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ORIGINAL RESEARCH—EPIDEMIOLOGY Prevalence of Female Sexual Dysfunction in Urban Chinese Women Based on Cutoff Scores of the Chinese Version of the Female Sexual Function Index: A Preliminary Study Jiehua Ma, MS,* Lianjun Pan, MD,* Yu Lei, MA,† Aixia Zhang, MA,* and Yanjing Kan, MD* *Department of Reproductive Health, State Key Laboratory of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital of Nanjing Medical University, Nanjing, China; †The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China DOI: 10.1111/jsm.12451
ABSTRACT
Introduction. The Female Sexual Function Index (FSFI) remains the most widely used scale for screening female sexual dysfunction (FSD), and the Chinese Version of the FSFI (CVFSFI) has been validated, but cutoff scores for the CVFSFI to distinguish between cases and noncases have not been developed, so the real prevalence of FSD in China is unknown. Aim. To establish clinical cutoff scores for the CVFSFI and to evaluate the prevalence of FSD in urban Chinese women. Methods. A cross-sectional study was conducted between June and December 2011. A total of 586 (age range of 22–60 years) women participated in the study. Receiving operating characteristic curve and classification and regression trees methodology were combined to establish clinical cutoff scores for the CVFSFI. The cutoff scores we developed were used to determine the prevalence of FSD in urban Chinese women. Main Outcome Measures. The prevalence of FSD based on cutoff scores developed herein. Results. The optimal CVFSFI cutoff score for the FSFI total score was 23.45 (sensitivity = 66.9%; specificity = 72.7%; area under curve [AUC] = 0.75). The cutoff score for each domain was also established as follows: ≤2.7 low desire (sensitivity = 55.2%; specificity = 78.3%; AUC = 0.73); ≤3.15 arousal disorder (sensitivity = 62.1%; specificity = 76.9%; AUC = 0.74); ≤4.05 lubrication disorder (sensitivity = 86.4%; specificity = 69.8%; AUC = 0.85); ≤3.8 orgasm disorder (sensitivity = 83.3%; specificity = 74.2%; AUC = 0.85); and ≤3.8 sexual pain (sensitivity = 65.4%; specificity = 80.6%; AUC = 0.79). Using these cutoff scores, we determined the prevalence for FSD, low desire, arousal disorder, lubrication disorder, orgasm disorder, and sexual pain to be 37.6%, 23.6%, 25.4%, 36.8%, 30.6%, and 21.8% in urban Chinese women, respectively. Conclusions. The present data may suggest that urban Chinese women might have a lower FSD prevalence than women from some other countries; however, further study to achieve a better understanding of its epidemiology in China is a high necessity. Ma J, Pan L, Zhang A, and Kan Y. Prevalence of Female Sexual Dysfunction in Urban Chinese Women Based on Cutoff Scores of the Chinese Version of the Female Sexual Function Index. J Sex Med 2014;11:909–919. Key Words. Female Sexual Dysfunction; Prevalence; Cutoff Score; China; Urban
These authors contributed equally to this study.
© 2014 International Society for Sexual Medicine
J Sex Med 2014;11:909–919
910 Introduction
F
emale sexual dysfunction (FSD) is a widespread problem, which is defined as disturbances in sexual desire and psychophysiological changes that characterize the sexual response cycle and cause marked distress and interpersonal difficulty. FSD is classified by the American Psychiatric Association as follows: hypoactive sexual desire, arousal, orgasmic disorders, and pain [1]. The prevalence data vary widely, ranging from 25% to 63% as reported by Kammerer-Doak and Rogers [2], and from 8% to 75% as reported by Nowosielski et al. [3]. Thus, the data suggest an apparent dependence on regions and diagnostic standards. The Female Sexual Function Index (FSFI) is a brief, multidimensional scale for assessing sexual function in women [4]. The FSFI is a 19-item multidimensional self-reporting measure that quantifies six domains of FSD, including desire, arousal, lubrication, orgasm, satisfaction, and pain. Each domain is scored on a scale of 0 or 1–5, with higher scores indicating better sexual function. A study entitled “Female Sexual Dysfunction in Young Korean Women” evaluated 504 women with an average age of 28.5 years (range of 18–52 years). The survey considered the cutoff score of the FSFI for FSD to be 25.0 points and noted a 43.5% prevalence [5]. In a survey based on the Colombian population, 30% of sexually active women 18–40 years of age scored
ORIGINAL RESEARCH—EPIDEMIOLOGY Prevalence of Female Sexual Dysfunction in Urban Chinese Women Based on Cutoff Scores of the Chinese Version of the Female Sexual Function Index: A Preliminary Study Jiehua Ma, MS,* Lianjun Pan, MD,* Yu Lei, MA,† Aixia Zhang, MA,* and Yanjing Kan, MD* *Department of Reproductive Health, State Key Laboratory of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital of Nanjing Medical University, Nanjing, China; †The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China DOI: 10.1111/jsm.12451
ABSTRACT
Introduction. The Female Sexual Function Index (FSFI) remains the most widely used scale for screening female sexual dysfunction (FSD), and the Chinese Version of the FSFI (CVFSFI) has been validated, but cutoff scores for the CVFSFI to distinguish between cases and noncases have not been developed, so the real prevalence of FSD in China is unknown. Aim. To establish clinical cutoff scores for the CVFSFI and to evaluate the prevalence of FSD in urban Chinese women. Methods. A cross-sectional study was conducted between June and December 2011. A total of 586 (age range of 22–60 years) women participated in the study. Receiving operating characteristic curve and classification and regression trees methodology were combined to establish clinical cutoff scores for the CVFSFI. The cutoff scores we developed were used to determine the prevalence of FSD in urban Chinese women. Main Outcome Measures. The prevalence of FSD based on cutoff scores developed herein. Results. The optimal CVFSFI cutoff score for the FSFI total score was 23.45 (sensitivity = 66.9%; specificity = 72.7%; area under curve [AUC] = 0.75). The cutoff score for each domain was also established as follows: ≤2.7 low desire (sensitivity = 55.2%; specificity = 78.3%; AUC = 0.73); ≤3.15 arousal disorder (sensitivity = 62.1%; specificity = 76.9%; AUC = 0.74); ≤4.05 lubrication disorder (sensitivity = 86.4%; specificity = 69.8%; AUC = 0.85); ≤3.8 orgasm disorder (sensitivity = 83.3%; specificity = 74.2%; AUC = 0.85); and ≤3.8 sexual pain (sensitivity = 65.4%; specificity = 80.6%; AUC = 0.79). Using these cutoff scores, we determined the prevalence for FSD, low desire, arousal disorder, lubrication disorder, orgasm disorder, and sexual pain to be 37.6%, 23.6%, 25.4%, 36.8%, 30.6%, and 21.8% in urban Chinese women, respectively. Conclusions. The present data may suggest that urban Chinese women might have a lower FSD prevalence than women from some other countries; however, further study to achieve a better understanding of its epidemiology in China is a high necessity. Ma J, Pan L, Zhang A, and Kan Y. Prevalence of Female Sexual Dysfunction in Urban Chinese Women Based on Cutoff Scores of the Chinese Version of the Female Sexual Function Index. J Sex Med 2014;11:909–919. Key Words. Female Sexual Dysfunction; Prevalence; Cutoff Score; China; Urban
These authors contributed equally to this study.
© 2014 International Society for Sexual Medicine
J Sex Med 2014;11:909–919
910 Introduction
F
emale sexual dysfunction (FSD) is a widespread problem, which is defined as disturbances in sexual desire and psychophysiological changes that characterize the sexual response cycle and cause marked distress and interpersonal difficulty. FSD is classified by the American Psychiatric Association as follows: hypoactive sexual desire, arousal, orgasmic disorders, and pain [1]. The prevalence data vary widely, ranging from 25% to 63% as reported by Kammerer-Doak and Rogers [2], and from 8% to 75% as reported by Nowosielski et al. [3]. Thus, the data suggest an apparent dependence on regions and diagnostic standards. The Female Sexual Function Index (FSFI) is a brief, multidimensional scale for assessing sexual function in women [4]. The FSFI is a 19-item multidimensional self-reporting measure that quantifies six domains of FSD, including desire, arousal, lubrication, orgasm, satisfaction, and pain. Each domain is scored on a scale of 0 or 1–5, with higher scores indicating better sexual function. A study entitled “Female Sexual Dysfunction in Young Korean Women” evaluated 504 women with an average age of 28.5 years (range of 18–52 years). The survey considered the cutoff score of the FSFI for FSD to be 25.0 points and noted a 43.5% prevalence [5]. In a survey based on the Colombian population, 30% of sexually active women 18–40 years of age scored
