Turkish Adaptation of Female Sexual Distress Scale-R: A Validity and Reliability Study

  • Yeter Kitiş
  • Ayten Şentürk Erenel
  • Esra Arslan GürcüoğluEmail author
Original Paper


While female sexual disorders are highly prevalent in Turkey, the percentage of the women seeking help on the issue is extremely low. Hence, we believe there is a need for a simple instrument to diagnose female sexual disorders. The aim of this study was to define the validity and reliability of the Female Sexual Distress Scale-R in Turkish and to determine its cutoff point according to the Female Sexual Function Index. The scale was administered to 214 women aged 19–63 years and living in Ankara. For the reliability analysis of the scale, internal consistency, split half analyses was used. To test the validity of the scale, exploratory and confirmatory factor analyses were used. To define the breakpoint, ROC curve analysis was used. The Cronbach alpha value of the scale is .96; the Guttman split half value is .094. For the validity study, Kaiser–Meyer–Olkin was found to be .93 and Bartlett’s sphericity was χ2 = 2440; p < 0.001. A single factor model that explains 66.78% of the total variance was obtained. The fit indexes were χ2/df = 2.351, RMSEA = 0.079, CFI = 0.970, IFI = 0.970, GFI = 0.923, and NFI = 0.949. The item-total correlations were defined as .621–.837. The scale has a high negative correlation with FSFI and its per sub-dimensions. In the ROC analysis, the area under the curve was defined to be .76, and the breakpoint was 7.5. The sensitivity of the scale was 71%, specificity was 70%, positive prediction power was .786, and negative prediction power was .679. It was concluded that the Turkish-language version of FSDS-R is a valid and reliable instrument in identifying female sexual disorders.


Female Sexual disorders Turkey Sensitivity Specificity 



We would like to thank our colleagues who offered their expert opinion in the translation of the scale into Turkish and retranslation into original language and retranslate into the original language. We would like to thank Dr. Leonard Derogatis for granting permission to validate the FSDS-R. And we would like to thank the women who participated in the study. Finally, our special thanks go to the members of the Academic Writing Center, Gazi University.

Author Contributions

YK, AŞE designed the study and methodology. EAG recruited the sample. The data have been analyzed by YK and EAG. All the authors have read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures (surveys) performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. An application was made to the Ethical Commission of Gazi University for ethical evaluation of the study and the ethical approval was granted (ethical approval number: 77082166-604.01.02-39521). The study started after the official permissions by Ankara Metropolitan Municipality and provincial municipalities were granted. The permission was granted for Turkish translation and distribution of the Female Sexual Distress Scale by the Dr. Leonard Derogatis who created the scale.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Akgül, A., & Çevik, O. (2005). Statistical analysis techniques: Business management practices in SPSS (2nd ed.). Ankara: Mustafa Bookstore.Google Scholar
  2. Alpar, R. (2016). Applied statistics and validity-reliability with examples in sports, health and education sciences. Ankara: Detay Publishing.Google Scholar
  3. Arafat, S. Y., Chowdhury, H. R., Qusar, M. S., & Hafez, M. A. (2016). Cross cultural adaptation & psychometric validation of research instruments: A methodological review. Journal of Behavioral Health, 5(3), 129–136. Scholar
  4. Aydın, S., Onaran, Ö. I., Topalan, K., Aydın, Ç. A., & Dansuk, R. (2016). Development and validation of turkish version of the female sexual distress scale-revised. Sexual Medicine, 4(1), 43–50. Scholar
  5. Bagherzadeh, R., Zahmatkeshan, N., Gharibi, T., Akaberian, S., Mirzaei, K., Kamali, F., et al. (2010). Prevalence of female sexual dysfunction and related factors for under treatment in Bushehrian Women of Iran. Sexuality and Disability, 28, 39–49. Scholar
  6. Buvat, J., Glasser, D., Neves, R. C., Duarte, F. G., Gingell, C., & Moreira, E. D., Jr. (2009). Global Study of Sexual Attitudes and Behaviours (GSSAB) Investigators’ Group. Sexual problems and associated help-seeking behavior patterns: Results of a population-based survey in France. International Journal of Urology, 16(7), 632–638. Scholar
  7. Büyüköztürk, Ş. (2002). Factor analysis: Basic concepts and using the development scale. Educational Administration in Theory and Practice, 32(32), 470–483.Google Scholar
  8. Çayan, S., Akbay, E., Bozlu, M., Canpolat, B., Acar, D., & Ulusoy, E. (2004). The prevalence of female sexual dysfunction and potential risk factors that may impair sexual function in Turkish women. Urologia Internationalis, 72, 52–57. Scholar
  9. Derogatis, L., Clayton, A., Lewis-D’Agostino, D., Wunderlich, G., & Fu, Y. (2008). Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder. The Journal of Sexual Medicine, 5(2), 357–364. Scholar
  10. 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(4), 317–330. Scholar
  11. Dirican, A. (2001). Evaluation of the diagnostic test’s performance and their comparisons. Cerrahpasa Journal of Medicine, 32(1), 25–30.Google Scholar
  12. Ege, E., Akın, B., Yaralı Arslan, S., & Bilgili, N. (2010). Sexual dysfunction incidence and risk factors in healthy women. Journal of TUBAV Science, 3(1), 137–144.Google Scholar
  13. Erbil, N. (2011). Prevalence and risk factors for female sexual dysfunction among Turkish women attending a maternity and gynecology outpatient clinic. Sexuality and Disability, 29, 377–386. Scholar
  14. Erenel, A. S., Eroglu, K., Vural, G., & Dilbaz, B. (2011). A Pilot Study: In what ways do women in turkey experience a change in their sexuality during pregnancy. Sexuality and Disability, 29, 207–216. Scholar
  15. Erenel, A. S., Golbasi, Z., Kavlak, T., & Dilbaz, S. (2015). Relationship between menopausal symptoms and sexual dysfunction among married Turkish women in 40–65 age group. International Journal of Nursing Practice, 21, 575–583. Scholar
  16. Erenel, A. S., & Kılınç, F. N. (2013). Does obesity increase sexual dysfuncion in women? Sexuality and Disability, 31, 53–62. Scholar
  17. Erenel, A. S., & Kitiş, Y. (2011). A study on determination of women’s sexual function. Journal of Turkish Clinics Nursing Science, 21(4), 251–259.Google Scholar
  18. Hajian-Tilaki, K. (2013). Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian Journal of Internal Medicine, 4(2), 627–635.Google Scholar
  19. Hullfish, K. L., Pastore, L. M., Mormon, A. J., Wernecke, Y., Bovbjerg, V. E., & Clayton, A. H. (2009). Sexual functioning of latino women seeking outpatient gynecologic care. The Journal of Sexual Medicine, 6, 61–69. Scholar
  20. Kanık, E. A., & Erden, S. (2003). Use of ROC tests (receiver operating characteristics) curve in assessing diagnostic tests. Journal of Mersin University Faculty of Medicine, 3, 260–268.Google Scholar
  21. Kaplan, S. A., Reis, R. B., Kohn, I. J., Ikeguchi, E. F., Laor, E., Te, A. E., et al. (1999). Safety and efficacy of sildenafil in postmenopausal women with sexual disfunction. Urology, 53(3), 481–486. Scholar
  22. Karakoç, F. Y., & Dönmez, L. (2014). Basic principles of scale development. Medical Education World, 40, 39–48.Google Scholar
  23. Karasar, N. (2009). Qualifications required in measurement and instrumentation. Scientific research method (19th ed., pp. 147–158). Ankara: Nobel Publication Distribution.Google Scholar
  24. Kline, R. B. (2005a). Principles and practice of structural equation modeling. New York: The Guilford Press.Google Scholar
  25. Kline, R. B. (2005b). Principles and practice of structural equation modeling (2nd ed.). New York: The Guilford Press.Google Scholar
  26. Marthol, H., & Hilz, M. J. (2004). Female sexual dysfunction: A systematic overview of classification, pathophysiology, diagnosis and treatment. Fortschritte der Neurologie-Psychiatrie, 72(3), 121–135.CrossRefGoogle Scholar
  27. Mercer, C. H., Fenton, K. A., Johnson, A. M., Wellings, K., Macdowall, W., McManus, S., et al. (2003). Sexual function problems and help seeking behaviour in Britain: National probability sample survey. BMJ, 327(7412), 426–427. Scholar
  28. Moreira, E. D., Jr., Brock, G., Glasser, D. B., Nicolosi, A., Laumann, E. O., Paik, A., et al. (2005). GSSAB Investigators’ Group. Help-seeking behaviour for sexual problems: The global study of sexual attitudes and behaviors. International Journal of Clinical Practice, 59(1), 6–16. Scholar
  29. Moreira, E. D., Glasser, D. B., Nicolosi, A., Duarte, F. G., & Gingell, C. (2008). Sexual problems and help seeking behaviour in adults in the United Kingdom and continental Europe. BJU International, 101(8), 1005–1011. Scholar
  30. Nappi, R. E., & Nijland, E. A. (2008). Women’s perception of sexuality around the menopause: Outcomes of a European telephone survey. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 137, 10–16. Scholar
  31. Nicolosi, A., Glasser, D. B., Kim, S. C., Marumo, K., & Laumann, E. O. (2005). Sexual behaviour and dysfunction and help-seeking patterns in adults aged 40–80 years in the urban population of Asian countries. BJU International, 95(4), 609–614. Scholar
  32. Oksuz, E., & Malhan, S. (2005). Reliability and validity of the Female Sexual Function Index in Turkish population. Sendrom, 17(7), 54–60.Google Scholar
  33. Oksuz, E., & Malhan, S. (2006). Prevalence and risk factors for female sexual dysfunction in Turkish women. The Journal of Urology, 175(2), 654–658. Scholar
  34. Rosen, C., Brown, J., Heiman, S., Leiblum, C., Meston, R., Shabsigh, D., et al. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex and Marital Therapy, 26(2), 191–208. Scholar
  35. Shifren, J. L., Monz, B. U., Russo, P. A., Segreti, A., & Johannes, C. B. (2008). Sexual problems and distress in United States women: Prevalence and correlates. Obstetrics and Gynecology, 112(5), 970–978. Scholar
  36. Srivastava, R., Thakar, R., & Sultan, A. (2008). Female sexual dysfunction in obstetrics and gynecology. Obstetrical and Gynecological Survey, 63, 527–537. Scholar
  37. Sümer, N. (2000). Yapısal eşitlik modelleri: Temel kavramlar ve örnek uygulamalar. Türk Psikoloji Yazıları, 3(6), 49–74.Google Scholar
  38. Tan, S. (2009). Misuses of KR-20 and Cronbach’s Alpha reliability coefficients. Education and Science, 34(152), 101–112.Google Scholar
  39. Taylor, A., & Gosney, M. A. (2011). Sexuality in older age: essential considerations for healthcare professionals. Age and Ageing, 40(5), 538–543. Scholar
  40. Vahdaninia, M., Montazeri, A., & Goshtasebi, A. (2009). Help-seeking behaviors for female sexual dysfunction: A cross sectional study from Iran. BMC Women’s Health, 9(3), 1–7. Scholar
  41. Varkevisser, C. M., Pathmanathan, I., & Brownlee, A. T. (2003). Designing and conducting health systems research projects (Vol. 1, p. 170). IDRC.
  42. World Health Organization: Sexual and Reproductive Health. (2016). Defining Sexual Health. Accessed October 21, 2016.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Public Health Nursing, Faculty of Health SciencesGazi UniversityBeşevlerTurkey
  2. 2.Department of Labor-Women’s Health and Diseases Nursing, Faculty of Health SciencesGazi UniversityBeşevlerTurkey

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