Abstract
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.
Similar content being viewed by others
References
Adams, D. B., Gold, A. R., & Burt, A. D. (1978). Rise in female-initiated sexual activity at ovulation and its suppression by oral contraceptives. New England Journal of Medicine, 299, 1145–1150. doi:10.1056/NEJM197811232992101.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Baser, R. E., Li, Y., & Carter, J. (2012). Psychometric validation of the Female Sexual Function Index (FSFI) in cancer survivors. Cancer, 118, 4606–4618. doi:10.1002/cncr.26739.
Bock, R. D., & Aitkin, M. (1981). Marginal maximum likelihood estimation of item parameters: An application of the EM algorithm. Psychometrika, 46, 443–459. doi:10.1007/BF02293801.
Carpenter, J. S., Woods, N. F., Otte, J. L., Guthrie, K. A., Hohensee, C., Newton, K. M., & LaCroix, A. Z. (2015). MsFLASH participants’ priorities for alleviating menopausal symptoms. Climacteric, 18, 859–866. doi:10.3109/13697137.2015.1083003.
Chang, S. R., Chang, T. C., Chen, K. H., & Lin, H. H. (2009). Developing and validating a Taiwan version of the Female Sexual Function Index for pregnant women. Journal of Sexual Medicine, 6, 1609–1616. doi:10.1111/j.1743-6109.2009.01247.x.
Chedraui, P., Perez-Lopez, F. R., Sanchez, H., Aguirre, W., Martinez, N., Miranda, O., & Zambrano, B. (2012). Assessment of sexual function of mid-aged Ecuadorian women with the 6-item Female Sexual Function Index. Maturitas, 71, 407–412. doi:10.1016/j.maturitas.2012.01.013.
Cohen, L. S., Joffe, H., Guthrie, K. A., Ensrud, K. E., Freeman, M., Carpenter, J. S., & Anderson, G. L. (2014). Efficacy of omega-3 for vasomotor symptoms treatment: A randomized controlled trial. Menopause, 21, 347–354. doi:10.1097/GME.0b013e31829e40b8.
Derogatis, L. R., Rosen, R., Leiblum, S., Burnett, A., & Heiman, J. (2002). The Female Sexual Distress Scale (FSDS): Initial validation of a standardized scale for assessment of sexually related personal distress in women. Journal of Sex and Marital Therapy, 28, 317–330. doi:10.1080/00926230290001448.
Fakhri, A., Pakpour, A. H., Burri, A., Morshedi, H., & Zeidi, I. M. (2012). The Female Sexual Function Index: Translation and validation of an Iranian version. Journal of Sexual Medicine, 9, 514–523. doi:10.1111/j.1743-6109.2011.02553.x.
Filocamo, M. T., Serati, M., Li Marzi, V., Costantini, E., Milanesi, M., Pietropaolo, A., … Villari, D. (2013). The Female Sexual Function Index (FSFI): Linguistic validation of the Italian version. Journal of Sexual Medicine, 11, 447–453. doi: 10.1111/jsm.12389.
Freeman, E. W., Guthrie, K. A., Caan, B., Sternfeld, B., Cohen, L. S., Joffe, H., … LaCroix, A. Z. (2011). Efficacy of escitalopram for hot flashes in healthy menopausal women: A randomized controlled trial. Journal of the American Medical Association, 305, 267–274. doi: 10.1001/jama.2010.2016.
Gerstenberger, E. P., Rosen, R. C., Brewer, J. V., Meston, C. M., Brotto, L. A., Wiegel, M., & Sand, M. (2010). Sexual desire and the Female Sexual Function Index (FSFI): A sexual desire cutpoint for clinical interpretation of the FSFI in women with and without hypoactive sexual desire disorder. Journal of Sexual Medicine, 7, 3096–3103. doi:10.1111/j.1743-6109.2010.01871.x.
Ghassamia, M., Asghari, A., Shaeiri, M. R., & Safarinejad, M. R. (2013). Validation of psychometric properties of the Persian version of the Female Sexual Function Index. Urology Journal, 10, 878–885. doi:10.3109/13651501.2014.940048.
Giraldo, P. C., Polpeta, N. C., Juliato, C. R., Yoshida, L. P., do Amaral, R. L., & Eleuterio Junior, J. (2012). Evaluation of sexual function in Brazilian women with recurrent vulvovaginal candidiasis and localized provoked vulvodynia. Journal of Sexual Medicine, 9, 805–811. doi:10.1111/j.1743-6109.2011.02584.x.
Hambleton, R. K., & Swaminathan, H. (1985). Item response theory: Principles and applications. Norwell, MA: Kluwer Academic.
Hays, R. D., Morales, L. S., & Reise, S. P. (2000). Item response theory and health outcomes measurement in the 21st century. Medical Care, 38, II28–II42. doi:10.1097/00005650-200009002-00007.
Isidori, A. M., Pozza, C., Esposito, K., Giugliano, D., Morano, S., Vignozzi, L., … Jannini, E. A. (2010). Development and validation of a 6-item version of the Female Sexual Function Index (FSFI) as a diagnostic tool for female sexual dysfunction. Journal of Sexual Medicine, 7, 1139–1146. doi: 10.1111/j.1743-6109.2009.01635.x.
Joffe, H., Guthrie, K. A., LaCroix, A. Z., Reed, S. D., Ensrud, K. E., Manson, J. E., & Cohen, L. (2014). Low-dose estradiol and the serotonin-norepinephrine reuptake inhibitor venlafaxine for vasomotor symptoms: A randomized clinical trial. JAMA Internal Medicine, 174, 1058–1066. doi:10.1001/jamainternmed.2014.1891.
Kriston, L., Gunzler, C., Rohde, A., & Berner, M. M. (2010). Is one question enough to detect female sexual dysfunctions? A diagnostic accuracy study in 6,194 women. Journal of Sexual Medicine, 7, 1831–1841. doi:10.1111/j.1743-6109.2010.01729.x.
Lee, Y., Lim, M. C., Son, Y., Joo, J., Park, K., Kim, J. S., & Park, S. Y. (2014). Development and evaluation of Korean version of Quality of Sexual Function (QSF-K) in healthy Korean women. Journal of Korean Medical Science, 29, 758–763. doi:10.3346/jkms.2014.29.6.758.
Lord, F. M. (1980). Applications of item response theory to practical testing problems. Hillsdale, NJ: L. Erlbaum Associates.
Newton, K. M., Carpenter, J. S., Guthrie, K. A., Anderson, G. L., Caan, B., Cohen, L. S., & Lacroix, A. Z. (2014a). Methods for the design of vasomotor symptom trials: The Menopausal Strategies Finding Lasting Answers to Symptoms and Health Network. Menopause, 21, 45–58. doi:10.1097/GME.0b013e31829337a4.
Newton, K. M., Reed, S. D., Guthrie, K. A., Sherman, K. J., Booth-Laforce, C., Caan, B., & Lacroix, A. Z. (2014b). Efficacy of yoga for vasomotor symptoms: A randomized controlled trial. Menopause, 21, 339–346. doi:10.1097/GME.0b013e31829e4baa.
Nowosielski, K., Wrobel, B., Sioma-Markowska, U., & Poreba, R. (2013). Development and validation of the Polish version of the Female Sexual Function Index in the Polish population of females. Journal of Sexual Medicine, 10, 386–395. doi:10.1111/jsm.12012.
O’Donnell, A. B., Araujo, A. B., & McKinlay, J. B. (2004). The health of normally aging men: The Massachusetts Male Aging Study (1987-2004). Experimental Gerontology, 39, 975–984. doi:10.1016/j.exger.2004.03.023.
Opperman, E. A., Benson, L. E., & Milhausen, R. R. (2013). Confirmatory factor analysis of the Female Sexual Function Index. Journal of Sex Research, 50, 29–36.
Perez-Lopez, F. R., Fernandez-Alonso, A. M., Trabalon-Pastor, M., Vara, C., & Chedraui, P. (2012). Assessment of sexual function and related factors in mid-aged sexually active Spanish women with the six-item Female Sex Function Index. Menopause, 19, 1224–1230. doi:10.1097/gme.0b013e3182546242.
Reed, S. D., Guthrie, K. A., Joffe, H., Shifren, J. L., Seguin, R. A., & Freeman, E. W. (2012). Sexual function in nondepressed women using escitalopram for vasomotor symptoms: A randomized controlled trial. Obstetrics and Gynecology, 119, 527–538. doi:10.1097/AOG.0b013e3182475fa4.
Reed, S. D., Mitchell, C. M., Joffe, H., Cohen, L., Shifren, J. L., Newton, K. M., … Guthrie, K. A. (2014). Sexual function in women on estradiol or venlafaxine for hot flushes: A randomized controlled trial. Obstetrics & Gynecology, 124, 233–241. doi: 10.1097/AOG.0000000000000386.
Reise, S. P., & Yu, J. (1990). Parameter recovery in the graded response model. Journal of Educational Measurement, 27, 133–144.
Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., … D’Agostino, R., Jr. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26, 191–208.
Samejima, F. (1969). Calibration of latent ability using a response pattern of graded scores. Psychometrika Monograph No. 17. Richmond, VA: Psychometric Society.
Scientific Software International. (2013). IRTPRO user guide. Skokie, IL: Scientific Software International.
Sidi, H., Abdullah, N., Puteh, S. E., & Midin, M. (2007). The Female Sexual Function Index (FSFI): Validation of the Malay version. Journal of Sexual Medicine, 4, 1642–1654. doi:10.1111/j.1743-6109.2007.00476.x.
Smith, G. T., McCarthy, D. M., & Anderson, K. G. (2000). On the sins of short-form development. Psychological Assessment, 12, 102–111.
Sternfeld, B., Guthrie, K. A., Ensrud, K. E., Lacroix, A. Z., Larson, J. C., Dunn, A. L., & Caan, B. J. (2014). Efficacy of exercise for menopausal symptoms: A randomized controlled trial. Menopause, 21, 330–338. doi:10.1097/GME.0b013e31829e4089.
Sternfeld, B., Lacroix, A., Caan, B. J., Dunn, A. L., Newton, K. M., Reed, S. D., & Ensrud, K. E. (2013). Design and methods of a multi-site, multi-behavioral treatment trial for menopausal symptoms: The MsFLASH experience. Contemporary Clinical Trials, 35, 25–34. doi:10.1016/j.cct.2013.02.009.
Sun, X., Li, C., Jin, L., Fan, Y., & Wang, D. (2011). Development and validation of Chinese version of Female Sexual Function Index in a Chinese population—A pilot study. Journal of Sexual Medicine, 8, 1101–1111. doi:10.1111/j.1743-6109.2010.02171.x.
Takahashi, M., Inokuchi, T., Watanabe, C., Saito, T., & Kai, I. (2011). The Female Sexual Function Index (FSFI): Development of a Japanese version. Journal of Sexual Medicine, 8, 2246–2254. doi:10.1111/j.1743-6109.2011.02267.x.
Wiegel, M., Meston, C., & Rosen, R. (2005). The Female Sexual Function Index (FSFI): Cross-validation and development of clinical cutoff scores. Journal of Sex & Marital Therapy, 31, 1–20. doi:10.1080/00926230590475206.
Acknowledgments
This study was funded by the National Institutes of Health as a cooperative agreement issued by the National Institute on Aging (NIA), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Center for Complementary and Alternative Medicine (NCCAM), the Office of Research on Women’s Health (ORWH), and Grants U01AG032656, U01AG032659, U01AG032669, U01AG032682, U01AG032699, and U01AG032700 from the NIA. At Indiana University, the project was funded in part with support from the Indiana Clinical and Translational Sciences Institute, Grant UL1RR02571 from the NIH, National Center for Research Resources, Clinical and Translational Sciences Award.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Carpenter, J.S., Jones, S.M.W., Studts, C.R. et al. Female Sexual Function Index Short Version: A MsFLASH Item Response Analysis. Arch Sex Behav 45, 1897–1905 (2016). https://doi.org/10.1007/s10508-016-0804-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-016-0804-5