Introduction
Methods
Conceptual framework and item selection
Measure formation and validation
Sample
Comparison measures and variables
Variable | Response options |
---|---|
Health status
| |
General health | 1. Excellent 2. Good 3. Fair 4. Bad |
Health condition or disability affecting sexual activity or enjoyment | 1. Yes 2. No |
Use of medication limiting sexual activity or enjoyment | 1. Yes 2. No |
Frequency of sex
| |
On how many occasions in the last 4 weeks have you had sex? | Number typed in |
From the BSFQ (men only): In the past 3 months, has the frequency of your sexual activity with a partner been: | 1. Less than you desire 2. As much as you desire 3. More than you desire |
Communication about sex
| |
Ease of communication about sex with partner | 1. Easy with a husband, wife or regular partner, but difficult with a new partner 2. Easy with a new partner, but difficult with a husband, wife or regular partner 3. Easy with any partner 4. Difficult with any partner 5. Depends/Would vary/Can’t say/Don’t know |
Views about sex
| |
Importance of a happy sexual relationship to successful marriage or long term relationship | 1. Very important 2. Quite important 3. Not very important 4. Not at all important 5. Don’t know |
Level of enjoyment of sex | 1. I always enjoy it 2. I enjoy it most of the time 3. I don’t often enjoy it 4. I never enjoy it |
Depression
| |
Frequency of feeling down, depressed or hopeless in the last two weeks | 1. Not at all 2. Several days 3. More than half of days 4. Nearly every day (Recoded to a binary variable, daily or not) |
Extent of agreement with statement “Generally speaking I am satisfied with my life at the moment” | 1. Strongly agree 2. Slightly agree 3. Neither agree nor disagree 4. Slightly disagree 5. Disagree strongly |
Currently use of prescription medicine for depression | Yes/no |
Alcohol use
| |
Frequency of alcohol use in last year | 1. Five or more days a week 2. Three or four days a week 3. Once or twice a week 4. Once or twice a month 5. Once or twice in the last year 6. Not at all in the last year (Recoded to a binary variable discriminating between frequent (at least 3 times a week) and less frequent use) |
Statistical analysis
Ethical approval
Results
Measure development
Items derived from qualitative development work | Question number in final measure (see “Appendix”) |
---|---|
Psycho-physiological aspect
| |
Desire for sex | Q1-1 |
Enjoyment | Q1-2 |
Lack of anxiety | Q1-3 |
Absence of discomfort/pain | Q1-4 |
Sexual arousal/excitement | Q1-5 |
Orgasm-ability to reach | Q1-6 |
Orgasm-not too early | Q1-7 |
Lubrication (F)/Erectile function (M) | Q1-8/9 |
Severity if difficulty present
| |
Duration since onset of difficulty | Item excluded based on psychometric analysis |
Frequency with which symptoms occur | Item excluded based on psychometric analysis |
Distress caused by Symptoms | Item excluded based on psychometric analysis |
Relational aspect
| |
Balance in levels of desire | Q2 |
Compatibility in sexual preferences | Q3 |
Partner does not have sexual difficulties | Q4 |
Emotional connection | Q5 |
Global self-rating aspect
| |
Overall satisfaction | Q6 |
Overall lack of distress/worry | Q7 |
Not avoiding sex | Q8 |
Perception that no problem exists | Item excluded based on psychometric analysis |
Not seeking professional help | Q9 |
Items excluded at the qualitative development stage |
---|
Decision to exclude based on the three decision rules (exclude if criterion overlaps with another; exclude if respondents view it as desirable rather than essential; exclude if associated with sexual function rather than part of construct itself) |
Functional sexual self: Happy body feeling, able to give and receive pleasure, positive sexual identity, Confidence to communicate needs, positive motives to have sex |
Psycho-physiological: Novelty, quality of orgasmic experience, actual frequency of sex, actual frequency relative to desired |
Relational: Trust, warmth, feeling wanted, compatibility in motive for sex, compatibility in sexual roles/identities, reciprocity, chemistry |
Contextual: Stress and tiredness, privacy |
Analysis and validation of final measure
CFI | TLI | RMSEA | |
---|---|---|---|
Unidimensional model | 0.915 | 0.902 | 0.085 |
Second order model | 0.914 | 0.898 | 0.098 |
General-Specific model |
0.963
|
0.951
|
0.064
|
General-Specific model—Measurement Invariancea
| 0.961 | 0.957 | 0.047 |
General-Specific model—Measurement Invarianceb
| 0.952 | 0.946 | 0.057 |
Q nmbr* | Measure items | Natsal-SF | SFS1 | SFS2 | SFS3 |
---|---|---|---|---|---|
Q1-1 | Lacked interest in having sex | 0.657 | 0.301 | ||
Q1-2 | Lacked enjoyment in sex | 0.678 | 0.566 | ||
Q1-3 | Felt anxious during sex | 0.585 | 0.108 | ||
Q1-4 | Felt physical pain as a result of sex | 0.605 | 0.188 | ||
Q1-5 | Felt no excitement or arousal during sex | 0.618 | 0.639 | ||
Q1-6 | Did not reach/had trouble reaching a climax | 0.493 | 0.499 | ||
Q1-7 | Reached a climax more quickly than you would like | 0.177 | −0.438 | ||
Q1-8/9 | Trouble getting or keeping an erection/uncomfortably dry vagina | 0.534 | 0.059 | ||
Q2 | My partner and I share about the same level of interest in having sex | 0.572 | 0.521 | ||
Q3 | My partner and I share the same sexual likes and dislikes | 0.413 | 0.776 | ||
Q4 | My partner has experienced sexual difficulties in the last year | 0.457 | 0.071 | ||
Q5 | How often would you say you feel emotionally close to your partner when you have sex together | 0.472 | 0.361 | ||
Q6 | I feel satisfied with my sex life |
−0.912 |
−0.402 | ||
Q7 | I feel distressed or worried about my sex life | 0.866 | 0.251 | ||
Q8 | I have avoided sex because of sexual difficulties, either my own or those of my partner | 0.813 | 0.459 | ||
Q9 | Sought help or advice regarding sex life |
−0.521 | 0.122 |
External validity
Clinical | FSFI-6 | BSFQ | Self rated health | Depression | Well-being | Alcohol | |
---|---|---|---|---|---|---|---|
Natsal-SF |
2.667** |
0.572** |
0.705** |
1.171* |
1.202* |
0.839* | 1.061 |
Gender |
0.231** | 1.106 | 1.275 | 0.834 |
0.514** | ||
Age |
0.963* |
0.126** |
−0.001* |
1.043
| 0.994 | 1.015 |
1.031** |
Ethnicity |
0.391** | 0.056 |
−0.031 | 1.141 | 1.152 | 0.994 |
2.144* |
Marital status |
1.979
*
|
−0.085 |
−0.070* | 1.119 | 0.961 |
2.611** | 1.099 |
Social grade |
−0.011 | 0.025 |
0.601
| 0.715 | 0.785 | 1.266 | |
Working Status |
−0.009 |
−0.034 | 1.310 | 0.795 | 1.117 | 0.951 | |
Self rated health |
0.380* |
0.098* | 0.010 |
1.597* |
0.274** | 0.849 | |
Depression | 0.700 |
−0.135* |
−0.057 |
1.617
|
0.103** | 1.404 | |
Well-being | 0.684 |
−0.084 |
−0.123
|
0.272
|
0.105** | 1.193 | |
Alcohol | 1.348 |
0.071* | 0.048 | 0.849 | 1.388 | 1.153 |