Cindy M. Meston

THE FEMALE SEXUAL FUNCTION INDEX (FSFI): A MULTIDIMENSIONAL SELF-REPORT INSTRUMENT FOR THE ASSESSMENT OF FEMALE SEXUAL FUNCTION

This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6- domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r=0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach’s alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p<0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric(as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbachs alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.

The Female Sexual Function Index (FSFI): Cross-Validation and Development of Clinical Cutoff Scores

The Female Sexual Function Index (FSFI) is a brief, multidimensional scale for assessing sexual function in women. The scale has received initial psychometric evaluation, including studies of reliability, convergent validity, and discriminant validity (Meston, 2003; Rosen et al., 2000). The present study was designed to cross-validate the FSFI in several samples of women with mixed sexual dysfunctions (N = 568) and to develop diagnostic cut-off scores for potential classification of womens sexual dysfunction. Some of these samples were drawn from our previous validation studies (N = 414), and some were added for purposes of the present study (N = 154). The combined data set consisted of multiple samples of women with sexual dysfunction diagnoses (N = 307), including female sexual arousal disorder (FSAD), hypoactive sexual desire disorder (HSDD), female sexual orgasm disorder (FSOD), dyspareunia/vaginismus (pain), and multiple sexual dysfunctions, in addition to a large sample of nondysfunctional controls (n = 261). We conducted analyses on the individual and combined samples, including replicating the original factor structure using principal components analysis with varimax rotation. We assessed Cronbachs alpha (internal reliability) and interdomain correlations and tested discriminant validity by means of a MANOVA (multivariate analysis of variance; dysfunction diagnosis x FSFI domain), with Bonferroni-corrected post hoc comparisons. We developed diagnostic cut off scores by means of standard receiver operating characteristics–curves and the CART (Classification and Regression Trees) procedure. Principal components analysis replicated the original five-factor structure, including desire/arousal, lubrication, orgasm, pain, and satisfaction. We found the internal reliability for the total FSFI and six domain scores to be good to excellent, with Cronbach alphas > 0.9 for the combined sample and above 0.8 for the sexually dysfunctional and nondysfunctional samples, independently. Discriminant validity testing confirmed the ability of both total and domain scores to differentiate between functional and nondysfunctional women. On the basis of sensitivity and specificity analyses and the CART procedure, we found an FSFI total score of 26.55 to be the optimal cut score for differentiating women with and without sexual dysfunction. On the basis of this cut-off, we found 70.7% of women with sexual dysfunction and 88.1% of the sexually functional women in the cross-validation sample to be correctly classified. Addition of the lubrication score in the model resulted in slightly improved specificity (from .707 to .772) at a slight cost of sensitivity (from .881 to .854) for identifying women without sexual dysfunction. We discuss the results in terms of potential strengths and weaknesses of the FSFI, as well in terms of further clinical and research implications.

Validation of the Female Sexual Function Index (FSFI) in Women with Female Orgasmic Disorder and in Women with Hypoactive Sexual Desire Disorder

Department of Psychology, University of Texas at Austin, Austin, Texas, USA The Female Sexual Functioning Index (FSFI; Rosen et al., 2000) is a self-report measure of sexual functioning that has been validated on a clinically diagnosed sample of women with female sexual arousal disorder. The present investigation extended the validation of the FSFI to include women with a primary clinical diagnosis of female orgasmic disorder (FOD; n = 71) or hypoactive sexual desire disorder (HSDD; n = 44). Internal consistency and divergent validity of the FSFI were within the acceptable range for these populations of women. Significant differences between women with FOD and controls and between women with HSDD and controls were noted for each of the FSFI domain and total scores.

Definitions of women's sexual dysfunction reconsidered: Advocating expansion and revision

In light of various shortcomings of the traditional nosology of womens sexual disorders for both clinical practice and research, an international multi-disciplinary group has reviewed the evidence for traditional assumptions about womens sexual response. It is apparent that fullfillment of sexual desire is an uncommon reason/incentive for sexual activity for many women and, in fact, sexual desire is frequently experienced only after sexual stimuli have elicited subjective sexual arousal. The latter is often poorly correlated with genital vasocongestion. Complaints of lack of subjective arousal despite apparently normal genital vasocongestion are common. Based on the review of existing evidence-based research, many modifications to the definitions of womens sexual dysfunctions are recommended. There is a new definition of sexual interest/desire disorder, sexual arousal disorders are separated into genital and subjective subtypes and the recently recognized condition of persistent sexual arousal is included. The definition of dyspareunia reflects the possibility of the pain precluding intercourse. The anticipation and fear of pain characteristic of vaginismus is noted while the assumed muscular spasm is omitted given the lack of evidence. Finally, a recommendation is made that all diagnoses be accompanied by descriptors relating to associated contextual factors and to the degree of distress.

Socially desirable responding and sexuality self‐reports

We assessed the impact of two distinct forms of socially desirable responding—self‐deceptive enhancement and impression management—on sexuality self‐reports (n = 504) under anonymous testing conditions. Results revealed significant positive relationships between self‐deceptive enhancement and sexual adjustment variables for both sexes. Impression management was significantly negatively related to a number of intrapersonal (e.g., unrestricted sexual fantasies, sexual drive) and interpersonal (e.g., sexual experience, virginity status) sexual behaviors for females, and to unrestricted sexual attitudes and fantasies for males. We calculated correlations were first calculated between self‐deceptive enhancement, impression management, and personality and conservatism scores. Self‐deceptive enhancement and impression management were significantly associated with personality for males and females, and with conservatism for females only. When personality and conservatism variance were partialed out, associations ...

The Association Between Sexual Satisfaction and Body Image in Women

INTRODUCTION Although sexual functioning has been linked to sexual satisfaction, it only partially explains the degree to which women report being sexually satisfied. Other factors include quality of life, relational variables, and individual factors such as body image. Of the few studies that have investigated the link between body image and sexual satisfaction, most have considered body image to be a single construct and have shown mixed results. AIM The present study assessed multiple body image variables in order to better understand which aspects of body image influence multiple domains of sexual satisfaction, including sexual communication, compatibility, contentment, personal concern, and relational concern in a community sample of women. METHODS Women between the ages of 18 and 49 years in sexual relationships (N = 154) participated in an Internet survey that assessed sexual functioning, five domains of sexual satisfaction, and several body image variables. MAIN OUTCOME MEASURES Body image variables included the sexual attractiveness, weight concern, and physical condition subscales of the Body Esteem Scale, the appearance-based subscale of the Cognitive Distractions During Sexual Activity Scale, and body mass index. Total score of the Sexual Satisfaction Scale for Women was the main outcome measure. Sexual functioning was measured by a modified Female Sexual Function Index. RESULTS Consistent with expectations, correlations indicated significant positive relationships between sexual functioning, sexual satisfaction, and all body image variables. A multiple regression analysis revealed that sexual satisfaction was predicted by high body esteem and low frequency of appearance-based distracting thoughts during sexual activity, even after controlling for sexual functioning status. CONCLUSION Several aspects of body image, including weight concern, physical condition, sexual attractiveness, and thoughts about the body during sexual activity predict sexual satisfaction in women. The findings suggest that women who experience low sexual satisfaction may benefit from treatments that target these specific aspects of body image.

Validated Instruments for Assessing Female Sexual Function

In this article, we review five instruments for assessing female sexual dysfunction (FSD): the Brief Index of Sexual Functioning for Women (BISF-W; Taylor, Rosen, & Leiblum, 1994), the Changes in Sexual Functioning Questionnaire (CSFQ; Clayton, McGarvy, & Clavet, 1997), the Derogatis Interview for Sexual Functioning (DISF/DISFSR; Derogatis, 1997), the Female Sexual Function Index (FSFI; Rosen et al., 2000), and the Golombok Rust Inventory of Sexual Satisfaction (GRISS; Rust & Golombok, 1986). The purpose of this article is to highlight the psychometric properties of these questionnaires in an effort to assist researchers in selecting effective measurement tools for FSD.

Sexual functioning and self‐reported depressive symptoms among college women

We conducted an exploratory study comparing 47 college‐aged women reporting depressive symptoms but not receiving antidepressant medication to 47 age‐matched controls. We examined various dimensions of sexual functioning, including sexual desire, arousal, orgasm, pain, pleasure, and satisfaction. The women with depressive symptoms reported more inhibited sexual arousal, more inhibited orgasm, more sexual pain problems, and less sexual satisfaction and pleasure than control participants. Novel to this study, the women with depressive symptoms reported greater desire for sexual activity alone (masturbation) than the nondepressed women. The findings are discussed in terms of primary reinforcers and depressive symptomology.

Women's Orgasm

Abstract An orgasm in the human female is a variable, transient peak sensation of intense pleasure, creating an altered state of consciousness, usually with an initiation accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions, and myotonia that resolves the sexually induced vasocongestion and myotonia, generally with an induction of well-being and contentment. Womens orgasms can be induced by erotic stimulation of a variety of genital and nongenital sites. As of yet, no definitive explanations for what triggers orgasm have emerged. Studies of brain imaging indicate increased activation at orgasm, compared to pre-orgasm, in the paraventricular nucleus of the hypothalamus, periaqueductal gray of the midbrain, hippocampus, and the cerebellum. Psychosocial factors commonly discussed in relation to female orgasmic ability include age, education, social class, religion, personality, and relationship issues. Findings from surveys and clinical reports suggest that orgasm problems are the second most frequently reported sexual problems in women. Cognitive-behavioral therapy for anorgasmia focuses on promoting changes in attitudes and sexually relevant thoughts, decreasing anxiety, and increasing orgasmic ability and satisfaction. To date there are no pharmacological agents proven to be beneficial beyond placebo in enhancing orgasmic function in women.

Ethnic Differences in Sexual Attitudes of U.S. College Students: Gender, Acculturation, and Religiosity Factors

Although it has been hypothesized that culture and religion play an important role in sexuality, the relative roles of acculturation and religiosity on ethnic differences in sexual attitudes have not been often empirically explored. The present study assessed differences in sexual attitudes in Euro-American, Asian, and Hispanic American populations using measures of acculturation to analyze the relative effects of heritage and mainstream cultures, as well as religiosity, within each ethnic group. A total of 1,415 college students (67% Euro-American, 16% Hispanic, 17% Asian; 32% men, 68% women) completed questionnaires which assessed attitudes towards homosexuality, gender role traditionality, casual sex, and extramarital sex. In concordance with previous studies, Asians reported more conservative sexual attitudes than did their Hispanic and Euro-American peers. Hispanics reported sexual attitudes similar to that of Euro-Americans. For both Hispanic and Asians, higher acculturation predicted sexual attitudes similar to that of Euro-Americans. For Asian, Hispanic, and Euro-American women, there was a significant interaction between intrinsic religiosity and spirituality such that the relationship between conservativism of sexual attitudes and intrinsic religiosity was stronger at higher levels of spirituality. In Euro-Americans and Asians, intrinsic religiosity and religious fundamentalism strongly predicted conservative sexual attitudes; while still significant, these relationships were not as pronounced in the Hispanic sample, implying an ethnic-by-religious effect. Novel to this study, acculturation did not mediate the relationship between religiosity and sexual attitudes, indicating that ethnic differences in religiosity effects were distinct from acculturation.