The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function
Open accessAbstract
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 < 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.
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- Findingown data
The FSFI demonstrated good construct validity through highly significant mean differences between FSAD and control groups on every domain (p<0.001).
“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).”
Quote in the paperSubstantial claim - Findingown data
The FSFI showed divergent validity against a marital satisfaction scale.
“Additionally, divergent validity with a scale of marital satisfaction was observed.”
Quote in the paperNot a substantial claim - Findingown data
Internal consistency of the FSFI was high, with Cronbach's alpha values of 0.82 and above.
“a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher)”
Quote in the paperSubstantial claim - Findingown data
A six-domain structure for the FSFI was identified from clinical interpretation of principal components analysis: desire, subjective arousal, lubrication, orgasm, satisfaction, and pain.
“Based on clinical interpretations of a principal components analysis, a 6domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain.”
Quote in the paperSubstantial claim- Rests on an assumption: Each female sexual disorder corresponds to different phases or domains of sexual function.
- Rests on an assumption: Sexual satisfaction is an important dimension of sexual function, although no separate diagnostic category exists for dysfunction in this dimension.
- Rests on an assumption: Sexual response and dysfunction involve both psychological and organic processes.
- Findingown data
Test-retest reliability coefficients were high for each FSFI domain, ranging from r=0.79 to 0.86.
“Overall testretest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86)”
Quote in the paperSubstantial claim
- Findingown data
Correlations between the Locke-Wallace Marital Adjustment Test and FSFI scores, even when statistically significant, were generally modest.
“As further support for the construct validity of the FSFI, the correlations between the Locke-Wallace and the FSFI, even when statistically significant, were generally modest in magnitude.”
Quote in the paperSubstantial claim - Findingown data
FSFI domain scores and full scale score showed only modest correlations with a measure of marital satisfaction (divergent validity).
“while showing only modest correlations with a measure of marital satisfaction (divergent validity).”
Quote in the paperSubstantial claim- Rests on an assumption: The Locke-Wallace Marital Adjustment Test validly measures marital satisfaction.
- Findingown data
Significantly more controls than FSAD subjects were unmarried (34% vs 19%).
“significantly more controls than FSAD subjects (34% vs 19%) were unmarried.”
Quote in the paperNot a substantial claim - Findingnone given
The FSFI is psychometrically sound.
“It is psychometrically sound”
Quote in the paperSubstantial claim - Findingown data
Based on factor analysis of the 19-item questionnaire in the complete sample, items were assigned to five domains: desire/arousal, lubrication, orgasm, satisfaction, and pain.
“Based on the results of the factor analysis of the 19-item questionnaire using the complete sample, individual items were assigned to five separate domains of female sexual function: desire/arousal, lubrication, orgasm, satisfaction, and pain.”
Quote in the paperSubstantial claim - Findingown data
In both groups, the strongest overlap between the marital adjustment test and the FSFI was with the satisfaction domain.
“In both groups, the strongest overlap with the marital adjustment test was observed for the satisfaction domain of the FSFI.”
Quote in the paperNot a substantial claim - Findingown data
When desire and arousal are treated as separate domains, their intercorrelation (r = 0.76) is stronger than the correlations among the other domains.
“When the first factor of desire and arousal is considered as two separate domains, the strength of the relationship between these two domains is greater than that between the other domains (r = 0.76).”
Quote in the paperNot a substantial claim - Findingown data
The FSFI has shown that it can distinguish clinical from nonclinical groups.
“has demonstrated ability to discriminate between clinical and nonclinical populations.”
Quote in the paperSubstantial claim- Rests on an assumption: The FSAD diagnosis used to classify subjects is valid.
- Rests on an assumption: The control group represents women with normal sexual response.
- Findingown data
Domain intercorrelations were generally lower for the FSAD group than for controls.
“The domain intercorrelations were generally lower for the FSAD group than for the controls”
Quote in the paperNot a substantial claim - Findingnone given
For subjects with sexual dysfunction, FSFI scores appeared fairly independent of marital adjustment.
“For subjects with sexual dysfunction, FSFI scores appeared to be fairly independent of the influence of marital adjustment.”
Quote in the paperNot a substantial claim- Rests on an assumption: The Locke-Wallace Marital Adjustment Test validly measures marital satisfaction.
- Findingown data
Domain intercorrelations were generally lower for the FSAD group than for the controls or total group.
“As indicated in Table 4, the domain intercorrelations were generally lower for the FSAD group than for the controls or total group.”
Quote in the paperNot a substantial claim - Findingown data
Factor analysis identified five domains of female sexual function: desire and subjective arousal, lubrication, orgasm, satisfaction, and pain/discomfort.
“Based on factor analytic methods, five factors or domains of sexual function were identified: (a) desire and subjective arousal, (b) lubrication, (c) orgasm, (d) satisfaction, and (e) pain/discomfort.”
Quote in the paperSubstantial claim - Findingreasoning
Dependence on sexual activity affected the original items relating to psychological distress, which were excluded from the final questionnaire due to ambiguity in interpretation.
“Dependence on sexual activity did affect the original items relating to psychological distress, which were not included in the final questionnaire due to ambiguity in their interpretation.”
Quote in the paperSubstantial claim - Findingown data
A significantly greater proportion of FSAD subjects than controls were taking antidepressant medications (19% vs 7%).
“A significantly greater number of FSAD than control subjects (19% vs 7%) were taking antidepressant medications”
Quote in the paperNot a substantial claim - Findingown data
In the FSAD group, the orgasm and sexual desire domains showed the least association with marital adjustment.
“In the FSAD group, the domains of orgasm and sexual desire showed the least association with marital adjustment.”
Quote in the paperNot a substantial claim - Findingown data
The fifth factor had an eigenvalue high enough to justify inclusion.
“The fifth factor had an eigenvalue high enough to justify inclusion.”
Quote in the paperSubstantial claim - Findingnone given
The questionnaire was intended and validated for evaluating female sexual function and quality of life in clinical trials or epidemiological research.
“The questionnaire described was designed and validated for assessment of female sexual function and quality of life in clinical trials or epidemiological studies.”
Quote in the paperSubstantial claim - Findingnone given
After item reduction, 19 items with optimal psychometric properties were selected, sampled from each of six domains.
“After a process of item reduction, 19 items with optimal psychometric properties, sampled from each of six domains, were selected.”
Quote in the paperSubstantial claim - Findingown data
Individual FSFI domain scores and the full scale score differentiated between FSAD and non-FSAD subjects (discriminant validity).
“individual domain scores of the FSFI, as well as the full scale score, showed good ability to differentiate between FSAD and non-FSAD subjects (discriminant validity)”
Quote in the paperSubstantial claim- Rests on an assumption: The FSAD diagnosis used to classify subjects is valid.
- Rests on an assumption: The control group represents women with normal sexual response.
- Findingown data
The largest differences between FSAD and control groups were in the lubrication and arousal domains.
“The largest differences between the groups were seen for the domains of lubrication and arousal.”
Quote in the paperNot a substantial claim - Findingown data
In the control group, the desire domain also showed low correlation with marital adjustment.
“The domain of desire also showed low correlation with marital adjustment in the control group.”
Quote in the paperNot a substantial claim - Interpretationreasoning
The FSFI is a brief self-report instrument for assessing female sexual function.
“This article presents the development of a brief, self-report measure of female sexual function.”
Quote in the paperSubstantial claim- Rests on an assumption: The most valid way to assess sexual function in women is in a naturalistic setting, and self-report is the only currently available method for measuring sexual response at home.
- Premisecitation
A recent study found that unmarried women are 1.5 times more likely to have climax problems.
“A recent study showed that unmarried women are 1½ times more likely to have climax problems (Laumann, Paik, & Rosen, 1999)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Laumann, Paik, & Rosen, 1999
Not checked in the free run.
- Premisecitation
Earlier measures were primarily unidimensional scales of sexual experience and behavior.
“Earlier measures were primarily unidimensional scales of sexual experience and behavior (Hoon, Hoon, & Wincze, 1976;Zuckerman, 1973).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Hoon, Hoon, & Wincze, 1976
Not checked in the free run.
- cites Zuckerman, 1973
Not checked in the free run.
- Interpretationown data
The clustering and factor loadings support the factorial validity of the final FSFI questionnaire.
“supporting the factoral validity of the final questionnaire.”
Quote in the paperSubstantial claim - Study design and conductown data
Frequency of sexual activity was significantly lower in the FSAD group than in the control group.
“The frequency of sexual activity also differentiated the two groups to a statistically significant degree, with lower frequency in the FSAD group compared to the control group.”
Quote in the paperNot a substantial claim - Premisecitation
Problems affecting one domain may interact with other disorders in a complex fashion, producing substantial overlap among diagnostic categories.
“Therefore, problems affecting one domain may interact with other disorders in a complex fashion, resulting in substantial overlap among diagnostic categories (Laumann, Paik, & Rosen, 1999;Rosen, Taylor, Leiblum, & Bachmann, 1993).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Laumann, Paik, & Rosen, 1999
Not checked in the free run.
- cites Rosen, Taylor, Leiblum, & Bachmann, 1993
Not checked in the free run.
- Study design and conductown data
There was a statistically significant group difference in antidepressant medication use: 19% of FSAD subjects vs 7% of controls (p=0.004).
“There was, however, a statistically significant group difference in the use of anti-depressant medications, with 19% of the subjects with FSAD currently taking some form of medication for depression, in comparison to 7% of the healthy controls (p = 0.004).”
Quote in the paperNot a substantial claim - Interpretationreasoning
For an unambiguous full scale score, the FSFI is appropriate only for women reporting some sexual activity during the measurement period.
“to derive an unambiguous full scale score, the FSFI is appropriately used only for subjects who have had some level of sexual activity during the measurement period.”
Quote in the paperSubstantial claim - Interpretationcitation
The higher proportion of unmarried controls may have reduced the ability to discriminate between groups on the orgasm domain.
“a factor that may have reduced the ability to discriminate between groups on the orgasm domain.”
Quote in the paperNot a substantial claim - Interpretationown data
The lower domain intercorrelations suggest greater independence among sexual function dimensions in FSAD patients than in women with normal sexual response.
“suggesting a greater level of independence among the dimensions of sexual function in patients with FSAD than in women with normal sexual response.”
Quote in the paperSubstantial claim- Rests on an assumption: The control group represents women with normal sexual response.
- Study design and conductreasoning
The study sample might have included women who were not sexually active.
“in the current study, subjects could have been selected who were not sexually active.”
Quote in the paperNot a substantial claim
- May combine two claims. 27
- Classified as probably not a substantial claim. 11
May combine two claims.
Findingown dataIn the FSAD group, items generally clustered in the predicted fashion and had relatively high factor loadings.
“Items generally clustered in the predicted fashion and had relatively high factor loadings, supporting the factoral validity of the final questionnaire.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe correlation between the Locke-Wallace and total FSFI score was low moderate for controls (r=0.53) and very low for FSAD subjects (r=0.22).
“The correlation between the Locke-Wallace and the total FSFI score was low moderate for the control group (r = 0.53) and very low for the FSAD group (r = 0.22).”
Quote in the paperSubstantial claimMay combine two claims.
Findingnone givenThe FSFI is a 19-item questionnaire developed as a brief, multidimensional self-report instrument for assessing key dimensions of sexual function in women.
“The FSFI, a 19-item questionnaire, has been developed as a brief, multidimensional self-report instrument for assessing the key dimensions of sexual function in women.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataIn the FSAD group, the highest positive correlation was between desire and arousal (r=0.71), consistent with the factor analysis.
“For FSAD subjects, the highest positive correlation was between the domains of desire and arousal (r = 0.71), consistent with the factor analysis results described above.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe factor loadings of the individual FSFI items matched the expected pattern, supporting the instrument's factorial validity.
“The factor loadings of the individual items fit the expected pattern, supporting the factorial validity of this instrument.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe initial validation study data indicated that most subjects understood the questions and response options, although some questions and choices were reworded for clarity.
“The data from this initial validation study indicated that the majority of subjects understood the questions and response options, although some of the questions and choices were re-worded to improve clarity.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataOverall test-retest reliability was relatively high for all domains (r=0.79-0.86) and for the total scale (r=0.88).
“As seen in Table 5, overall test-retest reliability was relatively high for all of the domains (r = 0.79 -0.86) and for the total scale (r = 0.88).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataPrincipal components analysis with varimax rotation on the 29-item questionnaire identified four factors with eigenvalues over 1.00 in all three samples, but a five-factor solution in the FSAD group yielded the most consistent factor loading pattern.
“Four factors with eigenvalues over 1.00 were identified for all three samples; however, a five-factor solution with the FSAD group yielded the most consistent pattern of factor loadings.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe factor loading pattern was similar for the total group and the FSAD group alone, but less clear for the control sample alone.
“The pattern of factor loadings was similar for the total group and the FSAD group alone.The pattern was less clear for the control sample alone.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataIn the FSAD group, the desire domain had the highest test-retest reliability (r=0.80), while other domains had moderately high correlations (r=0.62-0.71).
“For the FSAD group, the domain of desire showed the highest test-retest reliability (r = 0.80), with the other domains showing moderately high correlations (r = 0.62 -0.71).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataHigh inter-item correlations were observed for all six FSFI domains, with Cronbach's alpha values of 0.82 and higher.
“As shown, high inter-item correlations were observed for all six domains (Cronbach's alpha values of 0.82 and higher).”
Quote in the paperSubstantial claimMay combine two claims.
Findingnone givenThe individual FSFI domains and full scale score showed high internal consistency and acceptable test-retest reliability.
“The individual domains of the FSFI and the FSFI full scale score showed high internal consistency and acceptable test-retest reliability.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataIn general, domain score reliability was higher for the control group than for the FSAD group, though all reliability coefficients were statistically significant.
“In general, higher reliability of domain scores was obtained for the control group than for the FSAD group, though all reliability coefficients were statistically significant.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataIn the FSAD group, correlations between pain and desire (r=0.15) and between pain and orgasm (r=0.10) were not statistically significant.
“The correlations between pain and desire (r = 0. 15) and between pain and orgasm (r = 0.10) failed to reach statistical significance for the FSAD group.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe divergence of FSFI from the Locke-Wallace Marital Adjustment Test was greater for the FSAD group than for controls; among controls, marital satisfaction was moderately highly correlated with the FSFI global sexual satisfaction domain.
“Divergence of the FSFI from the Locke-Wallace Marital Adjustment Test was greater for the FSAD group than for the controls, for whom a moderately high correlation was observed between marital satisfaction and the FSFI domain of global sexual satisfaction.”
Quote in the paperSubstantial claim- Rests on an assumption: The Locke-Wallace Marital Adjustment Test validly measures marital satisfaction.
May combine two claims.
Findingown dataIn the control sample alone, one factor mixed lubrication and arousal items, and another mixed arousal and orgasm items.
“In this group, for example, one factor was comprised of a mix of lubrication and arousal items, and another consisted of a mix of arousal and orgasm items.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataStatistically significant differences between FSAD and control groups were observed for all FSFI domains and for the full scale score.
“As shown, statistically significant differences between the groups were observed for all the domains and for the full scale score.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe DSM-IV classification system was intended as a nomenclature for mental disorders only.
“the American Psychiatric Association's Diagnostic & Statistical Manual, version IV (DSM-IV) (American Psychiatric Association, 1994) system of classification was intended as a nomenclature for mental disorders only.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites American Psychiatric Association, 1994
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenThe findings suggest important gender differences in the patterning of female sexual function compared with similar questionnaire studies in males.
“Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataThe results support the reliability and psychometric and clinical validity of the FSFI for assessing key dimensions of female sexual function in clinical and nonclinical samples.
“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.”
Quote in the paperSubstantial claim- Rests on an assumption: A major barrier to clinical research in female sexual dysfunction is the absence of well-defined endpoints and outcomes, reflecting lack of consensus on definition and diagnostic framework.
- Rests on an assumption: There are no empirically validated instruments for assessing female arousal, which impedes pharmacological and psychological research in female sexual response.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationDSM-IV and ICD-10 recognize a subjective distress criterion in defining sexual dysfunction.
“The DSM-IV and ICD-10 also recognize the need for a subjective distress criterion in defining sexual dysfunction.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites American Psychiatric Association, 1994
Not checked in the free run.
- cites World Health Organization, 1992
Not checked in the free run.
May combine two claims.
Study design and conductown dataA factor analysis excluding subjects with no sexual activity in the past month (13 FSAD, 3 controls) produced a pattern very similar to the complete sample, so all subjects were included in further analyses.
“Since a pattern of factor results was obtained that was very similar to that described below for the complete sample, further analyses were performed with all study subjects included.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductown dataThe FSAD and control groups were comparable on race, education, income, and number of children.
“The two groups were comparable with respect to race, education, income, and number of children.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataThe mean age of the FSAD group (N=128) was 40.5±12.98 years and of the control group (N=131) was 39.7±13.15 years.
“The mean (± SD) ages of the FSAD group (N = 128) and control group (N = l31) were 40.5 ± 12.98 years and 39.7 ± 13.15 years, respectively.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataThe strong relationship between desire and arousal indicates considerable overlap between these dimensions in women, consistent with clinical observation and contrasting with findings in male sexual dysfunction studies.
“This relationship demonstrates a considerable overlap between the dimensions of desire and arousal in women, consistent with clinical observation and contrasting with findings in studies of sexual dysfunction in men (Rosen, Riley, Wagner, Osterloh, Kirkpatrick, & Mishra, 1997).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Rosen, Riley, Wagner, Osterloh, Kirkpatrick, & Mishra, 1997
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe groups did not differ significantly in the proportion taking hormone replacement therapy.
“The two groups did not differ signifi-cantly in the proportion of women taking hormone replacement therapy.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataA significantly greater percentage of healthy volunteers than women with FSAD used some form of contraceptive (54% vs 39%, p=0.033).
“A significantly greater percentage of healthy volunteers than women with FSAD also used some form of contraceptive (54% versus 39%, respectively, p = 0.033).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataThere was a statistically significant difference between groups in marital status (p=0.042), with more married women in the FSAD group (69% vs 55%) and more single women in the control group (34% vs 19%).
“There was a statistically significant difference between the two groups in marital status (p = 0.042), with a greater proportion of married women in the FSAD group (69% versus 55%) and more single women in the control group (34% versus 19%).”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationMore recent questionnaires provide greater detail on sexual frequency, desire, and arousal but were developed before the current classification of sexual disorders and do not address some aspects of current definitions.
“More recent questionnaires provide greater detail on sexual frequency, desire, and arousal, but were developed prior to the current classification of sexual disorders and do not address some aspects of the current definitions (Derogatis & Melisaratos, 1979;Taylor, Rosen, & Leiblum, 1994).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Derogatis & Melisaratos, 1979
Not checked in the free run.
- cites Taylor, Rosen, & Leiblum, 1994
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationown dataAntidepressant use may have contributed to drug-induced sexual dysfunction in the FSAD group.
“which may have contributed to drug-induced sexual dysfunction.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataA reanalysis of the FSFI factor structure excluding data from subjects with no recent sexual activity showed little change, so interpretation of study results was not affected.
“a reanalysis of the FSFI factor structure following the exclusion of data from subjects who reported that they had no recent sexual activity showed little change.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningAlthough the statistical solution supported five factors, clinical considerations led to separating desire/arousal, so the final instrument has six domains: desire, arousal, lubrication, orgasm, global satisfaction, and pain.
“While the statistical solution supported a 5-factor solution, clinical consideration dictated separating the domain of desire/arousal.Therefore, the final set of items was assigned to a six domain instrument measuring: (a) desire, (b) arousal, (c) lubrication, (d) orgasm, (e) global satisfaction, and (f) pain.”
Quote in the paperSubstantial claim- Rests on an assumption: Each female sexual disorder corresponds to different phases or domains of sexual function.
- Rests on an assumption: Sexual satisfaction is an important dimension of sexual function, although no separate diagnostic category exists for dysfunction in this dimension.
Classified as probably not a substantial claim.
Study design and conductnone givenSubjects from the clinical sample were age-matched within two years with subjects from the nonclinical sample.
“Subjects from the clinical sample were agematched (± 2 years) with subjects from the nonclinical sample.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationSexual response involves temporal sequencing and coordination of several phases.
“Sexual response involves a temporal sequencing and coordination of several phases (Masters & Johnson, 1966).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Masters & Johnson, 1966
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAn international consensus panel recommended retaining four major categories of female sexual dysfunction: desire disorders, arousal disorder, orgasmic disorder, and sexual pain disorders, as in DSM-IV and ICD-10.
“This panel recommended maintaining four major categories of dysfunction (desire disorders, arousal disorder, orgasmic disorder, and sexual pain disorders), as described in the DSM-IV and ICD-10 (International Classification of Diseases) (World Health Organization, 1992).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites International Consensus Development Conference on Female Sexual Dysfunctions: Definitions and Classifications, in press
Not checked in the free run.
- cites World Health Organization, 1992
Not checked in the free run.
The paper relies on this without support.
A major barrier to clinical research in female sexual dysfunction is the absence of well-defined endpoints and outcomes, reflecting lack of consensus on definition and diagnostic framework.
“A major barrier to the development of clinical research in this area has been the absence of well-defined endpoints and outcomes, which in turn reflects the current lack of consensus in regards to the definition and diagnostic framework for assessing and treating female sexual dysfunction.”
The paper relies on this without support.
At present there are no validated instruments specific to sexual distress.
“However, at the present time there are no validated sexual distress specific instruments.”
The paper relies on this without support.
The most valid way to assess sexual function in women is in a naturalistic setting, and self-report is the only currently available method for measuring sexual response at home.
“However, it has been proposed that the most valid way to assess sexual function in women is in a naturalistic setting, and the self-report technique is the only method currently available for measuring sexual response in an at-home setting.”
The paper relies on this without support.
Each female sexual disorder corresponds to different phases or domains of sexual function.
“Each of the different disorders (hypoactive sexual desire disorder, sexual arousal disorder, sexual pain disorders, and orgasmic disorder) has correspondence to different phases or domains of sexual function.”
The paper relies on this without support.
Sexual satisfaction is an important dimension of sexual function, although no separate diagnostic category exists for dysfunction in this dimension.
“Sexual satisfaction is considered one of the important dimensions of sexual function, although no separate diagnostic category is provided for dysfunction in this dimension.”
The paper relies on this without support.
Differentiating the hierarchy of disorders within a given patient may be quite difficult.
“Since differentiation of the hierarchy of disorders within a given patient may be quite difficult, instruments are needed that allow measurement of the relative strength of dysfunction within each domain.”
The paper relies on this without support.
Female sexual arousal has tended to be neglected as a target of diagnostic or empirical research, unlike male sexual arousal.
“Unlike male sexual arousal, which is relatively easy to assess and evaluate, female sexual arousal has tended to be neglected as a target of diagnostic or empirical research.”
The paper relies on this without support.
It has been difficult to specify what dimensions characterize female arousal and what constitutes an arousal disorder.
“It has been difficult to specify what dimensions characterize female arousal and what constitutes an arousal disorder.”
The paper relies on this without support.
There are no empirically validated instruments for assessing female arousal, which impedes pharmacological and psychological research in female sexual response.
“Similarly, there are, at present, no empirically validated instruments for assessing female arousal, which impedes pharmacological and psychological research in female sexual response.”
The paper relies on this without support.
Without an objectively validated self-report instrument demonstrating reliability and validity, outcome research in female sexuality will continue to lag behind male sexuality.
“Without an objectively validated self-report instrument that demonstrates both reliability and validity, outcome research in female sexuality will continue to lag behind that of male sexuality.”
The paper relies on this without support.
Sexual response and dysfunction involve both psychological and organic processes.
“Sexual response and dysfunction are conceptualized as involving both psychological and organic processes; however, the American Psychiatric Association's”
The paper relies on this without support.
The Locke-Wallace Marital Adjustment Test validly measures marital satisfaction.
“Divergence of the FSFI from the Locke-Wallace Marital Adjustment Test was greater for the FSAD group than for the controls”
The paper relies on this without support.
The FSAD diagnosis used to classify subjects is valid.
“differentiate between FSAD and non-FSAD subjects”
The paper relies on this without support.
The control group represents women with normal sexual response.
“women with normal sexual response”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
At baseline, there were no significant between-group differences on outcome and process measures, except that the control group had lower sexual desire.
“Between-groups comparisons on outcome and process measures showed no signi fi cant di ff erences between the groups at baseline, with the exception of a lower level of sexual desire in the control group (t=2.44 [35], p=0.020).”
From A feasibility trial of online Acceptance and Commitment Therapy for women with provoked vestibulodynia (2023) · cites this paper as [35]
Table 6 (Discriminant Validity) reports significant differences between FSAD patients and controls across the measured sexual-function domains. It also reports higher, not lower, desire in controls (6.9 versus 4.7; p < 0.001). These results contradict both the claimed lack of between-group differences and the claimed direction of the desire difference. (LLM, conf=0.91)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredAn FSFI score of 26.55 or less indicates significant sexual problems.
“A score of 26.55 or less indicates significant sexual problems [15, 16].”
From Association of mindfulness with female sexual dysfunction (2022) · cites this paper as [15]
The table in the Conclusions reports lower mean FSFI full-scale scores for patients with female sexual arousal disorder than for controls, supporting an association between lower scores and sexual problems. Neither that table nor the Discussion establishes 26.55 as a cutoff or says that a score at or below it indicates significant sexual problems (searched: 26.55, cutoff, diagnostic threshold). Page numbers were not available in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe FSFI is a validated instrument for evaluating female sexual dysfunction and sexual satisfaction.
“The Female Sexual Function Index (FSFI) questionnaire is a 19-item multidimensional self-report instrument for evaluating the main categories of female sexual dysfunction and sexual satisfaction (54,55).”
From A stepped-care approach to symptomatic endometriosis management: A participatory research initiative (2018) · cites this paper as [54]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Control-group married percentage does not match the count
MinorThe table lists 71 married controls and 131 controls overall, which gives 54.2%, not 51.6%. Even using the 130 controls with a recorded marital status gives 54.6%.
Reported 51.6 · recomputed 54.198473
“| Married | 88 (68.8) | 71 (51.6) | |”
Satisfaction score has an incorrect minimum
MinorTable 3 gives a minimum unweighted satisfaction score of 2. Applying the appendix's factor of 0.4 yields a minimum domain score of 0.8, not the reported 0.
Reported 0 · recomputed 0.8
“Satisfaction 14, 15, 16 0 (or 1)-5 0.4 0 6.0”
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Canada, A. L., Neese, L. E., Sui, D., & Schover, L. R. (2005) · Cancer · doi:10.1002/cncr.21537 · Cited by 217 · see citing works
Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy
Salvatore, S., Nappi, R. E., Parma, M., Chionna, R., LAGONA, F., Zerbinati, N., Ferrero, S., Origoni, M., Candiani, M., & Maggiore, U. L. R. (2014) · Climacteric · doi:10.3109/13697137.2014.975197 · Cited by 217 · see citing works
Female Sexual Function during Pregnancy and after Childbirth
Serati, M., Salvatore, S., Siesto, G., Cattoni, E., Zanirato, M., Khullar, V., Cromi, A., Ghezzi, F., & Bolis, P. (2010) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2010.01893.x · Cited by 216 · see citing works
Katz, M., Derogatis, L. R., Ackerman, R. T., Hedges, P., Lesko, L. M., Garcia, M., & Sand, M. S. (2013) · The Journal of Sexual Medicine · doi:10.1111/jsm.12189 · Cited by 215 · see citing works
Gynecologic cancer treatment and the impact of cancer-related infertility
Carter, J., Rowland, K., Chi, D., Brown, C. L., Abu‐Rustum, N. R., Castiel, M., & Barakat, R. R. (2005) · Gynecologic Oncology · doi:10.1016/j.ygyno.2004.12.019 · Cited by 212 · see citing works
Navaneethan, S. D., Vecchio, M., Johnson, D. W., Saglimbene, V. M., Graziano, G., Pellegrini, F., Lucisano, G., Craig, J. C., Ruospo, M., Gentile, G., et al. (2010) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2010.06.016 · Cited by 210 · see citing works
Women’s Sexual Desire and Arousal Disorders
Brotto, L. A., Bitzer, J., Laan, E. T. M., Leiblum, S. R., & Luria, M. (2010) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2009.01630.x · Cited by 210 · see citing works
Sexual Well-Being, Happiness, and Satisfaction, in Women: The Case for a New Conceptual Paradigm
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Lichen sclerosus: The 2023 update
De Luca, D. A., Papara, C., Vorobyev, A., Staiger, H., Bieber, K., Thaçi, D., & Ludwig, R. J. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1106318 · Cited by 208 · see citing works
Arabic Translation of Female Sexual Function Index and Validation in an Egyptian Population
Anis, T. H., Gheit, S. A., Saied, H. S., & kherbash, S. A. A. (2011) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2011.02471.x · Cited by 208 · see citing works
Efficacy and Safety of Flibanserin for the Treatment of Hypoactive Sexual Desire Disorder in Women
Jaspers, L., Feys, F., Bramer, W. M., Franco, O. H., Leusink, P., & Laan, E. T. M. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.8565 · Cited by 208 · see citing works
The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept
Higgins, J. A., & Smith, N. (2016) · The Journal of Sex Research · doi:10.1080/00224499.2015.1134425 · Cited by 207 · see citing works
van Lankveld, J. J. D. M., Granot, M., Schultz, W. C. M. W., Binik, Y. M., Wesselmann, U., Pukall, C. F., Bohm‐Starke, N., & Achtari, C. (2010) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2009.01631.x · Cited by 205 · see citing works
Rogers, R. G., Rockwood, T. H., Constantine, M. L., Thakar, R., KAMMERER-DOAK, D. N., Pauls, R. N., Parekh, M. H., Ridgeway, B., Jha, S., Pitkin, J., et al. (2013) · International Urogynecology Journal · doi:10.1007/s00192-012-2020-8 · Cited by 204 · see citing works
Desrochers, G., Bergeron, S., Khalifé, S., Dupuis, M.-J., & Jodoin, M. (2009) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e31819976e3 · Cited by 199 · see citing works
Long-Term Safety and Efficacy of Bremelanotide for Hypoactive Sexual Desire Disorder
Simon, J. A., Kingsberg, S. A., Portman, D. J., Williams, L. A., Krop, J. S., Jordan, R., Lucas, J. D., & Clayton, A. H. (2019) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000003514 · Cited by 199 · see citing works
- Authors
- Rosen, C. B.
- Venue
- Journal of Sex & Marital Therapy
- Publisher
- Informa UK Limited
- Published
- 2000-04
- Volume
- 26
- Issue
- 2
- Pages
- 191-208
- ISSN
- 0092-623X (ISSN-L)
- 1521-0715
- OpenAlex
- W2112997260
- Cited by
- 6,593
- References
- 12
- Citations by year
- 2026: 348 · 2025: 432 · 2024: 403 · 2023: 428 · 2022: 477 · 2021: 489 · 2020: 424 · 2019: 390 · 2018: 357 · 2017: 332 · 2016: 332 · 2015: 286 · 2014: 323 · 2013: 260 · 2012: 237
- FWCI
- 12.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Sex & Marital Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- Female Sexual Function Index, female sexual function, female sexual arousal disorder, self-report questionnaire, psychometric validation, test-retest reliability, construct validity, discriminant validity, sexual desire, subjective arousal, vaginal lubrication, orgasm, sexual satisfaction, sexual pain, marital satisfaction
- MeSH terms
- Adult, Aged, Female, Humans, Middle Aged, Surveys and Questionnaires, Self-Assessment, Reproducibility of Results, Sexual Dysfunctions, Psychological
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