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

epartment of Psychiatry, Robert Wood Johnson Medical School, University of Medicine & Dentistry of New Jersey, Piscataway, NJ 08854, USA.
Journal of Sex and Marital Therapy (Impact Factor: 1.27). 01/2005; 31(1):1-20. DOI: 10.1080/00926230590475206
Source: PubMed

ABSTRACT 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 crossvalidate the FSFI in several samples of women with mixed sexual dysfunctions (N = 568) and to develop diagnostic cut-off scores for potential classification of women's 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 Cronbach's 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 alpha's >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.

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    • "Higher scores indicate better sexual function. Subsequently, Wiegel et al. [26] determined a cut-off value for the FSFI-19 for the definition of FSD (total FSFI- 19 scores of 26.55 or less). Indeed, using this cut-off value it was found that 70.7% of women with sexual dysfunction and 88.1% of the sexually functional ones were correctly classified. "
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    ABSTRACT: Assessment of sexual function is a complex process, especially in women, which requires in any individual case: time, appropriate training and experience. The prevalence of female sexual dysfunction is quite variable depending on the studied population, assessment methods, comorbid conditions and treatments, and age. A large number of screening methods have been developed over the last decades which range from tedious, exhaustive and boring tools to very simple standardized questionnaires. The 19-item female sexual function index (FSFI-19) is among the most used and useful- instrument designed to assess female sexual function in all types of circumstances, sexual orientation and perform the comparison of transcultural factors. A short 6-item- version of the FSFI-19 has been developed to provide a quick general approach to the six original domains (one item per domain). Nevertheless, further studies are needed to demonstrate its validity in different clinical situations as it has been extensively demonstrated with the original tool.
    Maturitas 07/2015; DOI:10.1016/j.maturitas.2015.07.005 · 2.94 Impact Factor
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    • "To measure sexual function of female teachers, we use the Female Sexual Function Index (FSFI) — a multidimensional self report instrument — introduced by [14]. To characterize whether a participant suffer from sexual disorder or not, we use criteria suggested by [15], that the FSFI total score of 26.55 is the optimal cut-off score for differentiating women with and without sexual dysfunction. "
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    ABSTRACT: This research is aimed to find out whether sexual dysfunction affects female teachers performance in fulfilling pedagogical tasks. Eighty-four female teachers who work at 12 elementary schools in the city of Bandar Lampung, Lampung Province, Indonesia became the participants in this study. To assess the teacher's sexual quality, we used the Female Sexual Function Index (FSFI), a brief questionnaire designed to measure sexual functioning in women with focus on sexual desire, sexual arousal, lubrication, orgasm, satisfaction, and pain. To measure the quality of a teacher, two pupils were asked to become respondents and fill out a Likert Scale questionnaire containing both positive and negative quality indicators of the teacher. The positive indicators consist of punctual, prepared, approachable, respectful and professional, while the negative ones include bad tempered, rude, insulting, arrogant and domineering. Mann-Whitney comparison test and Spearman Rank Correlation were performed in data analysis. The results showed that 39 (46%) of the participant categorized as teachers without sexual disorder (total FSFI score of 29.1±1.33) and the other 45 (54%) categorized as teachers with sexual disorders (total FSFI score of 21.48 ± 2.84). Compared with the teacher without sexual dysfunction, teachers with sexual disorders tend to be less diligent (P <0.05), less prepared for class (P <0.001), less friendly (P <0.001) and less appreciative students (P <0.01). In addition, teachers with sexual problems tend to be more hothead (P< 0.001), rude (P<0.001) and domineering (P<0.01). As the conclusion, sexual dysfunction potentially affects teaching performance of the female teachers.
    11/2014; 2(2 6):244-247. DOI:10.12691/ajphr-2-6-5
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    • "Since then, the FSFI has been translated into many languages, becoming the gold standard for measuring female sexual function.9,14,15 FSD is diagnosed if the FSFI score is <26.55.6 "
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    ABSTRACT: Purpose To evaluate the validity and reliability of the Korean version of the Female Sexual Function Index-6 (FSFI-6K). Materials and Methods Participants were recruited from February 2013 to July 2013. The primary survey was conducted for 220 participants, and a follow-up was conducted 3 weeks (±1 week) after the primary survey. The FSFI-6K data were analyzed and compared to the reference values in the original FSFI. Results Of the 220 participants, 199 (90.5%) returned to follow-up, 18 (8.2%) had no further contact, and 3 (1.4%) declined to respond. The internal consistency of the FSFI-6K as measured by Cronbach's alpha was 0.888 and the reliability based on test-retest intraclass correlation was 0.606; these values were acceptable. The cutoff used for diagnosis of female sexual dysfunction by an receiver operating characteristics (ROC) curve was a score of 21; the sensitivity and specificity for this curve are 0.89 and 0.86, respectively. The area under the receiver operating curve was 0.948. Conclusion The FSFI-6K has high internal consistency and acceptable reliability. This validated questionnaire can be used for the Korean population.
    Yonsei Medical Journal 09/2014; 55(5):1442-6. DOI:10.3349/ymj.2014.55.5.1442 · 1.29 Impact Factor
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