceptable (CFI=.94, TLI=.91, RMSEA=.09, SRMR=.05). (Table 1, Table 2)
Internal consistency ranged from .72 to .82. Test–retest reliability demonstrated excellent temporal stability (ICC=.90, p<.001). Although some AVE values were <.50, CR≥.70 and HTMT<.85 supported convergent and discriminant validity.

The emergence of two distinct yet correlated dimensions suggests that erectile performance anxiety in Turkish men involves separable cognitive-control and emotional-reactive mechanisms. This organisation aligns with psychosexual models of performance anxiety and is relevant for clinical ED assessment, where differentiating cognitive monitoring from affective arousal may guide personalised interventions.

EPAI-TR is the first validated Turkish instrument measuring erectile performance anxiety and demonstrates strong psychometric adequacy in a non-clinical male sample. Its two-dimensional structure offers a clinically meaningful framework for psychosexual assessment and may support individualised management strategies in sexual health and urogenital practice.

Allen, M. S., Wood, A. M., & Sheffield, D. (2023). The psychology of erectile dysfunction. Current Directions in Psychological Science, 32(6), 487–493. https://doi.org/10.1177/09637214231192269
Telch, M. J., & Pujols, Y. (2013). The Erectile Performance Anxiety Index: Scale development and psychometric properties. The Journal of Sexual Medicine, 10(12), 3019–3028. https://doi.org/10.1111/jsm.12305