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.

Female sexual dysfunction is a multicausal and multidimensional problem combining biological, psychological and interpersonal determinants. It is age related, progressive and highly prevalent, affecting 20% to 50% of women. Based on epidemiological data from the National Health and Social Life Survey a third of women lack sexual interest and nearly a fourth do not experience orgasm. l Approximately 20% of women report lubrication difficulties and 20% find sex not pleasurable. Female sexual dysfunction has a major impact on quality of life and interpersonal relationships. For many women it has been physically disconcerting, emotionally distressing and socially disruptive.In contrast to the widespread interest in research and treatment of male sexual dysfunction, less attention has been paid to the sexual problems of

Recent consensus-based characterizations of female sexual dysfunction have emphasized personal distress as an essential component of their definition. To assist researchers and clinicians, we developed a new scale, the Female Sexual Distress Scale, to measure sexually related personal distress in women. In this article, we describe the initial stages in the development and validation of this instrument. Three studies involving a total of approximately 500 women were performed to evaluate the reliability and validity of the scale in different samples of sexually functional and dysfunctional women. Results indicated a unidimensional factor structure in both the original 20-item version and in a "polished" 12-item version. We observed a high degree of internal consistency and test-retest reliability in both versions across all three studies. Additionally, the scale showed a high degree of discriminative ability to distinguish between sexually dysfunctional and functional women in each of the studies. One study also showed a strong sensitivity to treatment response. Finally, we observed moderate positive correlations with other conceptually related nonsexual measures of distress, supporting the construct validity of the scale. Overall, these findings provide solid support for the FSDS as a valid and reliable measure for assessing sexually related personal distress in women.

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

Introduction Existing definitions of women's sexual disorders are based mainly on genitally focused events in a linear sequence model (desire, arousal and orgasm). Aim To revise definitions based on an alternative model reflecting women's reasons/incentives for sexual activity beyond any initial awareness of sexual desire. Methods An International Definitions Committee of 13 experts from seven countries repeatedly communicated, proposed new definitions and presented at the 2nd International Consultation on Sexual Medicine in Paris July 2003. Main Outcome Measure Expert opinions/recommendations are based on a process that involved review of evidence-based medical literature, extensive internal committee discussion, informal testing and re-testing of drafted definitions in various clinical settings, public presentation and deliberation. Results Women have many reasons/incentives for sexual activity. Desire may be experienced once sexual stimuli have triggered arousal. Arousal and desire co-occur and reinforce each other. Women's subjective arousal may be minimally influenced by genital congestion. An absence of desire any time during the sexual experience designates disorder. Arousal disorder subtypes are proposed that separate an absence of subjective arousal from all types of sexual stimulation, from an absence of subjective arousal when the only stimulus is genital. A new arousal disorder has provisionally been suggested, namely that of persistent genital arousal. Orgasm disorder is limited to absence of orgasm despite high subjective arousal. Dyspareunia includes partial painful vaginal entry attempts as well as pain with intercourse. Variable reflex muscle tightening around the vagina and an absence of abnormal physical findings are noted in the definition of vaginismus. Women's sexuality is highly contextual and descriptors are recommended re past psychosexual development, current context, as well as medical status. Diagnosing sexual disorders need not imply intrinsic dysfunction of the woman's own sex response system. Conclusions The International Definitions Committee has recommended a number of fundamental changes to the existing definitions of women's sexual disorders.