The Female Sexual Function Index (FSFI): Validation of the Malay Version

Female sexual function index for screening of female sexual dysfunction using DSM-5-TR criteria in Thai women: A prospective cross-sectional diagnostic study

Thai Female Sexual Function Index discrimination using the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria has not been investigated. This study aimed to evaluate the Female Sexual Function Index as a tool for assessing sexual symptoms and to determine the prevalence of female sexual dysfunction in Thai women using the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria. This prospective cross-sectional diagnostic study included sexually active women aged ≥18 years, interviewed from January to June 2023. The participants completed the Thai version of a comprehensive of the Female Sexual Function Index questionnaire encompassing general information and self-reported assessments of female sexual function, followed by a semi-structured interview of distress symptom severity. Female sexual function was determined by screening of the total Female Sexual Function Index score, whereas female sexual dysfunction was evaluated using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria. Using receiver operating characteristic curves, a clinical cutoff for the Female Sexual Function Index score of 23.1 was determined to identify female sexual dysfunction (area under the curve, 0.76; 95% confidence interval, 0.71-0.80; sensitivity, 75.6%; specificity, 67.7%; positive predictive value, 77.7%; negative predictive value, 65%). A prevalence of 40.2% for female sexual dysfunction was observed in the study population. The results of this study could be used as practical guidance for the screening of women affected by female sexual dysfunction in Thailand in the future.

Psychometric properties of the Romanian version of the female sexual function index (FSFI-RO)

BACKGROUND

Female sexual dysfunction (FSD) is a highly prevalent health disorder and no self-report questionnaire on female sexual function is available in Romanian. Therefore we considered the Female Sexual Function Index (FSFI) to be the most appropriate due to its excellent psychometric properties. The FSFI is a measuring scale with 19 items that assess the six domains of female sexual function: desire, arousal, lubrication, orgasm, satisfaction and pain. The paper aims to analyze the psychometric reliability and validity of the FSFI-RO (Romanian Version of the Female Sexual Function Index).

METHODS

385 women (aged 18 to 51) enrolled in the present study. To assess the presence of FSD we used the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for sexual dysfunction. Then we categorized the participants into two groups: the FSD group (41%) and the healthy control group (59%). Women were then asked to fill out a form that included sociodemographic information and the FSFI-RO questionnaire. A sample of 50 women agreed to re-answer FSFI-RO in a 4-week interval in order to evaluate the test-retest validity of the questionnaire. The data were summarized using descriptive statistics: the test-retest reliability was measured by the intraclass correlation coefficient (ICC); Cronbach's alpha was employed to evaluate the internal consistency of the Romanian version of the FSFI, and validity was assessed by the content and construct validity.

RESULTS

The results showed high test-retest reliability, with ICC from 0.942 to 0.991 in the domains and 0.987 in the total score. Regarding the internal consistency of the FSFI-RO, Cronbach's α coefficients were found to be high (α = 0.944). Convergent construct validity proved to be moderate to high in desire, arousal, lubrication, orgasm and, satisfaction domains, and weak correlation in the pain domain. Regarding the discriminant construct validity, the scores for each domain and the total score showed statistically significant differences between the FSD group and the control group.

CONCLUSIONS

The FSFI-RO showed similar psychometric properties to those of the original version, therefore being a reliable and valid instrument that can be used in Romanian-speaking women.

Sexual functioning and marital satisfaction among endometriosis patients in Malaysia: a cross-sectional study

Endometriosis affects the sexual functioning and marital satisfaction of couples in a complex manner due to its clinical presentation of the disease. This study aimed to evaluate the prevalence of sexual dysfunction and marital disharmony among women with endometriosis beyond their diagnosis and treatment. A cross-sectional online survey was conducted among women with endometriosis in an endometriosis society at a Malaysian university hospital. Sociodemographic and clinical data were collected. Sexual function was measured using the Malay Version Female Sexual Function Index (MVFSFI), while marital satisfaction was evaluated with the Malay Version Golombok Rust Inventory for Marital Satisfaction (MVGRIMS). A total of 166 patients participated in this survey. The median age was 35 years (Interquartile range, IQR:32.00-39.25 years); 91.6% of participants were Malay. The median score of MVFSFI was 56.00 (IQR: 34.75-68.00). Most of the study subjects (n = 96) reported poor to very severe marital satisfaction problems, equivalent to MVGRIMS transformed score of more than 5. High levels of MVGRIMS scores have a moderately strong negative correlation with lower scores for most domains of the MVFSFI. In the stepwise multiple logistic regression, only MVFSFI total scores (p = 0.029), MVFSFI lubrication scores (p = 0.009), and MVFSFI satisfaction (p = 0.010) scores were significantly associated with poor marital satisfaction. Both sexual dysfunction and marital satisfactions commonly affect women with endometriosis and are closely interlinked. Targeted efforts should be made in multiple aspects to improve the quality of sexual functioning and marital satisfaction among endometriosis patients.

Association between body mass index, body image and self-esteem with sexual function: A survey of young women in Singapore

Introduction

Obesity is thought to be a negative predictor of sexual function, but the relationship between body mass index (BMI) and sexual function has been inconsistent. Other factors such as body image and self-esteem may mediate this relationship. This study examined the association of BMI, body image and self-esteem with sexual function in young women.

Method

A total of 514 sexually active women aged 21 to 35 years completed an anonymised online questionnaire that used 3 scales to assess body image, self-esteem and female sexual function: Body Image States Scale (BISS), Rosenberg Self-Esteem Scale (RSES) and Female Sexual Function Index (FSFI). Higher scores for BISS, RSES and FSFI indicate more positive body image, higher self-esteem and better sexual function, respectively. Spearman correlation assessed the association among BMI, BISS and RSES scores, and with FSFI scores. Linear and multivariable logistic regression identified risk factors associated with sexual dysfunction (FSFI <26.55).

Results

BISS and RSES scores significantly correlated with FSFI scores (r=0.27 and r=0.32, respectively; both P<0.001), indicating that better body image and self-esteem were associated with better sexual function. Risk factors for sexual dysfunction were lower BISS and RSES scores, being married (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.07-2.15), having 1 child (OR 2.45; 95% CI 1.26-4.77) and having a perceived mental condition (OR 3.02; 95% CI 1.44-6.33). Factors in lack of sexual dysfunction include being of Malay ethnicity (OR 0.38; 95% CI 0.21-0.71) and being overweight (OR 0.46; 95% CI 0.27-0.78).

Conclusion

Women with poorer body image and lower self-esteem were more likely to have sexual dysfunction. These perceptions and states did not correlate with being overweight, and were better predictors over BMI to identify the population at-risk.

Sexual Dysfunction among Gynaecological Cancer Survivors: A Descriptive Cross-Sectional Study in Malaysia

BACKGROUND

Sexual dysfunction is a major issue among gynaecological cancer survivors. This study aimed to evaluate the prevalence of sexual dysfunction among survivors of gynaecological cancer in Malaysia and to determine its risk factors.

METHODS

A cross-sectional study was conducted of 116 married women with gynaecological cancer who attended the gynaeoncology and oncology clinics at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Sociodemographic and clinical data were collected. Sexual dysfunction was measured using the Malay Version Female Sexual Function Index (MVFSFI). Univariate and multivariate logistic regression analyses were used to determine the risk factors of female sexual dysfunction.

RESULTS

The prevalence of sexual dysfunction among gynaecological cancer survivors was 60% (70 out of 116). Sexual dissatisfaction was the most prevalent domain of sexual dysfunction at 68.1%. Sexual dysfunction was significantly associated with low education levels (Primary level, AOR = 4.92, 95% CI: 1.12-21.63; secondary level, AOR = 4.06, 95% CI: 1.14-14.44). Non-Malays were significantly more likely to have sexual dysfunction compared with Malays (AOR = 3.57, 95% CI: 1.16-11.06). In terms of treatment, combinations of surgery and radiotherapy (AOR = 4.66, 95% CI: 1.01-21.47) as well as surgery and chemoradiation (AOR = 5.77, 95% CI: 1.20-27.85) were considered.

CONCLUSIONS

Gynaecological cancer survivors with lower education levels, non-Malay ethnicity, and receiving treatment combinations of surgery and radiotherapy or surgery and chemoradiation have a higher risk of sexual dysfunction. A holistic approach in managing the various sociocultural and clinical issues is required to prevent sexual dysfunction among these patients.

Status of female sexual dysfunction among postmenopausal women in Bangladesh

BACKGROUND

Women's sexual health and physical desire for sex are most important for their emotional and physical well-being. This study aimed to examine the status of sexual dysfunction among postmenopausal women in Bangladesh and assess the significant risk factors behind this.

METHODS

A cross-sectional study was conducted among 45-55 years in four public and private hospitals in Bangladesh from April 2021 to June 2021 using a multi-stage sampling technique to enroll the study participants. The female sexual function index (FSFI) scale measured the prevalence of FSD, and the relationship of independent risk factors were assessed using a multivariate logistic regression model.

RESULTS

The total score of FSFI among postmenopausal Bangladeshi women was 18.07 ± 8.51. Among 260 participants, the prevalence of FSD was 56.9%. Out of all the significant risk factors, increasing age, urban population group, multiparous, homemakers, duration of menopause, and postmenopausal women with no hormone therapy were significantly associated with FSD. In contrast, those with regular physical activity were protective of FSD.

CONCLUSION

In conclusion, a significant proportion of postmenopausal Bangladeshi women are enduring sexual dysfunction. Proper hormonal therapy and non-hormonal therapies such as physical activity and pelvic floor muscle (Kegel) exercise with adequate counseling are helpful to cope in this distressing situation.

Is women's sexual function impaired by an abnormal pap smear?

OBJECTIVE

Although the stressful psychological impact on women of an abnormal Pap smear is well documented, little research has been undertaken on its sexual impact. Our objective was to assess the impact of an abnormal Pap smear on the sexual function of affected women.

METHODS

A prospective study compared the sexual function of 48 women with an abnormal Pap smear (case group) with that of 48 women with a normal Pap smear (control group). Sexual function was assessed using the Female Sexual Function Index and the Hospital Anxiety Depression Scale. The questionnaires were mailed to the participants.

RESULTS

Surprisingly, the risk of sexual dysfunction was comparable between women with and without an abnormal Pap smear (odds ratio [OR] 0.7; p = 0.4). The OR remained statistically non-significant after adjustment for risk factors. Multivariable analysis showed that only older age at first intercourse, depression and anxiety were identified as factors significantly associated with sexual dysfunction.

CONCLUSION

Contrary to our clinical experience, female sexual function is not impaired by an abnormal Pap smear. Further research is needed to better understand how sexuality in women with abnormal Pap smears may be affected.

Factor structure, internal consistency and distribution of Female Sexual Function Index among Mexican women with early diagnostic of breast cancer

 Background: Female Sexual Dysfunction (FSD) occurs frequently in women with breast cancer due to oncologic treatments. It is essential to have a validated instrument to diagnose and quantify FSD in this population accurately. Objective: To validate the Female Sexual Function Index (FSFI). Method: The FSFI was applied to 272 sexually active Mexican women with recent diagnosis of breast cancer who had not initiated systemic cancer treatment. Results: The FSFI six-factor model is valid by confirmatory factor analysis, and the inventory and its factors have adequate internal consistency reliability. Conclusions: This study provides enough evidence about the reliability and factor structure of the FSFI questionnaire in the context of breast cancer clinical practice in Mexico.

Measurement invariance of Female Sexual Function Index: a study with heterosexual and lesbian Portuguese women

The Female Sexual Function Index is a powerful screening tool for female sexual dysfunction extensively used worldwide. Nonetheless, its factorial structure and psychometric properties have been tested almost exclusively with heterosexual samples. The current study aimed to testing the original factorial structure, reliability and temporal stability in two samples of women (heterosexual and lesbian), and to assess the measurement invariance across sexual orientation. An online sample of 752 Portuguese women (376 lesbian women and 376 heterosexual women) recruited between May 2012 and 2013 participated in the study and completed a sociodemographic questionnaire and the FSFI. For temporal stability, 30 Portuguese women were recruited online in May 2017. Confirmatory factor analysis, reliability analysis and temporal stability were assessed independently for each sample. Measurement invariance (configural, metric, and scalar) was also assessed. Main findings for both samples corroborate the six-factor structure and revealed excellent levels of temporal stability, with Cronbach alphas and McDonalds Omega of .95 for heterosexual sample, and .96 for lesbian women sample. Results corroborate measurement invariance (configural, metric, and scalar) across sample type. Overall, the FSFI revealed a good-fit for the six-factor model in both heterosexual and women sample, with excellent levels of reliability and temporal stability, and showed measurement invariance across sexual orientation. These findings support the use of the FSFI with lesbian women.

Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia

INTRODUCTION

Female sexual dysfunction (FSD) is a common complication among breast cancer patients following treatment.

AIM

To assess the prevalence and factors associated with FSD among breast cancer patients in Kelantan.

METHODS

This cross-sectional study recruited female patients, aged 18-65, who were married and sexually active with their partner, diagnosed with breast cancer, and had undergone breast surgery. Those with underlying psychiatry disorders, previous pelvic surgery, and husbands with sexual problems were excluded. The questionnaire contained demographic and clinical information, together with the Malay Version of the Breast Impact of Treatment Scale and the Malay Version of Female Sexual Distress Scale-Revised. Their sexual function was evaluated using the Malay Version of the Female Sexual Function Index-6. The data were analyzed with simple and multiple linear regressions.

MAIN OUTCOME MEASURES

The prevalence and associated factors for FSD in breast cancer patients.

RESULTS

Ninety-four eligible patients were recruited for this study. In total, 73.4% (n = 69) of the patients reported having sexual dysfunction. A family history of breast cancer (P = 0.040), duration of marriage (P = 0.046), and frequency of sexual intercourse (P = 0.002) were significant factors associated with FSD in breast cancer patients after surgery.

CONCLUSION

The significant associated factors shown to influence the FSD score include family history of breast cancer, duration of marriage, and frequency of sexual intercourse. About 73.4% of patients have risk of developing FSD after receiving breast cancer treatment. Siang OP, Draman N, Muhamad R, et al. Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia. Sex Med 2021;9:100351.

Psychosocial Determinants of Marital Satisfaction Among Gynecologic Cancer Survivors in Malaysia

Introduction: Marital issues among gynecologic cancer survivors are common but complex. This study aimed to investigate the relationship between sociodemographic and clinical factors, including sexual dysfunction and marital satisfaction among Malaysian gynecologic cancer survivors. Methods: A cross-sectional survey of married women with gynecologic cancers was conducted at a Malaysian university hospital. Sociodemographic and clinical data were gathered. Sexual dysfunction was measured using the Malay Version Female Sexual Function Index (MVFSFI), while marital satisfaction was evaluated with the Malay Version Golombok Rust Inventory for Marital Satisfaction (MVGRIMS). Results: A total of 116 patients participated in this study. The median age was 59.0 years (Interquartile range, IQR: 49.0-67.0 years); the median duration of marriage was 32 years (IQR: 20.0-40.8 years). 80.2% had a secondary and lower level of education. 37.9% of study subjects (n = 44) reported poor-and below-levels of marital satisfaction, which was equivalent to MVGRIMS transformed scores of >5. The median FSFI total score was 49.9 (IQR: 2.0-63.0). MVGRIMS transformed score correlated significantly with all MVFSFI sub-scores. In logistic regression, lower educational levels were associated with poor marital satisfaction [primary, (adjusted Odds Ratio) aOR = 12.67, 95% CI: 1.40-114.87; secondary: aOR = 11.52, 95% CI: 1.39-95.72], while higher MVFSFI total score reduced the likelihood of poor marital satisfaction (aOR = 0.979, 95% CI: 0.964-0.994). Conclusion: Both sexual dysfunction and low education level may affect marital satisfaction among gynecologic cancer survivors. Targeted efforts focusing on sex education for patients may help to improve marital satisfaction.

Introducing sexual dysfunction in mental care

Introduction: People with any psychiatric disorder tend to have difficulties in responding sexually. However,sexual dysfunction (SD) is usually under-recognized, even the tightly hormonal and neuronal common connexions through the brain-sex axis. Multiple sources of resistance to SD assessment and intervention persist. Areas covered: The present review aims to underline the feasibility to introduce SD evaluation in patients with any psychiatric disorders, evaluating the potential mutual benefits of their management. Expert opinion: Women and men living with mental disorders frequently display sexual difficulties; however, some of them consider sexuality as a relevant parameter of their quality of life. In fact, SD as a side effect is a frequent reason for stopping the intake of medication. What is more, a holistic approach integrating sexual function could foster a better understanding of mental pathologies due to a common origin of pathogenesis. This could improve care quality, in keeping with the global tendency toward the development of personalized medicine. Consistently, the integration of SD assessment is highly recommended in mental health, all the more so when a psychotropic drug is prescribed. An expected consequence would be a reconstruction of the healthcare professional's consideration for the sexuality of people experiencing mental disorders.

The effect of ear acupressure (auriculotherapy) on sexual function of lactating women: protocol of a randomized sham controlled trial

BACKGROUND

Lactation has a negative effect on female sexual function. Hormonal changes during lactation cause changes which might lead to dyspareunia, lack of libido, and anorgasmia. There are various pharmacological and non-pharmacological approaches to treat sexual dysfunction. While pharmacological treatment has multiple unwanted side effects, non-pharmacological therapies such as complementary medicine are a potential safer alternative. The aim of this study is to evaluate the effect of ear acupressure on sexual function of lactating women.

METHODS/DESIGN

This is a randomized clinical trial with a parallel sham control group. In this study, 76 lactating women between 6 months and 1 year after childbirth were referred to health care centers in Qazvin City and would be invited to participate. Participants will be divided into intervention (n = 38) and control (n = 38) groups using simple block randomization. Both intervention and sham control groups will be visited over 10 sessions within a 4-day interval. At each visit, the adhesives containing Vaccaria seed will be adhered for the intervention group, while non-latex-based adhesives with no Vaccaria seeds will be placed on the same ear acupoints for the sham control group. Selected ear acupoints include genitalia (two ear points), pelvic point, master shoulder, and posterior pituitary gland. The women will be asked to hold the seeds on their ears for 3 days and press each ear point three times a day for 20 s. After 3 days, they will be asked to remove the seeds from their ears and rest for 1 day. Sexual function as primary outcome in both groups will be assessed using the Female Sexual Function Index before and immediately after 1 and 2 months after the intervention. Also, Sexual Quality of Life as secondary outcome will be assessed using Sexual Quality of Life-Female (SQOL-F) before and 2 months after intervention. Data will be analyzed using repeated measure ANOVA at the significant level of 0.05.

DISCUSSION

This study is expected to support the impact of ear channel ear acupressure on sexual function in lactating women.

TRIAL REGISTRATION

Iranian Clinical Trial Registration Center IRCT20190626044028N1 . Registered on 16 August 2019.

The female sexual function index: reliability and validity in Spanish postmenopausal women

OBJECTIVE

To examine the reliability and validity of the Spanish version of the Female Sexual Function Index (FSFI) and its ability to discriminate between women with and without female sexual dysfunction (FSD) among Spanish postmenopausal women.

METHODS

A total of 152 postmenopausal women completed the Spanish version of FSFI. Internal consistency, test-retest reliability, and construct validity (exploratory factor analysis) were analyzed. Concurrent and divergent validity were assessed using a visual analog scale for overall satisfaction with sexual life and the Hospital Anxiety and Depression Scale, respectively. To determine the ability and the accuracy of the FSFI total score in discriminating between women with and without FSD, a receiver-operating characteristic curve analysis was performed.

RESULTS

Factor analysis suggested a three-factor structure (explained variance 77.77%). The Spanish FSFI showed substantial-to-excellent test-retest reliability, with good internal consistency in the FSFI total score (Cronbach's alpha = 0.964), and also in its three dimensions. The FSFI total and domains scores showed strong (r > 0.50) and significant correlations (P < 0.01) with overall satisfaction with sexual life (concurrent validity), and low correlations with anxiety and depression (divergent validity). The Spanish FSFI total score and dimensions were significantly able to discriminate between women with and without FSD (P < 0.05), with an optimal cut-off point of <24.95 for the FSFI total score (64.15% sensitivity and 75.76% specificity).

CONCLUSIONS

The Spanish FSFI is a valid and reliable instrument for assessing and discriminating for FSD among Spanish postmenopausal women.

The Female Sexual Function Index: Transculturally Adaptation and Psychometric Validation in Spanish Women

BACKGROUND

The evaluation of sexual function is an important outcome in women who suffer some pelvic floor disorders (PFD). The Female Sexual Function Index (FSFI) is the most widely used questionnaire to evaluate the sexual health in female population. This study presents the adaptation and psychometric validation of the FSFI for Spanish women with PFD.

METHODS

The Spanish version of the FSFI was developed through the forward and backward translation process. The psychometric properties of reliability, validity, responsiveness, and feasibility were conducted in Spanish women with PFD who were assigned to the case or control group (with or without sexual dysfunction respectively).

RESULTS

A total of 323 Spanish women with PFD were recruited. The cross-cultural adaptation of the Spanish FSFI achieved a good semantic, conceptual, idiomatic, and content equivalence. The test-retest reliability was shown to be high in all of the cases. The convergent validity showed high results in the domain intercorrelations between each domain and total FSFI. The discriminant validity showed statistically significant differences between sexual dysfunction and control groups. The responsiveness was shown to be moderate to good in the dimensions and excellent in the total FSFI.

CONCLUSIONS

Spanish FSFI can be used as a reliable, valid, responsive, and feasible instrument for assessing sexual function in women.

Validation of the Vietnamese Translation Version of the Female Sexual Function Index in Infertile Patients

INTRODUCTION

The Female Sexual Function Index (FSFI) is regarded as a self-administered screening questionnaire for assessing the presence of any type of sexual dysfunction.

AIM

The aim of this study was to investigate the psychometric properties of the Vietnamese translation version of the Female Sexual Function Index (VN-FSFI) in a sample of infertile Vietnamese women.

METHODS

An existing Vietnamese translated-FSFI version was used as a first-step approach to back-translate into English. Based on the comparison of the original English version and the back-translation script, a modified version of the FSFI was revised. This version was evaluated for "content validity" by a panel of 3 experts and for "face validity" by a pilot study that was based on its results to refine to reach the last Vietnamese FSFI version (VN-FSFI version). A cross-sectional survey to investigate psychometric reliability and validity of the last VN-FSFI version was conducted with 271 infertile Vietnamese women from January 2017 through February 2018, at a hospital located in a central region of Vietnam. Construct validity was evaluated by principal component analysis using varimax rotation and factor analysis. Reliability studies on internal consistency (Cronbach's alpha coefficient, domain inter-correlations, and domain-total correlations) and on test-retest (Intraclass correlation coefficient).

MAIN OUTCOME MEASURE

Construct validity and the reliability of the VN-FSFI version.

RESULTS

Based on principal component analysis, a 5-factor model was established, consisting of arousal/orgasm, satisfaction, pain, lubrication, and desire that explained 72.32% of the total variance. The factorial structure supported to 6 retrieved domains that corresponded to the original version. The Cronbach's alpha coefficients were 0.92 for the total scale and 0.72-0.89 for the domains. Domain inter-correlations ranged from 0.36-0.73 and domain-total correlation coefficients ranged from 0.67-0.84. Test-retest correlation coefficients over 2-4 weeks were 0.97 (P < .001) for the total scale and 0.84-0.96 for the domains.

CONCLUSION

With good psychometric properties, which are almost similar to the original English version, this Vietnamese translation version of the Female Sexual Function Index (VN-FSFI version) was proved to be a valid and reliable instrument to measure multidimensional aspects of sexual function in infertile Vietnamese women. Ho TTT, Le MT, Truong QV, et al. Validation of the Vietnamese Translation Version of the Female Sexual Function Index in Infertile Patients. Sex Med 2019;8:57-64.

Prevalence of sexual dysfunction in pregnancy

PURPOSE

This study aims to determine the prevalence of sexual dysfunction during pregnancy and to determine its associated factors.

METHODS

This 6-month cross-sectional study adopted convenience sampling; inclusion criteria were healthy pregnant women, sexually active and living together with their partner for 3 months prior to recruitment into this study. Women who received advice to avoid sexual intercourse, with any medical illness and/or those conceived via assisted reproductive technology were excluded. Participants filled in a questionnaire consisting of demographic details and Malay Version Female Sexual Function Index Questionnaire. Data were analysed using SPSS 24.0; categorical data were analyzed by Chi-square and Fisher exact test.

RESULTS

One hundred pregnant women with a mean age of 31 + 4.31 years old participated. By using the cut-off FSFI score of 26.55, 81 (81%) participants were diagnosed to have sexual dysfunction. The mean FSFI score was 20.41 ± 8.45 (range 2.6-33.5; median 23.6). All the mean FSFI scores of first, second and third trimesters were low with 22.80 ± 10.67, 23.81 ± 7.18 and 18.74 ± 8.43, respectively. The mean score for desire, arousal, satisfaction and pain were significantly lower in the third trimester than earlier gestation. There was a significant difference in the incidence of difficulties in desire, arousal, lubrication, satisfaction and pain between first and second trimester combined, as compared to the third trimester of pregnancy. Trimester of pregnancy was found to have a significant association with the incidence of sexual dysfunction.

CONCLUSION

Sexual dysfunction among pregnant women is a significant burden. Despite being a common health problem, it is often neglected.

Resolution of Female Sexual Dysfunction (FSD) Among the Obese Multiethnic Malaysian Women Now a Reality with Bariatric Surgery: a Prospective Pilot Study in Malaysia

INTRODUCTION

Female sexual dysfunction (FSD) among the obese women is often under diagnosed and ignored especially in Malaysia, a nation of conservative multiethnic society. There are only a few studies on FSD resolution post-bariatric surgery. The objective was to identify the rate and resolution or improvement of FSD, among obese multiethnic Malaysian women post-bariatric surgery.

MATERIAL AND METHODS

This is a prospective study of women undergoing bariatric surgery, between May 2017 and April 2018. FSD was diagnosed using the Malay version of Female Sexual Function Index (MVFSFI) questionnaire. Patients filled up the questionnaire before and 6 months after surgery. Association between BMI reduction and FSFI score improvement was measured using Fisher's exact test. Outcomes between types of surgery (sleeve gastrectomy and gastric bypass) was compared.

RESULTS

Fifty-two women completed the study. The mean age was 38.77 ± 6.7. There were 44 (84.6%) Malay patients, 7 (13.5%) Indian patients, and 1 (1.9%) Chinese patient. There was a significant reduction in mean BMI, 39.89 ± 6.9 pre-surgery to 30.32 ± 5.4 post-surgery (p value < 0.001). The rate of FSD among the obese is 75.0% pre-surgery compared to 36.0% post-surgery. There was a significant improvement in mean FSFI score pre- and post-surgery: 18.73 and 25.93 respectively and in each of all 6 domains (p value < 0.001). There was a significant association between BMI reduction and improvement in FSFI score (p = 0.019). There was no difference in outcomes between types of surgery.

CONCLUSION

FSD is highly prevalent among the obese multiethnic Malaysian women. Bariatric surgery has proven benefit in resolving FSD across all sexual domains and should be considered as a management option in this group of women.

Sexual satisfaction and sexual function in women with gynecologic cancer: validation of the Sexual Satisfaction Scale for Women in Taiwan

OBJECTIVE

To date, there are few validated multidimensional measures of sexual satisfaction that have been translated and empirically validated among Chinese speaking women with gynecologic cancer. The study was undertaken to validate the Sexual Satisfaction Scale for Women and to examine sexual satisfaction and sexual functioning in a sample of women with gynecologic cancer.

METHODS

A cross-sectional survey was conducted in 209 women, of which 106 had gynecologic cancer and 103 were in the non-cancer group with no history of cancer. Self-evaluations included the Female Sexual Function Index and Sexual Satisfaction Scale for Women Traditional Chinese version. Analyses for internal consistency, test-retest reliability, and construct validity were performed. Analysis of variance was conducted for group comparison on sexual satisfaction and sexual functioning.

RESULTS

The Sexual Satisfaction Scale for Women Traditional Chinese version showed good internal consistency reliability (Cronbach's α=0.965) and acceptable test-retest reliability (r=0.954). The confirmatory factor analysis on the Sexual Satisfaction Scale for Women Traditional Chinese version suggested the goodness of fit indices (χ²/df, root mean square residual, goodness of fit index, normed-fit index, comparative fit index, and adjusted goodness of fit index) were good. The women with gynecologic cancer gave significantly lower ratings (mean 102.18) than those without cancer (mean 118.09) for each of the Sexual Satisfaction Scale for Women Traditional Chinese version domains and total score. Significant differences between women with cancer (mean 13.08) and without cancer (mean 22.92) were noted for each of the Female Sexual Function Index domains and total scores (all p<0.0001).

CONCLUSIONS

This translated version of the Sexual Satisfaction Scale for Women appears to be a reliable and valid instrument for measuring multifaceted components of sexual satisfaction in the general and clinical population of women rooted in Chinese culture.

The Sexual Satisfaction Scale for Women (SSS-W): Adaptation and Validation of a Traditional Chinese Version in Taiwan

Sexual satisfaction is a key factor in an individual's sexual health and overall well-being. The aim of this study was to validate the most comprehensive index of sexual satisfaction-the SSS-W-for use among Chinese-speaking individuals. A total of 103 women (20-65 years old) participated in this survey study. An SSS-W traditional Chinese version (SSS-W-TC) was developed following the guidelines for cross-cultural translation and adaptation. The translated version, the SSS-W-TC, demonstrates psychometric properties within the satisfactory range, suggesting the feasibility of the SSS-W-TC for use in Taiwan. In terms of internal consistency, the reliability of the SSS-W-TC and its subscales is excellent. High test-retest reliability coefficients were obtained for all subscales of the translated version, demonstrating acceptable stability of the SSS-W-TC across measurement intervals. The ability of the SSS-W-TC to discriminate sexually functional and dysfunctional women shows evidence of concurrent validity. Low to modest correlations between the total and domain scores of the SSS-W and the Female Sexual Function Index Satisfaction domain echo the need for a multidimensional measure of sexual satisfaction in this population. The development of the SSS-W-TC lays the groundwork for future researchers who wish to conduct cross-cultural work in sexual satisfaction using Chinese-speaking samples.

Psychometric properties of the Persian language version of the Female Sexual Function index among postmenopausal women

Objective

The present research aimed to evaluate the psychometric properties of the Persian language version of the Female Sexual Function Index (FSFI) among postmenopausal women.

Material and Methods

This secondary analysis examined 402 healthy postmenopausal Iranian women presenting to healthcare centers across Iran. The sampling method was convenience sampling. The translation of the FSFI and its cross-cultural adaptation were conducted under the guidelines proposed by Beaton. The reliability (Cronbach’s alpha coefficient and test-rest reliability) and construct validity confirmatory factor analysis) were assessed. Model fitting index [such as the root mean square error of approximation (RMSEA), the Goodness of Fit Index (GFI) and the Comparative Fit Index (CFI)] was calculated.

Results

The mean age of the study participants was 53.63±7.8 years. Test-retest reliability was high for both the entire scale (r=0.964; p<0.001) and its six dimensions (0.76-0.94; p<0.001). The Cronbach’s alpha of the entire scale and its dimensions was greater than 0.80. The original six-factor was used, which showed a relatively poor fit (χ²=667.054; p<0.001; χ²/df=4.86; GFI=0.92; RMSEA=0.098; GFI=0.85). After adding three correlated error terms to the six-factor model, an acceptable fit was obtained (χ²=470.542; p<0.001; χ²/df=3.51; CFI=0.95; RMSEA=0.079; GFI=0.89).

Conclusion

According to our results, the FSFI tool indicated a satisfactory fit for a six-factor model, as similar to the original English version, for use in clinical practice and research regarding healthy postmenopausal Iranian women. More research needs to be conducted on this scale to assess all of its psychometric properties.

Translation, Adaptation, and Preliminary Validation of the Female Sexual Function Index into Spanish (Colombia)

The Female Sexual Function Index (FSFI) subjectively explores the dimensions of female sexual functioning. This research undertook to adapt and validate the FSFI to Spanish language in a Colombian sample. To this effect, this study was conducted in two steps, namely: (1) cultural adaptation of the scale with the collaboration of seven experts; and (2) preliminary validation of the scale in a sample of 925 participants. Reliability indices were appropriate in this sample, and external validity in relation to other measures showed significant relationships. Findings suggest that the FSFI is reliable and valid in Spanish for a Colombian population. Further research is needed to establish the test-retest reliability and discriminant validity of this Spanish version.

Female Sexual Function and Dysfunction: A Cross-National Prevalence Study in Slovenia

The purpose of the current study was to evaluate the prevalence of female sexual dysfunction in Slovenia. We aimed to explore the prevalence itself, comparison among demographic groups and potential correlations. Data were collected based on the validated standardized Female Sexual Function Index (FSFI) (N=605). Most participants had sexual intercourse with one partner (n=523), and the majority of sexual relationships were heterosexual (n=584). University educated subjects had the highest claims of arousal, followed by those with master/doctoral degrees and college educated ones. The lowest level was expressed by subjects with elementary school. The youngest subjects (18-23 years) expressed the highest levels of desire and arousal, followed by the 24-29 age group. The 42-47 age group reported higher levels of lubrication and orgasm. The claim of satisfaction was highest in the 24-29 age group, while the pain was highest in the 42-47 age group. Strong correlation was found between the claims of desire and arousal (r=0.585), arousal and lubrication (r=0.879), lubrication and pain (r=0.856), orgasm and lubrication (r=0.856), satisfaction and orgasm (r=0.782), and pain and arousal (r=0.776) (p<0.001). We identified a 31% prevalence of female sexual dysfunction in Slovenia.

Long-term postpartum effect of severe maternal morbidity on sexual function

There was limited knowledge on the sexual function in women who have survived severe obstetric complications. The aim of this study was to compare the level of sexual functioning among women with and without severe morbidity at six months postpartum and to identify the factors associated with sexual function scores of women. A prospective double-cohort study design was applied at two tertiary hospitals over a six-month period. Postpartum women with and without severe maternal morbidity were selected as the exposed and the non-exposed group, respectively. The study included 145 exposed and 187 non-exposed women. Those with severe maternal morbidity were significantly ( P < 0.001) older (mean (SD): 31.6 years (6.26) vs. 29.2 years (5.65)) and had longer hospital stays (mean (SD): 5.9 days (3.79) vs. 3.6 days (2.23)). They were also more likely to have delivered preterm (75.9 vs. 93.0) and to have had a caesarean section (80.7 vs. 67.9) than those without severe maternal morbidity. After adjusting for age and mental health, there was no significant difference in Female Sexual Function Index scores ( P = 0.895) between the two groups. Both groups showed the highest sexual dysfunction in pain and the lowest dysfunction in orgasm. Linear regression analyses showed no association between Female Sexual Function Index scores and sociodemographic characteristics, reproductive history, or quality of life. Sexual function in women with severe maternal morbidity did not differ from that in women without severe maternal morbidity. In-depth qualitative studies of women who have experienced potentially life-threatening conditions may improve the understanding of their sexual function.

Association of brain-derived neurotrophic factor valine to methionine polymorphism with sexual dysfunction following selective serotonin reuptake inhibitor treatment in female patients with major depressive disorder

INTRODUCTION

The occurrence of female sexual dysfunction (FSD) in patients with major depressive disorder (MDD) receiving selective serotonin reuptake inhibitors (SSRIs) treatment gives negative impacts on patients' quality of life and causes treatment discontinuation. We aimed to investigate whether genetic polymorphism of identified candidate gene is associated with FSD in our study population.

METHODS

This is a cross-sectional study. A total of 95 female patients with MDD who met the criteria of the study were recruited and were specifically assessed on the sexual function by trained psychiatrists. Patients' DNA was genotyped for BDNF Val66Met polymorphism using real-time polymerase chain reaction.

RESULTS

The prevalence of FSD in this study is 31.6%. In the FSD group, patients with problematic marriage were significantly more frequent compared with patients who did not have problematic marriage (P = 0.009). Significant association was detected in the lubrication domain with BDNF Val66Met polymorphism (P = 0.030) using additive genetic model, with even stronger association when using the recessive model (P = 0.013).

DISCUSSION

This study suggested that there was no significant association between BDNF Val66Met with FSD. However, this polymorphism is significantly associated with lubrication disorder in patients treated with SSRIs.

Female Sexual Function Index Short Version: A MsFLASH Item Response Analysis

The Female Sexual Function Index (FSFI) is a psychometrically sound and popular 19-item self-report measure, but its length may preclude its use in studies with multiple outcome measures, especially when sexual function is not a primary endpoint. Only one attempt has been made to create a shorter scale, resulting in the Italian FSFI-6, later translated into Spanish and Korean without further psychometric analysis. Our study evaluated whether a subset of items on the 19-item English-language FSFI would perform as well as the full-length FSFI in peri- and postmenopausal women. We used baseline data from 898 peri- and postmenopausal women recruited from multiple communities, ages 42-62 years, and enrolled in randomized controlled trials for vasomotor symptom management. Goals were to (1) create a psychometrically sound, shorter version of the FSFI for use in peri- and postmenopausal women as a continuous measure and (2) compare it to the Italian FSFI-6. Results indicated that a 9-item scale provided more information than the FSFI-6 across a spectrum of sexual functioning, was able to capture sample variability, and showed sufficient range without floor or ceiling effects. All but one of the items from the Italian 6-item version were included in the 9-item version. Most omitted FSFI items focused on frequency of events or experiences. When assessment of sexual function is a secondary endpoint and subject burden related to questionnaire length is a priority, the 9-item FSFI may provide important information about sexual function in English-speaking peri- and postmenopausal women.

The Female Sexual Function Index (FSFI): Translation, Validation, and Cross-Cultural Adaptation of an Urdu Version "FSFI-U"

INTRODUCTION

Female sexual dysfunction (FSD) is a common problem, and many self-report questionnaires are available for its evaluation. Pakistani women with sexual problems feel shy to consult with their physician. A validated self-report questionnaire, in the local language with modest expressions is required for these women.

AIM

The aim of this study was to translate, cross-culturally adapt, and perform a psychometric validation of an Urdu translation of the Female Sexual Function Index (FSFI).

METHODS

The FSFI was translated in Urdu, and its precision was ascertained through reverse translation. It was pretested on 22 bilingual women and refined again to reach at a reliable Urdu version of the questionnaire FSFI-U. One hundred sixteen bilingual women, in a stable sexual relationship over the previous 6 months were finally asked to fill out the FSFI and FSFI-U. Their sexual function was then clinically evaluated and responses were compared with the clinical assessment as well as with each other.

MAIN OUTCOME MEASURES

The responses were analyzed through descriptive statistics for reliability, face validity, agreement between the responses to the original English version and to the FSFI-U, and also for test-retest consistency. The data were analyzed statistically using Cronbach's alpha analysis, Intraclass correlation coefficients, Pearson correlation, and Student's t-test.

RESULTS

FSFI was found to be easily understandable and capable of adequately evaluating and measuring various aspects of female sexual function. A high degree of internal consistency was demonstrated on Cronbach's alpha analysis. Cronbach's α coefficient for various domains was sufficiently high ranging from 0.84 to 0.97. The clinical assessment of the presence and severity of FSD also matched with the self-report questionnaire. Similarly, various domains of FSFI had high degree of correlation in the Urdu version of FSFI (P < 0.001).

CONCLUSION

The Urdu translation version of FSFI is valid and reliable for use in the literate population of Pakistan. Rehman KU, Asif Mahmood M, Sheikh SS, Sultan T, Khan MA. The Female Sexual Function Index (FSFI): Translation, Validation, and Cross-Cultural Adaptation of an Urdu Version "FSFI-U". Sex Med 2015;3:244-250.

Sexual Functioning, Desire, and Satisfaction in Women with TBI and Healthy Controls

Traumatic brain injury (TBI) can substantially alter many areas of a person's life and there has been little research published regarding sexual functioning in women with TBI. Methods. A total of 58 women (29 with TBI and 29 healthy controls) from Neiva, Colombia, participated. There were no statistically significant differences between groups in sociodemographic characteristics. All 58 women completed the Sexual Quality of Life Questionnaire (SQoL), Female Sexual Functioning Index (FSFI), Sexual Desire Inventory (SDI), and the Sexual Satisfaction Index (ISS). Results. Women with TBI scored statistically significantly lower on the SQoL (p < 0.001), FSFI subscales of desire (p < 0.05), arousal (p < 0.05), lubrication (p < 0.05), orgasm (p < 0.05), and satisfaction (p < 0.05), and the ISS (p < 0.001) than healthy controls. Multiple linear regressions revealed that age was negatively associated with some sexuality measures, while months since the TBI incident were positively associated with these variables. Conclusion. These results disclose that women with TBI do not fare as well as controls in these measures of sexual functioning and were less sexually satisfied. Future research is required to further understand the impact of TBI on sexual function and satisfaction to inform for rehabilitation programs.

Effect of Infertility on Sexual Function: A Cross-Sectional Study

INTRODUCTION

Sexual dysfunction is an important psychological disorder that may increase in infertile couples.

AIM

To evaluate the effect of infertility on sexual function in women attending in private and public institutions in Ilam during 2013.

MATERIALS AND METHODS

In a cross - sectional study evaluated the sexual function among 384 women attending in health care centers of Ilam western of Iran during 2013. Participants were divided in two groups, fertilities and infertilities women. Data was collected by trained research midwives using demographic and FSFI questionnaires. SPSS software Package 16 was used to analyse the data of this project. Differences were regarded statistically significant with an alpha error of 0.05.

RESULTS

The mean age was 29.29 ± 6.7 years in fertile and 31.74 ± 8.07 in infertile women. Significant difference was reported in mean age between fertile and infertile women (p=0.014). The Mean± SD of all demissions of female sexual function was difference between fertile and infertile women. Sexual function was lower in infertile women.

CONCLUSION

All dimensions of sexual function were lower in infertile women in compared with fertile women. Further research should be done on this subject and ways to address such problems should be found.

The prevalence of sexual dysfunction in the female health care providers in Jeddah, Saudi Arabia

The objective of this study was to determine the prevalence of sexual dysfunction in Saudi and non-Saudi female health care providers in Jeddah, Saudi Arabia. One -hundred twenty (60 Saudi and 60 non-Saudi) sexually active female health care professionals in Jeddah, Saudi Arabia, were anonymously surveyed using the English version of the female sexual function index questionnaire. The individual domain scores for pain, arousal, lubrication, orgasm, satisfaction, pain, and overall score for the Saudi and non-Saudi women were calculated and compared. The two groups were comparable in demographic characteristics. No statistically significant differences were found between Saudi and non-Saudi women in desire (P = .22) and arousal scores (P = .47). However, non-Saudi women had significantly higher lubrication (P < .001), orgasm (P = .015), satisfaction (P = .004), and pain scores (P = .015). The overall scores in Saudi and non-Saudi women were low (23.40 ± 4.50 compared with 26.18 ± 5.97), but non-Saudi women had a significantly higher overall score (P = .005). Taken together, sexual dysfunction is prevalent among Saudi and non-Saudi female health care providers, with Saudi women demonstrating lower scores in four sexual function domains and the overall score.

Genetic determinants of selective serotonin reuptake inhibitor related sexual dysfunction

Sexual dysfunction is a troubling obstacle for individuals being treated for depression and can be caused by both depressive symptoms as well as antidepressant drugs. Selective serotonin reuptake inhibitors (SSRIs) represent a class of antidepressants commonly associated with sexual dysfunction, even after symptomatic improvement. Candidate gene studies have identified associations between sexual dysfunction and altered SSRI pharmacokinetics or to the neurotransmitter systems affected by depression and SSRI treatment. The multifactorial nature of this phenotype and study heterogeneity are currently limitations to the translation of these findings to clinical use. Larger, prospective studies of genetic-guided antidepressant selection may help to clarify the clinical utility of pharmacogenetics in minimizing sexual side effects.

Development and validation of the Korean version of the Female Sexual Function Index-6 (FSFI-6K)

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.

Female sexual dysfunction in patients with major depressive disorder (MDD) treated with selective serotonin reuptake inhibitor (SSRI) and its association with serotonin 2A-1438 G/A single nucleotide polymorphisms

INTRODUCTION

Selective serotonin reuptake inhibitors (SSRIs) are known for their sexual side effects. Different SSRIs may affect different areas of sexual function at different rates.

AIMS

The study aimed to determine the prevalence of female sexual dysfunction (FSD), its clinical correlates, and association with 5HT2A (rs6311) single nucleotide polymorphisms (SNPs) in patients with major depressive disorder (MDD) who were on SSRI therapy.

METHODS

This was a cross-sectional study on 95 female outpatients with MDD treated with SSRI. The patients were in remission as determined by Montgomery-Asberg Depression Rating Scale. Genomic DNA was isolated from buccal swabs and samples were processed using a real time polymerase chain reaction.

MAIN OUTCOME MEASURES

The presence or absence of FSD as measured by the Malay Version of Female Sexual Function Index and 5HT2A-1438 G/A (rs6311) SNP.

RESULTS

The overall prevalence of FSD was 32.6%. After controlling for age, number of children, education level, total monthly income, SSRI types, and SSRI dosing, being employed significantly enhanced FSD by 4.5 times (odds ratio [OR] = 4.51; 95% confidence interval [CI] 1.00, 20.30; P = 0.05). Those having marital problems were 6.7 times more likely to have FSD (OR = 6.67; 95% CI 1.57, 28.34). 5HT2A-1438 G/A (rs6311) SNP was not significantly associated with FSD.

CONCLUSION

There was no significant association between FSD and the 5HT2A (rs6311) SNP in patients with MDD on SSRI therapy. Employment status and marital state were significantly associated with FSD among these patients.

The relationship between sexual functioning among couples undergoing infertility treatment: a pair of perfect gloves

OBJECTIVE

The study aimed to measure the relationship of sexual functioning between male and female partners, who sought infertility treatment in a university hospital setting in Malaysia.

METHODS

This cross-sectional study was conducted on couples with infertility problems attending the Medically Assisted Conception Center (MACC). The female and male sexual functioning was measured using the Malay Version of Female Sexual Function Index (MVFSFI) and Malay Version of International Index of Erectile Function (IIEF), respectively. The relationship between the female and male sexual functioning was measured using correlation statistical analyses. A total of 269 subjects (150 females and 119 males) who met the requirement of the study, were recruited.

RESULTS

The female and male sexual functioning was moderately correlated (r=0.574). Female sexual arousal and sexual satisfaction domains scores had the largest correlation (r=0.522 and r=0.507 respectively) to IIEF total score. On the other hand, male intercourse satisfaction (IS) domain score had the highest correlation (r=0.574) to FSFI total score. A strong correlation between male and female sexual function was observed.

CONCLUSION

It is speculated that possible interaction of male and female sexual functioning may be multifactorial and complex.

Prevalence and risk factors of female sexual dysfunction among healthcare personnel in Malaysia

OBJECTIVE

To determine the prevalence and risk factors of female sexual dysfunction (FSD) among healthcare personnel in selected healthcare facilities in Malaysia.

METHODS

This was a cross-sectional study carried out at three large healthcare facilities that were selected by convenience sampling. Within each facility, stratified random sampling was used to select suitable candidates to participate in the study (n=201). Validated questionnaires were used to assess depression, anxiety, sexual function in women and erectile dysfunction (ED) in their partners.

RESULTS

The prevalence of FSD was 5.5%. Women with sexual dysfunction were more likely to be married longer (OR=4.08; 95% CI; 1.15-4.50), had lower frequency of sexual intercourse (OR=5.00; 95% C; 1.05-23.76) and had a spouse with ED (OR=24.35; 95% CI; 4.55-130.37). Multivariate analysis showed that ED was the strongest predictor for FSD (AOR=27.30; 95% CI; 4.706-159.08).

CONCLUSION

One in eighteen female healthcare personnel suffered from FSD and presence of ED in the partner strongly impacted her sexual function, negatively. The findings highlight the importance of including the male partner in clinical assessment of FSD.

Factor analysis study on sexual responses in women with type 2 diabetes mellitus

AIMS

This study compared the components of sexual responses between Malaysian women with Type 2 diabetes mellitus and those without the disease.

METHODS

This cross-sectional study measured sexual responses by using the validated Malay version of Female Sexual Function Index. A factor analysis with varimax rotation method was employed using principal component analysis to explore the correlation structure of the different domains of sexual responses between the two groups. Components of sexual responses were obtained using Kaiser's criteria and compared between those in the diabetic and non-diabetic groups.

RESULTS

A total of 353 women (178 with diabetes and 175 without diabetes) were recruited. Three components of sexual responses emerged from the analysis in the study and control groups. Sexual pain was found to form a component together with lubrication and orgasm domains among the women with diabetes, unlike those without diabetes, where pain stood on its own. Sexual desire and arousal formed one component and satisfaction formed another in both groups.

CONCLUSIONS

The domains in the sexual responses of Malaysian women were highly overlapping. It is concluded that the presence of pain as part of lubrication and orgasm component in women with diabetes indicates the importance of intact genital sensation, even though an adverse type of sensation, for vaginal congestion and orgasm to occur in this group of women.

Sexual desire disorder in female healthcare personnel in Malaysia

INTRODUCTION

The aim of this study was to determine the prevalence and risk factors for female sexual desire disorder (FSDD) among healthcare personnel at selected healthcare facilities in Malaysia.

METHODS

Two hundred and one female healthcare workers from three large tertiary hospitals were selected by stratified random sampling to participate in this cross-sectional study. Validated questionnaires were used to assess depression, anxiety, and sexual function in women and erectile dysfunction (ED) in their partners.

RESULTS

The prevalence of FSDD was 18.9%. Women with low sexual desire were more likely to have higher educational attainment (OR = 3.06; 95% CI; 1.22-7.66), lower frequency of sexual intercourse (OR = 12.81; 95% CI; 4.43-37.83), two or more children (OR = 3.05; 95% CI; 1.02-9.09), duration of marriage of 20 years or more (OR = 2.62; 95% CI; 1.27-5.40), and a spouse with ED (OR = 2.86; 95% CI; 1.08-7.56).

DISCUSSION

FSDD is common among female healthcare personnel in Malaysia, affecting nearly one in five women. The implication of low sexual desire is important in terms of contributing to a meaningful sexual relationship, and indirectly affects the quality of life of the healthcare personnel.

Phases of female sexual response cycle among Malaysian women with infertility: a factor analysis study

INTRODUCTION

This cross-sectional study aimed to determine the construct of the phases of the female sexual response cycle (SRC) among women attending an infertility clinic in a Malaysian tertiary center.

METHODS

The sexual response phases were measured with a validated Malay version of the Female Sexual Function Index (FSFI). The correlation structure of the items of the SRC phases (i.e. desire, arousal, orgasm, satisfaction and pain) was determined using principal component analysis (PCA), with varimax rotation method. The number of factors obtained was decided using Kaiser's criteria.

RESULTS

A total of 150 married women with a mean age of 32 years participated in this study. Factor loadings using PCA with varimax rotation divided the sexual domains into three components. The first construct comprised sexual arousal, lubrication and pain (suggesting a mechanical component). The second construct were orgasm and sexual satisfaction (suggesting a physical achievement). Sexual desire, suggesting a psychological component, stood on its own as the third.

DISCUSSION

The findings suggest that three constructs could be identified and in favor of the Basson model (a non-linear concept of SRC) for Malaysian women's sexual functioning. Understanding this would help clinicians to strategize the treatment approach of sexual dysfunction in women with infertility.

Risk and associated factors of female sexual orgasmic disorder in women with hypertension in Malaysia

INTRODUCTION

The objective of this study was to examine the risk of female sexual orgasmic disorder among a group of women with hypertension in Malaysia. The associated factors were also examined.

METHODS

This cross-sectional study involved 348 hypertensive women attending the primary care or hypertension clinic in a teaching hospital in Malaysia. Female sexual orgasmic disorder was assessed using the Orgasmic subscale of the Malay Version of the Female Sexual Function Index (MVFSFI). Basic socio-demographic data of the subjects was collected using a predesigned questionnaire. Medical records were reviewed to gather patients' medical information.

RESULTS

The risk of female sexual orgasmic disorder among hypertensive women was 14.1%. Univariate analysis found that older age, longer duration of marriage, lower educational level, and menopause were associated with higher risk of female sexual orgasmic disorder. These factors were not significant in multivariate analysis.

DISCUSSION

The risk of female sexual orgasmic disorder was relatively low in Malaysian women with hypertension. No risk factors were associated with female sexual orgasmic disorder in the current study.

Association between 5HT2A polymorphism and selective serotonin re-uptake inhibitor (SSRI)-induced sexual desire disorder (SDD) among Malaysian women

INTRODUCTION

SSRIs are known for their sexual side-effects with a variable rate of sexual dysfunction (SD). 5HT2A (rs6311) single nucleotide polymorphism (SNP) was found to have significant association with SD. The purpose of this study was to determine the prevalence of female SDD, its clinical correlates and association with 5HT2A (rs6311) SNP in patients with major depressive disorder (MDD) treated with SSRIs.

METHODS

This was a cross-sectional study. We evaluated 95 female outpatients with MDD treated with SSRIs who were in remission. Outcome measures were stratified by the presence or absence of SDD. A buccal swab was obtained from each patient and sent for genotyping in the Pharmacogenomics and Medical Biotechnology Laboratory of Universiti Malaya.

RESULTS

The overall prevalence of female SD was 32.6%. The prevalence of female SDD was 62.1%. Those with arousal problem, lubrication problem, sexual satisfaction problem, orgasm problem and problematic marriage were more likely to have sexual desire disorder. The majority of participants who had sexual desire disorder had genotype TT (42.4%) but there was no significant association observed. After controlling for age, number of children, education level, SSRI type, lubrication problem, orgasm problem, satisfaction problem and marital problem, only arousal problem significantly enhanced the presence of sexual desire disorder by 8.5 times (odds ratio = 8.46, 95% confidence interval = 1.24-57.58; P = 0.018).

DISCUSSION

This study showed that there was no significant association between SDD and the 5HT2A (rs6311) SNP. Arousal problem significantly enhanced the presence of sexual desire disorder.

Sexual arousal difficulties in women treated with antidepressants: a comparison between escitalopram and fluoxetine

OBJECTIVE

To compare the risk of sexual arousal difficulties between two groups of depressed female patients in remission who were treated with either escitalopram or fluoxetine. Associated factors were also examined.

METHODS

This was a cross-sectional study involving 112 female patients attending the psychiatric clinic, University Kebangsaan Malaysia Medical Centre (UKMMC) with depressive disorders as assessed by using the Structured Clinical Interview for DSM-IV (SCID), who had been in remission for the previous 2 months as defined by a score of < or = 10 from an assessment using the Montgomery-Asberg Depression Rating Scale (MADRS) and were treated with either fluoxetine or escitalopram. Sexual arousal difficulties were assessed using the arousal subscale of Malay Version of the Female Sexual Function Index (MVFSFI).

RESULTS

The rate of sexual arousal difficulties was 41.1% for all subjects. Sexual arousal difficulties occurred in 50.0% of subjects treated with fluoxetine and 32.1% with escitalopram. However, this difference was not statistically significant (p = 0.055). Multivariate logistic regression analysis showed that higher dose of antidepressant (adjusted OR = 4.08, 95 CI = 1.70-9.81) was significantly associated with female sexual arousal difficulties.

CONCLUSION

The risk of sexual arousal difficulties was higher in female patients who were treated with higher doses of either fluoxetine or escitalopram.

Development and validation of the Polish version of the Female Sexual Function Index in the Polish population of females

INTRODUCTION

Unlike male sexual function, which is relatively easy to assess, female sexual function is still a diagnostic challenge. Although numerous new measurements for female sexual dysfunction (FSD) have recently been developed, the Female Sexual Function Index (FSFI) remains the gold standard for screening. It has been validated in more than 30 countries. The FSFI has been used in several studies conducted in Poland, but it has never been standardized for Polish women.

AIM

The aim of this study was to develop a Polish version of the FSFI (PL-FSFI).

MATERIALS AND METHODS

In total, 189 women aged 18-55 years were included in the study. Eighty-five were diagnosed with FSD as per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) criteria; 104 women did not have FSD. All subjects completed the PL-FSFI at baseline (day 0), day 7, and day 28.

MAIN OUTCOME MEASURES

Test-retest reliability was determined by Pearson's product-moment correlations. Reliability was tested using Cronbach's α coefficient. Construct validity was evaluated by principal component analysis using varimax rotation and factor analysis. Discriminant validity was assessed with between-groups analysis of variance.

RESULTS

All domains of the PL-FSFI demonstrated satisfactory internal consistencies, with Cronbach's α value of >0.70 for the entire sample. The test-retest reliability demonstrated good-to-excellent agreement between the assessment points. Based on principal component analysis, a 5-factor model was established that explained 83.62% of the total variance. Domain intercorrelations of the PL-FSFI ranged from 0.37-0.77. The optimal PL-FSFI cutoff score was 27.50, with 87.1% sensitivity and 83.1% specificity.

CONCLUSION

The PL-FSFI is a reliable questionnaire with good psychometric and discriminative validity. Therefore, it can be used as a tool for preliminary screening for FSD among Polish women.

The relationship between pelvic organ prolapse, genital body image, and sexual health

AIMS

Pelvic organ prolapse involves physical changes to the genitals, potentially distressing to women. We hypothesized poorer genital body image in prolapsed women versus controls and that genital body image would correlate with sexual health.

METHODS

Seventy-four sexually active women, 13 with prolapse, 24 with surgically corrected prolapse, 37 without prolapse, completed the Genital Self Image Scale (GSIS-20), Body Esteem Scale (BES), and Female Sexual Function Index (FSFI).

RESULTS

In prolapsed women median GSIS-20 scores were 28/40, women with surgically corrected prolapse 32/40 and never prolapsed 34/40 (χ(2) = 9.6, P < 0.01). Post hoc analysis showed significant differences between prolapsed and never prolapsed groups (P < 0.05). After adjusting for BES, GSIS-20 correlated with overall FSFI (r = 0.384, P < 0.01), and its subscales of desire (r = 0.34, P < 0.05) and satisfaction (r = 0.41, P < 0.01).

CONCLUSIONS

Women with prolapse are at risk for poorer genital body image and reduced sexual health.

Latent structures of female sexual functioning

For the last three decades, male and female sexual responses have been conceptualized as similar, based on separated and sequential phases as proposed by the models of Masters and Johnson (1966) and Kaplan (1979) model. However, there is a growing debate around the need to conceptualize female sexual response and the classification of sexual dysfunction in women, in view of the upcoming editions of the DSM and ICD. The aim of this study was to test, using structural equation modeling, five conceptual, alternative models of female sexual function, using a sample of women with sexual difficulties and a sample of women without sexual problems. A total of 1993 Portuguese women participated in the study and completed a modified version of the Female Sexual Function Index. Findings suggested a four-factor solution as the model that best fit the data regarding women presenting sexual difficulties: (1) desire/arousal; (2) lubrication; (3) orgasm; (4) pain/vaginismus. In relation to sexually healthy women, the best model was a five-factor solution comprising of (1) desire; (2) arousal; (3) lubrication; (4) orgasm; and (5) pain/vaginismus. Discriminant validity between factors was supported, suggesting that these dimensions measure distinct phenomena. Model fit to the data significantly decreased in both samples, as models began to successively consider greater levels of overlap among phases of sexual function, towards a single-factor solution. By suggesting the overlap between pain and vaginismus, results partially support the new classification that is currently being discussed regarding DSM-5. Additionally, results on the relationship between sexual desire and arousal were inconclusive as sexually healthy women were better characterized by a five-factor model that considered the structural independence among these factors, whereas women with sexual difficulties better fit with a four-factor model merging sexual desire and subjective sexual arousal.

Hypoactive sexual desire among depressed female patients treated with selective serotonin reuptake inhibitors: a comparison between escitalopram and fluoxetine

OBJECTIVE

To determine the risk of hypoactive sexual desire (HSD) in depressed female patients treated with selective serotonin reuptake inhibitors, comparing escitalopram and fluoxetine. The associated factors were also examined.

METHODS

This cross-sectional study involved 112 female patients (56 in each group) diagnosed to have major depressive disorder who were in remission (as defined by the Diagnostic and Statistical Manual-IV (DSM-IV) in the past 2 months and the Montgomery-Asberg Depression Rating Scale (MADRS) score of ≤ 10) from the psychiatric clinic, University Kebangsaan Malaysia Medical Centre (UKMMC). They were interviewed using the Structured Clinical Interview for DSM-IV (SCID). Hypoactive sexual desire was assessed using the Desire subscale of the Malay Version of the Female Sexual Function Index (MVFSFI).

RESULTS

The risk of hypoactive sexual desire was 50.9% for all patients; 64.3% for the fluoxetine group and 37.5% for the escitalopram group. Multivariate logistic regression analysis showed fluoxetine therapy (adjusted OR = 3.08, CI = 1.23, 7.73) and moderate to high dosage of antidepressant (adjusted OR = 4.27, CI = 1.66, 10.95) were significantly associated with hypoactive sexual desire.

CONCLUSION

Those treated with fluoxetine had significantly higher rates of HSD than those on escitalopram. Moderate to high antidepressant dosage is another significant predictor of HSD in depressed women treated with SSRIs.