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ORIGINAL RESEARCH Sexual Dysfunctional Beliefs Questionnaire (SDBQ): Translation and Psychometric Properties of the Iranian Version Atefe Abdolmanafi, MA,* Parviz Azadfallah, PhD,* Ladan Fata, PhD,† Mohsen Roosta, MA,‡ Maria Manuela Peixoto, PhD,§ and Pedro Nobre, PhD§ *Department of Psychology, Faculty of Human Sciences, Tarbiat Modares University, Tehran, Iran; †Medical Education and Development Center, Iran University of Medical Sciences, Tehran, Iran; ‡Department of Psychology, Faculty of Psychology and Education Sciences, University of Tehran, Tehran, Iran; §Faculty of Psychology and Education Science, University of Porto, Portugal DOI: 10.1111/jsm.12931
ABSTRACT
Introduction. The sexual dysfunctional beliefs questionnaire (SDBQ) is a validated measure for assessing dysfunctional sexual beliefs. Aims. The aim of this study was to translate and validate the SDBQ to Iranian context. Methods. In order to translate the questionnaire from English into Persian, a forward–backward procedure was applied. After linguistic validation, the psychometric properties of the Iranian version were assessed for both men and women. A total of 387 participants (226 women and 161 men) completed the SDBQ. Main Outcome Measures. A principle component analysis with varimax rotation was performed for both the male and female samples. Reliability was evaluated by calculating Cronbach’s alpha (internal consistency) and test–retest coefficients (intraclass correlation coefficient). Results. The results from the principle component analysis identified six factors in the female version: sexual conservatism and female sexual passivity, beliefs about masturbation, body image beliefs, sexual desire and pleasure as a sin, age-related beliefs, and denying affection primacy. In the male version six factors were also identified: sex as an abuse of men’s power, beliefs related to women’s satisfaction, sexual conservatism, female sexual power, “macho” beliefs, and restrictive attitudes toward sex. Findings support the original six-factor solution for the male sample. For the female sample, although a six-factor solution was found, original motherhood-related beliefs were included in the sexual conservatism and female sexual passivity factor, and a new dimension has emerged, related to masturbation beliefs. Additionally, results indicated that the SDBQ had good internal consistency and test–retest reliability in both male and female versions. Conclusion. Current findings support the reliability and validity of the SDBQ in an Iranian sample and suggest its applicability to assess sexual beliefs in both clinical samples and the general population in Iran. Abdolmanafi A, Azadfallah P, Fata L, Roosta M, Peixoto MM, and Nobre P. Sexual Dysfunctional Beliefs Questionnaire (SDBQ): Translation and psychometric properties of the Iranian version. J Sex Med 2015;12:1820–1827. Key Words. Dysfunctional Sexual Beliefs; Assessment Questionnaire; Psychometric Properties; Validation
Introduction
D
ysfunctional sexual beliefs are defined as unrealistic and inaccurate ideas about sexuality and sexual response that are unconditionally accepted as true even in the absence of evidence.
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Misinformation regarding sexuality is learned across time, through parenting style, exposure to sociocultural beliefs, past sexual experiences or sex education programs [1–5]. Sexual beliefs are usually conceptualized as vulnerability factors for the development of sexual © 2015 International Society for Sexual Medicine
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Validation, Psychometric Properties, Sexual Beliefs problems in men and women [3–6]. Zilbergeld [5] listed several sexual myths, according to his extensive experience in sex therapy with couples. Men’s sexual myths are mainly related to sexual performance (e.g., “A real man performs in sex”) and to sexual scripts (e.g., “Good sex is spontaneous, with no planning and no talking;” “All touching is sexual or should lead to sex”), which promote sexual problems and support unreal expectations regarding sexual behavior and performance [5]. Along with male myths, Hawton [1] described sexual myths for women, standing for a double standard: repressive for women (e.g., “Any women who initiates sex is immoral”), and permissive, but demanding for men “Sex must only ever occur at the instigation of the man” [1]. Later, Heiman and LoPiccolo [7] suggested sexual myths emphasizing body image and aging concerns (“Sex is only for women under 30 years old;” “Female sexual life ends with menopause”), as well as performance demands in women (“Normal women have orgasm whenever they have sex”). A specific questionnaire was developed by Nobre, Pinto-Gouveia, and Gomes [4], in order to assess dysfunctional sexual beliefs in men and women, the sexual dysfunctional beliefs questionnaire (SDBQ). The male version of the SDBQ assesses six dimensions: sexual conservatism; female sexual power; “macho” belief; beliefs about women’s sexual satisfaction; restricted attitudes toward sexual activity; and sex as an abuse of men’s power. On the other hand, the female version assesses six dimensions: sexual conservatism; sexual desire and pleasure as a sin; age-related beliefs; body image beliefs; affection primacy; and motherhood primacy [4]. Moreover, research has shown that the SDBQ presents good convergent and discriminant validity as well as adequate reliability [4]. Studies using the SDBQ conducted in clinical samples of men and women with sexual problems indicated that women with sexual dysfunction presented significantly more sexual beliefs associated with aging and body image, sexual conservatism, and beliefs related to sexual desire and pleasure as a sin, compared with sexually healthy women [3,8]. Instead of, catastrophizing ideas about men’s sexual failure, demands regarding women’s satisfaction and coitus primacy, and “macho” beliefs were more common among men with erectile disorder [6,9]. More recently, sexual dysfunctional beliefs were studied in samples of men and women with sexual desire problems [10,11] and in gay men with distressing sexual symptoms [12]. Findings have
shown that conservative beliefs and sexual beliefsrelated to the aging process were significant predictors of sexual desire in women [10], while restrictive attitudes toward sexuality were the best predictor of male sexual desire [11]. Additionally, gay men presenting distressing sexual symptoms also reported more frequently beliefs in sex as an abuse of men’s power [12]. Moreover, conservative attitudes and restricted sexual standards were also found in women with vaginismus [13], and sexual desire problems [14–16]. Therefore, the assessment of dysfunctional sexual beliefs is an important domain to be taken into consideration in the evaluation and treatment of sexual problems. Sexual problems are highly prevalent in Iran, with ranges from 26% to 51% [17]. Additionally, concerning sexual beliefs, research findings have shown that sexual obedience within marriage is considered an indicator of modesty and selfrespect for women [18]. Therefore, modesty is a symbol of a Muslim idealized woman, and Iranian women should achieve that modesty by fulfilling sexual duty and by satisfying their husbands on any sexual occasion [18]. Thus, considering the major role that dysfunctional sexual beliefs play on sexual dysfunction [3,5], assessing sexual beliefs in the Iranian population would allow a better understanding of the role of beliefs in predicting sexual problems in a specific cultural context, as well as would promote the development of better target psychological interventions for the treatment of sexual dysfunction in Iran. Aims
Given the lack of empirical evidence on vulnerability dimensions for sexual dysfunction in Iranian men and women, the present study aimed to evaluate the validity and reliability of the SDBQ [4] in the Iranian context. The SDBQ [4] was translated into Persian, and construct validity, internal consistency, and test–retest reliability were assessed in order to explore the psychometric characteristics of the SDBQ Iranian version. Methods
Participants and Procedures Two hundred twenty-six women and 161 men participated in the study. The sample group was recruited voluntarily in different regions of Qom and Tehran city between March and June 2014. The study was approved by the Ethical Committee J Sex Med 2015;12:1820–1827
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Table 1 Sociodemographic characteristics of the sample (N = 387)
Age M Min–Max Standard deviation Educational levels (years) 0 to 4 5 to 12 More than 13
Women (n = 226)
Men (n = 161)
29.82 18–54 8.78 % 2.5 17.2 79.8
30.66 20–50 7.28 % 10.6 37.2 52.1
of the Tarbiat Modares University in Iran. Participants were selected using a convenience sampling method. Volunteers received a brief study explanation by a researcher, and were invited to sign an informed consent. After signing the informed consent, the participants completed the sociodemographic characteristics measure and the Iranian version of the SDBQ. No incentives were given. The participants were excluded if they suffered from a mental or psychiatry disorder, if they do not identify themselves as heterosexual, or if they do not have a sexual partner in the past 3 months. The mean age of women was 29.82 years (standard deviation [SD] = 8.78) and the mean age for men was 30.66 years (SD = 7.28). The sociodemographic characteristics of the sample are shown in Table 1. Main Outcome Measures
Sociodemographic Information Participants answered to a brief sociodemographic measure (e.g., assessing age, educational level information). SDBQ—Male Version The SDBQ—male version [4] is a 40-item selfreported measure that allows assessing sexualityrelated beliefs. Participants answered the questions with a 5-point Likert scale (1 = completely disagree; 5 = completely agree). Five domains can be assessed: sexual conservatism (e.g., “Foreplay is a waste of time;” “In sex, the quickest/faster the better”); “macho” beliefs (e.g., “A real man has sexual intercourse very often;” “A man must be capable of maintaining an erection until the end of any sex”); beliefs about partner’s sexual satisfaction (e.g., “A man who doesn’t sexually satisfy the partner is a failure;” “Penis erection is essential for partner’s sexual satisfaction”); restrictive attitudes toward sex (e.g., “It is not appropriate to have sexual fantasies during sexual J Sex Med 2015;12:1820–1827
intercourse;” “Repeated engagement on oral/anal sex can cause serious health problems”); sex as an abuse of men’s sexual power (e.g., “Sex is an abuse of male’s power;” “Sex is a violation of a partner’s body”), and partner’s sexual power (e.g., “If a man lets himself go sexually he is under a partner’s control;” “The consequences of a sexual failure are catastrophic”). Scales were computed as sums with higher scores indicating more dysfunctional sexual beliefs. Psychometric studies supported test–retest reliability (r = 0.73), discriminant validity and internal consistency (Cronbach alpha value of 0.93) of the questionnaire [4].
SDBQ—Female Version The SDBQ—female version [4] is a 40-item selfreported measure assessing beliefs related to sexuality. Participants answered the questions using a 5-point Likert scale (1 = completely disagree; 5 = completely agree). The SDBQ—female version assesses six dimensions: sexual conservatism (e.g., “Masturbation is wrong and sinful;” “Oral sex is one of the biggest perversions”); sexual desire and pleasure as sin (e.g., “Sex is dirty and sinful;” “Experiencing pleasure during sexual activity is not acceptable in a virtuous woman”); age-related beliefs (e.g., “After menopause women can’t reach orgasm;” “As women age the pleasure they get from sex decreases”); body image beliefs (e.g., “Women who are not physically attractive can’t be sexually satisfied;” “An ugly woman is not capable of sexually satisfying her partner”); motherhood primacy (e.g., “Sex is meant only for procreation;” “The most wonderful emotions that a woman can experience are maternal;”) and affection primacy (e.g., “Love and affection from a partner are necessary for good sex;” “Sex without love is like food without flavor”). Scales are computed as sums. For SDBQ total score, affection primacy subscale was not used. Higher scores were associated with more dysfunctional sexual beliefs. Psychometric studies indicated good test–retest reliability (r = 0.80), internal consistency (Cronbach’s alpha = 0.81), and discriminant validity [4]. Linguistic Validation The SDBQ [4] was translated into Persian by two researchers independently. The two translated versions were then compared and a single Persian provisional version was produced. The provisional Persian version was translated back into English by an English expert. The English version was checked with the original questionnaire. This version was tested in a pilot study with 10 women
Validation, Psychometric Properties, Sexual Beliefs and men in order to identify any possible problem with the questionnaire items before the final Persian version of the SDBQ was produced.
Statistical Analysis Psychometric properties of the Iranian version of the SDBQ were assessed by several statistical tests as follows: Validity To estimate construct validity, exploratory factor analysis was performed to determine the underlying constructs of the questionnaire. Varimax rotation was applied. Reliability The internal consistency was assessed using Cronbach’s alpha. Values equal to or greater than 0.70 were considered satisfactory [19]. In addition, to estimate the questionnaire stability, test–retest reliability was conducted to assess the intraclass correlation coefficient (ICC). Thirty participants completed the questionnaire twice in 4-week intervals. ICC values of 0.40 or above were considered satisfactory. Results
Validity and Reliability Analysis for the SDBQ Female Version To explore the factor structure of the Iranian version of the SDBQ—female version, an exploratory factor analysis, using principal components analysis (PCA) was conducted on the 40 items, with varimax rotation. The Kaiser–Meyer–Olkin (KMO) supported the adequacy of the sample (KMO = 0.775), and Bartlett’s test of sphericity suggested that correlations between items were largely enough for a principal component analysis (PCA; χ2 = 2531.918, P < 0.001). The PCA identified six factors with eigenvalues greater than 1 accounting for 41.9% of total variance. The item selection for each component was based on loadings higher than 0.4 on the respective factor. Items that did not load high on any of the factors were excluded (below 0.4). Six items were excluded based on these criteria: 17_ “Orgasm is possible only by vaginal intercourse”, 27_“Sexual intercourse during menstruation can cause health problems”, 28_ “Oral sex is one of the biggest perversions”, 31_ “The most wonderful emotions that a woman can experience are maternal”, 33_“In the bedroom the woman is the boss”,
1823 35_“There is just one acceptable way of having sex (missionary position)”. Table 2 shows the component loadings for each item, after varimax rotation. The intercorrelation between the various dimensions of the female version showed statistically significant correlations. The results are shown in Table 3. Also, the range of possible domain for SDBQ is presented in Table 4. Test–retest reliability for female version was assessed by two consecutive administrations of the questionnaires with a 4-week interval. Results showed statistically significant correlations (r = 0.81). Internal consistency was evaluated using Cronbach’s alpha statistic for the total scale. The Cronbach’s alpha coefficient for the female version was 0.82.
Validity and Reliability Analysis for the SDBQ Male Version To explore the factor structure of the Iranian version of the SDBQ—male version, an exploratory factor analysis, using PCA was conducted on the 40 items, with varimax rotation. The KMO supported the adequacy of the sample (KMO = 0.701), and Bartlett’s test of sphericity suggested that correlations between items were largely enough for a PCA (χ2 = 2494.103, P < 0.001). The PCA identified six factors with eigenvalues greater than 1 accounting for 47.5% of total variance. The item selection for each component was based on loadings higher than 0.4 on the respective factor. Items that did not load high on any of the factors were excluded (0.4?). Three items were excluded based on these criteria: 7_ “A woman may have doubts about a man’s virility when he fails an erection”, 15_ “In bed the woman is the boss;” and 40_ “The greater the sexual intimacy, the greater the potential for getting hurt”. Table 5 shows the component loadings for each item, after rotation. The intercorrelations between the different factors of the sexual beliefs questionnaire in the male version present a consistent relationship (Table 6). The range of possible domain for SDBQ is presented in Table 7. Likewise, test–retest reliability for male version was assessed by two consecutive administrations of the questionnaires with a four week interval. Results showed statistically significant correlations for the total scale (r = 0.75). Internal consistency was evaluated using Cronbach’s alpha statistic for the total scale. The Cronbach’s alpha coefficient for the male version was 0.84. J Sex Med 2015;12:1820–1827
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Table 2 Female sexual dysfunctional beliefs questionnaire (SDBQ) principal component analysis with varimax rotation (n = 226) Factors SDBQ items
1
Sexual conservatism and female sexual passivity 26. Sex is meant only for procreation 34. Sex should happen only if a man initiates 13. Reaching climax/orgasm is acceptable for men, but not for women 14. Sexual activity must be initiated by man 29. If women let themselves go sexually they are totally under men’s control’ 12. A good mother can’t be sexually active 22. Sex is a beautiful and pure activity* 25 Any woman who initiates sexual activity is immoral 11. In the bedroom the man is the boss 39. A woman who only derives sexual pleasure through clitoral stimulation is sick or perverted 30. Being nice and smiling at men can be dangerous Masturbation-related beliefs 7. Masturbation is not a proper activity for respectable women 2. Masturbation is wrong and sinful 1. Love and affection from a partner are necessary for good sex* 4. The best gift woman could bring to marriage is her virginity 3. The most important component of sex is mutual affection* Age-related beliefs 5. After menopause women lose their sexual desire 20. As women age the pleasure they get from sex decreases 21. men only pay attention to young, attractive women 18. The goal of sex is for men to be satisfied 8. After menopause women can’t reach orgasm Sexual desire and pleasure as sin beliefs 36. Experiencing pleasure during sexual intercourse is not acceptable in a virtuous woman 15. Sex is dirty and sinful 40. Pure girls don’t engage in sexual activity 37. A good mother must control her sexual urges 6. Women who have sexual fantasies are perverted 9. There are a variety of ways of getting pleasure and reaching orgasm* Denying affection primacy 19 A successful professional career implies control of sexual behavior 16 Simultaneous orgasm for two partners is essential for a satisfying sexual encounter 23. Sex without love is like food without flavor* 24. As long as both consent agree anything goes* Body image beliefs 38. An ugly woman is not capable of sexually satisfying her partner 10. Women who are not physically attractive can’t be sexually satisfied 32. Anal sex is a perverted activity*
2
3
4
5
6
0.676 0.627 0.594 0.585 0.548 0.519 0.489 0.466 0.439 431. 430. 0.757 0.745 0.492 0.484 0.441 0.606 0.567 0.543 0.525 0.512 0.646 0.568 0.504 0.439 0.434 0.428 0.616 573. 0.532 0.538 0.666 0.650 0.435
*Items 1, 3, 22, 23, 24 are scored in reverse order
Discussion
The SDBQ [4] is a self-reported measure used for assessing male and female dysfunctional sexual Table 3
beliefs, which allow discriminating between individuals with and without sexual dysfunctions [3]. Therefore, the current study investigated the psychometric properties of the Iranian version of the
Female sexual dysfunctional beliefs questionnaire domain intercorrelations (n = 226)
Domains
F1
F2
F3
F4
F5
F6
F1 Sexual conservatism and female sexual passivity F2 Masturbation-related beliefs F3 Age-related beliefs F4 Sexual desire and pleasure as a sin F5 Denying affection primacy F6 Body image-related beliefs
— 0.206** 0.449*** 0.403*** 0.361*** 0.432***
— 0.155* 0.284*** 0.012 0.058
— 0.267*** 0.225** 0.274***
— 0.268*** 0.244***
— 0.277***
—
*P < 0.05. **P < 0.01. ***P < 0.001
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Validation, Psychometric Properties, Sexual Beliefs Table 4
Domain of the sexual dysfunctional beliefs questionnaire (female version)
Domains
Item numbers
Minimum
Maximum
F1 Sexual conservatism and female sexual passivity F2 Masturbation-related beliefs F3 Age-related beliefs F4 Sexual desire and pleasure as a sin F5 Denying affection primacy F6 Body image-related beliefs
11, 12, 13, 14, 22, 25, 26, 29, 30, 34, 39 1, 2, 3, 4, 7 5, 8, 18, 20, 21 6, 9, 15, 36, 37, 40 16, 19, 23, 24 10, 32, 38
11 5 5 6 4 3
55 25 25 30 20 15
SDBQ. After linguistic validation, exploratory factor analysis using PCA, and internal consistency and test–retest reliability were performed in a sample of men and women from Iran.
Findings from the exploratory factor analysis using PCA corroborated the six-factor solution for the female version of the SDBQ, explaining 41% of total variance and including the domains of
Table 5 Male sexual dysfunctional beliefs questionnaire (SDBQ) principal component analysis with varimax rotation (n = 161) Factors SDBQ items Sex as an abuse of men’s power 24. Foreplay is a waste of time 25. Sex is meant only for procreation 9. A shorter duration of intercourse is a sign of man’s power 34. Sex is a violation of a woman’s body 26. In sex, the quickest/faster the best 10. Sex is an abuse of male’s power 12. Women only pay attention to attractive younger man 1. A real man has sexual intercourse very often 28. A real man is always ready for sex and must be capable of satisfying any woman Beliefs about women’s sexual satisfaction 31. A man must be capable of maintaining an erection until the end of any sex 2. Orgasm is possible only by vaginal intercourse 16. Men who are not capable of penetrating women can’t satisfy them 22. The quality of the erection is what most satisfies women 3. Penile erection is essential for a woman’s sexual satisfaction 20. A woman may stop loving a man if he is not capable of satisfying her sexually 17. In sex, getting to the climax is most important 35. A man who doesn’t sexually satisfy a woman is a failure 18. In sex anything but vaginal intercourse is unacceptable 11 The consequences of a sexual failure are catastrophic 19. A woman’s body is her best weapon Sexual conservatism 30. Anal sex is a perverted activity 21. Vaginal intercourse is the only legitimate type of sex 32. There is only one acceptable way of having sex *37. Sex can be good even without orgasm 14. There are certain universal rules about what is normal during sexual activity 4. Homosexuality is a sickness Female sexual power 39. A woman at her sexual peak can get whatever she wants from a man 29. If a man lets himself go sexually he is under a woman’s control 23. A successful career implies the control of sexual urges 27. People who don’t control their sexual urges are more easily controlled by others Macho beliefs 36. Whenever a situation arises, a real man must be capable of penetration 38. A real man doesn’t need much stimulation to reach orgasm 6. A real man must wait the necessary amount of time to sexual satisfy a woman 5. Women have no other choice but to be sex. Subjugated by man’s power Restrictive attitudes toward sex 33. Sexual intercourse before marriage is a sin 8. Repeated engagement on oral/ anal sex can cause serious health problems 13. It is not appropriate to have sexual fantasies during sexual intercourse
1
2
3
4
5
6
0.770 0.769 0.766 0.753 0.701 0.642 0.540 0.527 0.517 0.634 0.618 0.613 0.602 0.567 0.542 0.504 0.486 0.483 427. 423. 0.665 0.658 0.620 0.475 0.448 0.435 0.616 0.593 0.531 0.405 686. 0.528 505. 416. 621. 535. 400.
*Item 37 is scored in reverse order
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Abdolmanafi et al. Male sexual dysfunctional beliefs questionnaire domain intercorrelations (n = 161)
Domains
F1
F2
F3
F4
F5
F6
F1 F2 F3 F4 F5 F6
— 0.227** 0.329*** 0.074 0.405*** −0.064
— 0.198* 0.290*** 0.433*** 0.108
— 0.182* 0.210** 0.370***
— 0.254** 0.294***
— 0.043
—
Sex as an abuse of men’s power Beliefs about women’s sexual satisfaction Sexual conservatism Female sexual power “Macho” beliefs Restrictive attitudes toward sex
*P < 0.05. **P < 0.01. ***P < 0.001
sexual conservatism and female sexual passivity, masturbation-related beliefs, body image-related beliefs, sexual desire and pleasure as a sin, agerelated beliefs, and denying affection primacy. Likewise, the statistical analyze for the male version of the SDBQ also showed a six-factor solution for the SDBQ—male version, explaining 47% of total variance and including the domains of sex as an abuse of men’s power, beliefs related to women’s satisfaction, sexual conservatism, female sexual power, “macho” beliefs, and Restrictive attitudes toward sex. Therefore, current data support the original six-factor solution for the male sample, proposed by Nobre, Pinto-Gouveia, and Gomes [4]. For the female sample, although a sixfactor solution was found, original motherhoodrelated beliefs were included in the sexual conservatism and female sexual passivity factor, and a new dimension has emerged, related to masturbation beliefs. While unexpected, current findings suggest a stronger presence of conservative and restrictive attitudes toward sexuality in Iranian women, mostly related to masturbation. In Iran, women expressions of sexuality are highly inappropriate, as it could be an indicator of threatening the highly interdependent social order as well as the integrity of the family [20]. Conservative societies such as Iran, emphasize on strict moral and rigid social conduct, thus a restrained sexuality is valued [21]. Nevertheless, in both male and female versions there are a few disparities in the items that constitute each dimension. Also, the items excluded in our analysis were not the same excluded in the original scale. This may reflect the Table 7
measurement characteristics of the instrument itself, or mirror the sample’s cultural or linguistic peculiarities. For instance, in countries such as Iran, religion has an important influence in sexual beliefs. Some Muslims believe that pleasure should not be achieved and needs to be controlled, as it undermines faith and morality. Additionally, for some Muslims sexuality is not a central in their lives [22]. Therefore, different sociocultural backgrounds might lead to different interpretations of sexual issues, and to few disparities in the items that constitute each dimension. As a result, further studies, with larger samples, and using other measures for assessing the discriminant and convergent validity are required. Moreover, internal consistency showed good results, with Cronbach’s alpha values meeting the threshold of 0.82 and 0.84 for the male and female versions, respectively. Likewise, test–retest reliability of the measure was verified with good ICC, indicating that the SDBQ is highly reproducible over a 4-week interval. Overall, the Iranian version of the SDBQ demonstrated good psychometric properties. However, the study presented some limitations. The study was conducted with a convenience sample, and no information regarding sexual functioning was assessed. Also, the size of the sample did not allow running confirmatory factor analysis. Therefore, further studies are required in order to replicate current findings and extend the psychometric properties of the SDBQ with larger samples. In conclusion, sexuality research among Iranian population is scarce; therefore, current findings
Domain of the sexual dysfunctional beliefs questionnaire (male version)
Domains
Item numbers
Minimum
Maximum
F1 F2 F3 F4 F5 F6
1, 9, 10, 12, 24, 25, 26, 28, 34 2, 3, 11, 16, 17, 18, 19, 20, 22, 31, 35 4, 14, 21, 30, 32, 37 23, 27, 29, 39 5, 6, 36, 38 8, 13, 33
9 11 6 4 4 3
45 55 30 20 20 15
Sex as an abuse of men’s power Beliefs about women’s sexual satisfaction Sexual Conservatism Female sexual power “Macho” beliefs Restrictive attitudes toward sex
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Validation, Psychometric Properties, Sexual Beliefs may be of the utmost importance for promoting sexual beliefs-related studies within this population. Given the role of cultural background and religion influence in Iran, the present study may allow extending current knowledge about sexual beliefs and the role that they play in determining sexual health in men and women from Iran. Current data suggested that the Iranian version of the SDBQ is a valid and reliable measure for assessing dysfunctional sexual beliefs, and its use is recommended, in both clinical context and research fields. Further studies should be conducted in order to better understand the specificities of sexual beliefs in Iran as well as to test its role on sexual health among Iranian men and women. Acknowledgments
This study was a part of dissertation for receiving PhD degree in Psychology that was supported by Faculty of Human Sciences, Tarbiat Modares University, Tehran, Iran. We appreciate this institution for facilitating the study sampling and least but not least all of the participants. Corresponding Author: Parviz Azadfallah, PhD, Department of Psychology, Faculty of Human Sciences, Tarbiat Modares University, Chamran Highway JalaleHighway, Al-e-Ahmad, Tehran 14115-111, Iran. Tel: +9821-82884658; Fax: +9821-82883676; E-mail: [email protected] Conflict of Interest: The author(s) report no conflicts of interest. Statement of Authorship
Category 1 (a) Conception and Design Atefe Abdolmanafi; Parviz Azadfallah; Ladan Fata (b) Acquisition of Data Atefe Abdolmanafi; Mohsen Roosta (c) Analysis and Interpretation of Data Atefe Abdolmanafi; Maria Manuela Peixoto; Pedro Nobre
Category 2 (a) Drafting the Article Atefe Abdolmanafi; Maria Manuela Peixoto; Pedro Nobre (b) Revising It for Intellectual Content Atefe Abdolmanafi; Maria Manuela Peixoto; Pedro Nobre
Category 3 (a) Final Approval of the Completed Article Atefe Abdolmanafi; Parviz Azadfallah; Ladan Fata; Maria Manuela Peixoto; Pedro Nobre
References 1 Hawton K. Sex therapy: A practical guide. Northvale, NJ: Jason Aronson Inc; 1985. 2 Kaplan H. Disorders of sexual desire and other new concepts and techniques in sex therapy. New York: Brunner Mazel; 1979. 3 Nobre P, Pinto-Gouveia J. Dysfunctional sexual beliefs as vulnerability factors for sexual dysfunction. J Sex Res 2006;43:68– 75. 4 Nobre P, Pinto-Gouveia J, Gomes F. Sexual dysfunctional beliefs questionnaire: An instrument to assess sexual dysfunctional beliefs as vulnerability factors to sexual problems. J Sex Relat Ther 2003;18:171–204. 5 Zilbergeld B. The new male sexuality. Revised edition. New York: Bantam Books; 1999. 6 Nobre P. Psychological determinants of erectile dysfunction: Testing a cognitive-emotional model. J Sex Med 2010;7:1429– 37. 7 Heiman JR, LoPiccolo J. Becoming orgasmic: A sexual and personal growth program for women. Revised edition. New York: Prentice-Hall; 1988. 8 Nobre P, Pinto-Gouveia J. Cognitive and emotional predictors of female sexual dysfunctions: Preliminary findings. J Sex Marital Ther 2008;34:325–42. 9 Nobre P, Pinto-Gouveia J. Erectile dysfunction: An empirical approach based on Beck’s cognitive theory. Sex Relat Ther 2000;15:351–66. 10 Carvalho J, Nobre P. Predictors of women’s sexual desire: The role of psychopathology, cognitive-emotional determinants, relationship dimensions, and medical factors. J Sex Med 2010;7:928–37. 11 Carvalho J, Nobre P. Predictors of men’s sexual desire: The role of psychological, cognitive-emotional, relational and medical factors. J Sex Res 2011;48:254–62. 12 Peixoto MM, Nobre P. Dysfunctional sexual beliefs: A comparative study with heterosexual men and women, gay men, and lesbian women, with and without sexual problems. J Sex Med 2014;11:2690–700. 13 Borg C, de Jong PJ, Schultz WW. Vaginismus and dyspareunia: Relationship with general and sex-related moral standards. J Sex Med 2011;8:223–31. 14 Woo JS, Brotto L, Gorzalka BB. The relationship between sex guilt and sexual desire in a community sample of Chinese and Euro-Canadian women. J Sex Res 2012;49:290–8. 15 Woo JS, Brotto L, Gorzalka BB. The role of sex guilt in the relationship between culture and women’s sexual desire. Arch Sex Behav 2011;40:385–94. 16 Woo JS, Morshedian N, Brotto L, Gorzalka BB. Sex guilt mediates the relationship between religiosity and sexual desire in East Asian and Euro-Canadian college-aged women. Arch Sex Behav 2012;41:1485–95. 17 Fakhri A, Pakpour AH, Burri A, Morshedi H, Zeidi IM. The female sexual function index: Translation and validation of an Iranian version. J Sex Med 2012;9:514–23. 18 Merghati Khoei E, Whelan A, Cohen J. Sharing beliefs: What sexuality means to Muslim Iranian women living in Australia. Cult Health Sex 2008;10:237–48. 19 Cronbach L. Coefficient alpha and the internal structure of tests. Psychometrika 1951;16:297–334. 20 Okazaki S. Influences of culture on Asian Americans’ sexuality. J Sex Res 2010;39:34–41. 21 Abraham M. Sexual abuse in South Asian immigrant marriages. J Violence Against Women 1999;5:591–618. 22 Sabbah FA. Women in the Muslim unconscious. Paris: Pergamon Press; 1984.
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ORIGINAL RESEARCH Sexual Dysfunctional Beliefs Questionnaire (SDBQ): Translation and Psychometric Properties of the Iranian Version Atefe Abdolmanafi, MA,* Parviz Azadfallah, PhD,* Ladan Fata, PhD,† Mohsen Roosta, MA,‡ Maria Manuela Peixoto, PhD,§ and Pedro Nobre, PhD§ *Department of Psychology, Faculty of Human Sciences, Tarbiat Modares University, Tehran, Iran; †Medical Education and Development Center, Iran University of Medical Sciences, Tehran, Iran; ‡Department of Psychology, Faculty of Psychology and Education Sciences, University of Tehran, Tehran, Iran; §Faculty of Psychology and Education Science, University of Porto, Portugal DOI: 10.1111/jsm.12931
ABSTRACT
Introduction. The sexual dysfunctional beliefs questionnaire (SDBQ) is a validated measure for assessing dysfunctional sexual beliefs. Aims. The aim of this study was to translate and validate the SDBQ to Iranian context. Methods. In order to translate the questionnaire from English into Persian, a forward–backward procedure was applied. After linguistic validation, the psychometric properties of the Iranian version were assessed for both men and women. A total of 387 participants (226 women and 161 men) completed the SDBQ. Main Outcome Measures. A principle component analysis with varimax rotation was performed for both the male and female samples. Reliability was evaluated by calculating Cronbach’s alpha (internal consistency) and test–retest coefficients (intraclass correlation coefficient). Results. The results from the principle component analysis identified six factors in the female version: sexual conservatism and female sexual passivity, beliefs about masturbation, body image beliefs, sexual desire and pleasure as a sin, age-related beliefs, and denying affection primacy. In the male version six factors were also identified: sex as an abuse of men’s power, beliefs related to women’s satisfaction, sexual conservatism, female sexual power, “macho” beliefs, and restrictive attitudes toward sex. Findings support the original six-factor solution for the male sample. For the female sample, although a six-factor solution was found, original motherhood-related beliefs were included in the sexual conservatism and female sexual passivity factor, and a new dimension has emerged, related to masturbation beliefs. Additionally, results indicated that the SDBQ had good internal consistency and test–retest reliability in both male and female versions. Conclusion. Current findings support the reliability and validity of the SDBQ in an Iranian sample and suggest its applicability to assess sexual beliefs in both clinical samples and the general population in Iran. Abdolmanafi A, Azadfallah P, Fata L, Roosta M, Peixoto MM, and Nobre P. Sexual Dysfunctional Beliefs Questionnaire (SDBQ): Translation and psychometric properties of the Iranian version. J Sex Med 2015;12:1820–1827. Key Words. Dysfunctional Sexual Beliefs; Assessment Questionnaire; Psychometric Properties; Validation
Introduction
D
ysfunctional sexual beliefs are defined as unrealistic and inaccurate ideas about sexuality and sexual response that are unconditionally accepted as true even in the absence of evidence.
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Misinformation regarding sexuality is learned across time, through parenting style, exposure to sociocultural beliefs, past sexual experiences or sex education programs [1–5]. Sexual beliefs are usually conceptualized as vulnerability factors for the development of sexual © 2015 International Society for Sexual Medicine
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Validation, Psychometric Properties, Sexual Beliefs problems in men and women [3–6]. Zilbergeld [5] listed several sexual myths, according to his extensive experience in sex therapy with couples. Men’s sexual myths are mainly related to sexual performance (e.g., “A real man performs in sex”) and to sexual scripts (e.g., “Good sex is spontaneous, with no planning and no talking;” “All touching is sexual or should lead to sex”), which promote sexual problems and support unreal expectations regarding sexual behavior and performance [5]. Along with male myths, Hawton [1] described sexual myths for women, standing for a double standard: repressive for women (e.g., “Any women who initiates sex is immoral”), and permissive, but demanding for men “Sex must only ever occur at the instigation of the man” [1]. Later, Heiman and LoPiccolo [7] suggested sexual myths emphasizing body image and aging concerns (“Sex is only for women under 30 years old;” “Female sexual life ends with menopause”), as well as performance demands in women (“Normal women have orgasm whenever they have sex”). A specific questionnaire was developed by Nobre, Pinto-Gouveia, and Gomes [4], in order to assess dysfunctional sexual beliefs in men and women, the sexual dysfunctional beliefs questionnaire (SDBQ). The male version of the SDBQ assesses six dimensions: sexual conservatism; female sexual power; “macho” belief; beliefs about women’s sexual satisfaction; restricted attitudes toward sexual activity; and sex as an abuse of men’s power. On the other hand, the female version assesses six dimensions: sexual conservatism; sexual desire and pleasure as a sin; age-related beliefs; body image beliefs; affection primacy; and motherhood primacy [4]. Moreover, research has shown that the SDBQ presents good convergent and discriminant validity as well as adequate reliability [4]. Studies using the SDBQ conducted in clinical samples of men and women with sexual problems indicated that women with sexual dysfunction presented significantly more sexual beliefs associated with aging and body image, sexual conservatism, and beliefs related to sexual desire and pleasure as a sin, compared with sexually healthy women [3,8]. Instead of, catastrophizing ideas about men’s sexual failure, demands regarding women’s satisfaction and coitus primacy, and “macho” beliefs were more common among men with erectile disorder [6,9]. More recently, sexual dysfunctional beliefs were studied in samples of men and women with sexual desire problems [10,11] and in gay men with distressing sexual symptoms [12]. Findings have
shown that conservative beliefs and sexual beliefsrelated to the aging process were significant predictors of sexual desire in women [10], while restrictive attitudes toward sexuality were the best predictor of male sexual desire [11]. Additionally, gay men presenting distressing sexual symptoms also reported more frequently beliefs in sex as an abuse of men’s power [12]. Moreover, conservative attitudes and restricted sexual standards were also found in women with vaginismus [13], and sexual desire problems [14–16]. Therefore, the assessment of dysfunctional sexual beliefs is an important domain to be taken into consideration in the evaluation and treatment of sexual problems. Sexual problems are highly prevalent in Iran, with ranges from 26% to 51% [17]. Additionally, concerning sexual beliefs, research findings have shown that sexual obedience within marriage is considered an indicator of modesty and selfrespect for women [18]. Therefore, modesty is a symbol of a Muslim idealized woman, and Iranian women should achieve that modesty by fulfilling sexual duty and by satisfying their husbands on any sexual occasion [18]. Thus, considering the major role that dysfunctional sexual beliefs play on sexual dysfunction [3,5], assessing sexual beliefs in the Iranian population would allow a better understanding of the role of beliefs in predicting sexual problems in a specific cultural context, as well as would promote the development of better target psychological interventions for the treatment of sexual dysfunction in Iran. Aims
Given the lack of empirical evidence on vulnerability dimensions for sexual dysfunction in Iranian men and women, the present study aimed to evaluate the validity and reliability of the SDBQ [4] in the Iranian context. The SDBQ [4] was translated into Persian, and construct validity, internal consistency, and test–retest reliability were assessed in order to explore the psychometric characteristics of the SDBQ Iranian version. Methods
Participants and Procedures Two hundred twenty-six women and 161 men participated in the study. The sample group was recruited voluntarily in different regions of Qom and Tehran city between March and June 2014. The study was approved by the Ethical Committee J Sex Med 2015;12:1820–1827
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Table 1 Sociodemographic characteristics of the sample (N = 387)
Age M Min–Max Standard deviation Educational levels (years) 0 to 4 5 to 12 More than 13
Women (n = 226)
Men (n = 161)
29.82 18–54 8.78 % 2.5 17.2 79.8
30.66 20–50 7.28 % 10.6 37.2 52.1
of the Tarbiat Modares University in Iran. Participants were selected using a convenience sampling method. Volunteers received a brief study explanation by a researcher, and were invited to sign an informed consent. After signing the informed consent, the participants completed the sociodemographic characteristics measure and the Iranian version of the SDBQ. No incentives were given. The participants were excluded if they suffered from a mental or psychiatry disorder, if they do not identify themselves as heterosexual, or if they do not have a sexual partner in the past 3 months. The mean age of women was 29.82 years (standard deviation [SD] = 8.78) and the mean age for men was 30.66 years (SD = 7.28). The sociodemographic characteristics of the sample are shown in Table 1. Main Outcome Measures
Sociodemographic Information Participants answered to a brief sociodemographic measure (e.g., assessing age, educational level information). SDBQ—Male Version The SDBQ—male version [4] is a 40-item selfreported measure that allows assessing sexualityrelated beliefs. Participants answered the questions with a 5-point Likert scale (1 = completely disagree; 5 = completely agree). Five domains can be assessed: sexual conservatism (e.g., “Foreplay is a waste of time;” “In sex, the quickest/faster the better”); “macho” beliefs (e.g., “A real man has sexual intercourse very often;” “A man must be capable of maintaining an erection until the end of any sex”); beliefs about partner’s sexual satisfaction (e.g., “A man who doesn’t sexually satisfy the partner is a failure;” “Penis erection is essential for partner’s sexual satisfaction”); restrictive attitudes toward sex (e.g., “It is not appropriate to have sexual fantasies during sexual J Sex Med 2015;12:1820–1827
intercourse;” “Repeated engagement on oral/anal sex can cause serious health problems”); sex as an abuse of men’s sexual power (e.g., “Sex is an abuse of male’s power;” “Sex is a violation of a partner’s body”), and partner’s sexual power (e.g., “If a man lets himself go sexually he is under a partner’s control;” “The consequences of a sexual failure are catastrophic”). Scales were computed as sums with higher scores indicating more dysfunctional sexual beliefs. Psychometric studies supported test–retest reliability (r = 0.73), discriminant validity and internal consistency (Cronbach alpha value of 0.93) of the questionnaire [4].
SDBQ—Female Version The SDBQ—female version [4] is a 40-item selfreported measure assessing beliefs related to sexuality. Participants answered the questions using a 5-point Likert scale (1 = completely disagree; 5 = completely agree). The SDBQ—female version assesses six dimensions: sexual conservatism (e.g., “Masturbation is wrong and sinful;” “Oral sex is one of the biggest perversions”); sexual desire and pleasure as sin (e.g., “Sex is dirty and sinful;” “Experiencing pleasure during sexual activity is not acceptable in a virtuous woman”); age-related beliefs (e.g., “After menopause women can’t reach orgasm;” “As women age the pleasure they get from sex decreases”); body image beliefs (e.g., “Women who are not physically attractive can’t be sexually satisfied;” “An ugly woman is not capable of sexually satisfying her partner”); motherhood primacy (e.g., “Sex is meant only for procreation;” “The most wonderful emotions that a woman can experience are maternal;”) and affection primacy (e.g., “Love and affection from a partner are necessary for good sex;” “Sex without love is like food without flavor”). Scales are computed as sums. For SDBQ total score, affection primacy subscale was not used. Higher scores were associated with more dysfunctional sexual beliefs. Psychometric studies indicated good test–retest reliability (r = 0.80), internal consistency (Cronbach’s alpha = 0.81), and discriminant validity [4]. Linguistic Validation The SDBQ [4] was translated into Persian by two researchers independently. The two translated versions were then compared and a single Persian provisional version was produced. The provisional Persian version was translated back into English by an English expert. The English version was checked with the original questionnaire. This version was tested in a pilot study with 10 women
Validation, Psychometric Properties, Sexual Beliefs and men in order to identify any possible problem with the questionnaire items before the final Persian version of the SDBQ was produced.
Statistical Analysis Psychometric properties of the Iranian version of the SDBQ were assessed by several statistical tests as follows: Validity To estimate construct validity, exploratory factor analysis was performed to determine the underlying constructs of the questionnaire. Varimax rotation was applied. Reliability The internal consistency was assessed using Cronbach’s alpha. Values equal to or greater than 0.70 were considered satisfactory [19]. In addition, to estimate the questionnaire stability, test–retest reliability was conducted to assess the intraclass correlation coefficient (ICC). Thirty participants completed the questionnaire twice in 4-week intervals. ICC values of 0.40 or above were considered satisfactory. Results
Validity and Reliability Analysis for the SDBQ Female Version To explore the factor structure of the Iranian version of the SDBQ—female version, an exploratory factor analysis, using principal components analysis (PCA) was conducted on the 40 items, with varimax rotation. The Kaiser–Meyer–Olkin (KMO) supported the adequacy of the sample (KMO = 0.775), and Bartlett’s test of sphericity suggested that correlations between items were largely enough for a principal component analysis (PCA; χ2 = 2531.918, P < 0.001). The PCA identified six factors with eigenvalues greater than 1 accounting for 41.9% of total variance. The item selection for each component was based on loadings higher than 0.4 on the respective factor. Items that did not load high on any of the factors were excluded (below 0.4). Six items were excluded based on these criteria: 17_ “Orgasm is possible only by vaginal intercourse”, 27_“Sexual intercourse during menstruation can cause health problems”, 28_ “Oral sex is one of the biggest perversions”, 31_ “The most wonderful emotions that a woman can experience are maternal”, 33_“In the bedroom the woman is the boss”,
1823 35_“There is just one acceptable way of having sex (missionary position)”. Table 2 shows the component loadings for each item, after varimax rotation. The intercorrelation between the various dimensions of the female version showed statistically significant correlations. The results are shown in Table 3. Also, the range of possible domain for SDBQ is presented in Table 4. Test–retest reliability for female version was assessed by two consecutive administrations of the questionnaires with a 4-week interval. Results showed statistically significant correlations (r = 0.81). Internal consistency was evaluated using Cronbach’s alpha statistic for the total scale. The Cronbach’s alpha coefficient for the female version was 0.82.
Validity and Reliability Analysis for the SDBQ Male Version To explore the factor structure of the Iranian version of the SDBQ—male version, an exploratory factor analysis, using PCA was conducted on the 40 items, with varimax rotation. The KMO supported the adequacy of the sample (KMO = 0.701), and Bartlett’s test of sphericity suggested that correlations between items were largely enough for a PCA (χ2 = 2494.103, P < 0.001). The PCA identified six factors with eigenvalues greater than 1 accounting for 47.5% of total variance. The item selection for each component was based on loadings higher than 0.4 on the respective factor. Items that did not load high on any of the factors were excluded (0.4?). Three items were excluded based on these criteria: 7_ “A woman may have doubts about a man’s virility when he fails an erection”, 15_ “In bed the woman is the boss;” and 40_ “The greater the sexual intimacy, the greater the potential for getting hurt”. Table 5 shows the component loadings for each item, after rotation. The intercorrelations between the different factors of the sexual beliefs questionnaire in the male version present a consistent relationship (Table 6). The range of possible domain for SDBQ is presented in Table 7. Likewise, test–retest reliability for male version was assessed by two consecutive administrations of the questionnaires with a four week interval. Results showed statistically significant correlations for the total scale (r = 0.75). Internal consistency was evaluated using Cronbach’s alpha statistic for the total scale. The Cronbach’s alpha coefficient for the male version was 0.84. J Sex Med 2015;12:1820–1827
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Table 2 Female sexual dysfunctional beliefs questionnaire (SDBQ) principal component analysis with varimax rotation (n = 226) Factors SDBQ items
1
Sexual conservatism and female sexual passivity 26. Sex is meant only for procreation 34. Sex should happen only if a man initiates 13. Reaching climax/orgasm is acceptable for men, but not for women 14. Sexual activity must be initiated by man 29. If women let themselves go sexually they are totally under men’s control’ 12. A good mother can’t be sexually active 22. Sex is a beautiful and pure activity* 25 Any woman who initiates sexual activity is immoral 11. In the bedroom the man is the boss 39. A woman who only derives sexual pleasure through clitoral stimulation is sick or perverted 30. Being nice and smiling at men can be dangerous Masturbation-related beliefs 7. Masturbation is not a proper activity for respectable women 2. Masturbation is wrong and sinful 1. Love and affection from a partner are necessary for good sex* 4. The best gift woman could bring to marriage is her virginity 3. The most important component of sex is mutual affection* Age-related beliefs 5. After menopause women lose their sexual desire 20. As women age the pleasure they get from sex decreases 21. men only pay attention to young, attractive women 18. The goal of sex is for men to be satisfied 8. After menopause women can’t reach orgasm Sexual desire and pleasure as sin beliefs 36. Experiencing pleasure during sexual intercourse is not acceptable in a virtuous woman 15. Sex is dirty and sinful 40. Pure girls don’t engage in sexual activity 37. A good mother must control her sexual urges 6. Women who have sexual fantasies are perverted 9. There are a variety of ways of getting pleasure and reaching orgasm* Denying affection primacy 19 A successful professional career implies control of sexual behavior 16 Simultaneous orgasm for two partners is essential for a satisfying sexual encounter 23. Sex without love is like food without flavor* 24. As long as both consent agree anything goes* Body image beliefs 38. An ugly woman is not capable of sexually satisfying her partner 10. Women who are not physically attractive can’t be sexually satisfied 32. Anal sex is a perverted activity*
2
3
4
5
6
0.676 0.627 0.594 0.585 0.548 0.519 0.489 0.466 0.439 431. 430. 0.757 0.745 0.492 0.484 0.441 0.606 0.567 0.543 0.525 0.512 0.646 0.568 0.504 0.439 0.434 0.428 0.616 573. 0.532 0.538 0.666 0.650 0.435
*Items 1, 3, 22, 23, 24 are scored in reverse order
Discussion
The SDBQ [4] is a self-reported measure used for assessing male and female dysfunctional sexual Table 3
beliefs, which allow discriminating between individuals with and without sexual dysfunctions [3]. Therefore, the current study investigated the psychometric properties of the Iranian version of the
Female sexual dysfunctional beliefs questionnaire domain intercorrelations (n = 226)
Domains
F1
F2
F3
F4
F5
F6
F1 Sexual conservatism and female sexual passivity F2 Masturbation-related beliefs F3 Age-related beliefs F4 Sexual desire and pleasure as a sin F5 Denying affection primacy F6 Body image-related beliefs
— 0.206** 0.449*** 0.403*** 0.361*** 0.432***
— 0.155* 0.284*** 0.012 0.058
— 0.267*** 0.225** 0.274***
— 0.268*** 0.244***
— 0.277***
—
*P < 0.05. **P < 0.01. ***P < 0.001
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Validation, Psychometric Properties, Sexual Beliefs Table 4
Domain of the sexual dysfunctional beliefs questionnaire (female version)
Domains
Item numbers
Minimum
Maximum
F1 Sexual conservatism and female sexual passivity F2 Masturbation-related beliefs F3 Age-related beliefs F4 Sexual desire and pleasure as a sin F5 Denying affection primacy F6 Body image-related beliefs
11, 12, 13, 14, 22, 25, 26, 29, 30, 34, 39 1, 2, 3, 4, 7 5, 8, 18, 20, 21 6, 9, 15, 36, 37, 40 16, 19, 23, 24 10, 32, 38
11 5 5 6 4 3
55 25 25 30 20 15
SDBQ. After linguistic validation, exploratory factor analysis using PCA, and internal consistency and test–retest reliability were performed in a sample of men and women from Iran.
Findings from the exploratory factor analysis using PCA corroborated the six-factor solution for the female version of the SDBQ, explaining 41% of total variance and including the domains of
Table 5 Male sexual dysfunctional beliefs questionnaire (SDBQ) principal component analysis with varimax rotation (n = 161) Factors SDBQ items Sex as an abuse of men’s power 24. Foreplay is a waste of time 25. Sex is meant only for procreation 9. A shorter duration of intercourse is a sign of man’s power 34. Sex is a violation of a woman’s body 26. In sex, the quickest/faster the best 10. Sex is an abuse of male’s power 12. Women only pay attention to attractive younger man 1. A real man has sexual intercourse very often 28. A real man is always ready for sex and must be capable of satisfying any woman Beliefs about women’s sexual satisfaction 31. A man must be capable of maintaining an erection until the end of any sex 2. Orgasm is possible only by vaginal intercourse 16. Men who are not capable of penetrating women can’t satisfy them 22. The quality of the erection is what most satisfies women 3. Penile erection is essential for a woman’s sexual satisfaction 20. A woman may stop loving a man if he is not capable of satisfying her sexually 17. In sex, getting to the climax is most important 35. A man who doesn’t sexually satisfy a woman is a failure 18. In sex anything but vaginal intercourse is unacceptable 11 The consequences of a sexual failure are catastrophic 19. A woman’s body is her best weapon Sexual conservatism 30. Anal sex is a perverted activity 21. Vaginal intercourse is the only legitimate type of sex 32. There is only one acceptable way of having sex *37. Sex can be good even without orgasm 14. There are certain universal rules about what is normal during sexual activity 4. Homosexuality is a sickness Female sexual power 39. A woman at her sexual peak can get whatever she wants from a man 29. If a man lets himself go sexually he is under a woman’s control 23. A successful career implies the control of sexual urges 27. People who don’t control their sexual urges are more easily controlled by others Macho beliefs 36. Whenever a situation arises, a real man must be capable of penetration 38. A real man doesn’t need much stimulation to reach orgasm 6. A real man must wait the necessary amount of time to sexual satisfy a woman 5. Women have no other choice but to be sex. Subjugated by man’s power Restrictive attitudes toward sex 33. Sexual intercourse before marriage is a sin 8. Repeated engagement on oral/ anal sex can cause serious health problems 13. It is not appropriate to have sexual fantasies during sexual intercourse
1
2
3
4
5
6
0.770 0.769 0.766 0.753 0.701 0.642 0.540 0.527 0.517 0.634 0.618 0.613 0.602 0.567 0.542 0.504 0.486 0.483 427. 423. 0.665 0.658 0.620 0.475 0.448 0.435 0.616 0.593 0.531 0.405 686. 0.528 505. 416. 621. 535. 400.
*Item 37 is scored in reverse order
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Abdolmanafi et al. Male sexual dysfunctional beliefs questionnaire domain intercorrelations (n = 161)
Domains
F1
F2
F3
F4
F5
F6
F1 F2 F3 F4 F5 F6
— 0.227** 0.329*** 0.074 0.405*** −0.064
— 0.198* 0.290*** 0.433*** 0.108
— 0.182* 0.210** 0.370***
— 0.254** 0.294***
— 0.043
—
Sex as an abuse of men’s power Beliefs about women’s sexual satisfaction Sexual conservatism Female sexual power “Macho” beliefs Restrictive attitudes toward sex
*P < 0.05. **P < 0.01. ***P < 0.001
sexual conservatism and female sexual passivity, masturbation-related beliefs, body image-related beliefs, sexual desire and pleasure as a sin, agerelated beliefs, and denying affection primacy. Likewise, the statistical analyze for the male version of the SDBQ also showed a six-factor solution for the SDBQ—male version, explaining 47% of total variance and including the domains of sex as an abuse of men’s power, beliefs related to women’s satisfaction, sexual conservatism, female sexual power, “macho” beliefs, and Restrictive attitudes toward sex. Therefore, current data support the original six-factor solution for the male sample, proposed by Nobre, Pinto-Gouveia, and Gomes [4]. For the female sample, although a sixfactor solution was found, original motherhoodrelated beliefs were included in the sexual conservatism and female sexual passivity factor, and a new dimension has emerged, related to masturbation beliefs. While unexpected, current findings suggest a stronger presence of conservative and restrictive attitudes toward sexuality in Iranian women, mostly related to masturbation. In Iran, women expressions of sexuality are highly inappropriate, as it could be an indicator of threatening the highly interdependent social order as well as the integrity of the family [20]. Conservative societies such as Iran, emphasize on strict moral and rigid social conduct, thus a restrained sexuality is valued [21]. Nevertheless, in both male and female versions there are a few disparities in the items that constitute each dimension. Also, the items excluded in our analysis were not the same excluded in the original scale. This may reflect the Table 7
measurement characteristics of the instrument itself, or mirror the sample’s cultural or linguistic peculiarities. For instance, in countries such as Iran, religion has an important influence in sexual beliefs. Some Muslims believe that pleasure should not be achieved and needs to be controlled, as it undermines faith and morality. Additionally, for some Muslims sexuality is not a central in their lives [22]. Therefore, different sociocultural backgrounds might lead to different interpretations of sexual issues, and to few disparities in the items that constitute each dimension. As a result, further studies, with larger samples, and using other measures for assessing the discriminant and convergent validity are required. Moreover, internal consistency showed good results, with Cronbach’s alpha values meeting the threshold of 0.82 and 0.84 for the male and female versions, respectively. Likewise, test–retest reliability of the measure was verified with good ICC, indicating that the SDBQ is highly reproducible over a 4-week interval. Overall, the Iranian version of the SDBQ demonstrated good psychometric properties. However, the study presented some limitations. The study was conducted with a convenience sample, and no information regarding sexual functioning was assessed. Also, the size of the sample did not allow running confirmatory factor analysis. Therefore, further studies are required in order to replicate current findings and extend the psychometric properties of the SDBQ with larger samples. In conclusion, sexuality research among Iranian population is scarce; therefore, current findings
Domain of the sexual dysfunctional beliefs questionnaire (male version)
Domains
Item numbers
Minimum
Maximum
F1 F2 F3 F4 F5 F6
1, 9, 10, 12, 24, 25, 26, 28, 34 2, 3, 11, 16, 17, 18, 19, 20, 22, 31, 35 4, 14, 21, 30, 32, 37 23, 27, 29, 39 5, 6, 36, 38 8, 13, 33
9 11 6 4 4 3
45 55 30 20 20 15
Sex as an abuse of men’s power Beliefs about women’s sexual satisfaction Sexual Conservatism Female sexual power “Macho” beliefs Restrictive attitudes toward sex
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Validation, Psychometric Properties, Sexual Beliefs may be of the utmost importance for promoting sexual beliefs-related studies within this population. Given the role of cultural background and religion influence in Iran, the present study may allow extending current knowledge about sexual beliefs and the role that they play in determining sexual health in men and women from Iran. Current data suggested that the Iranian version of the SDBQ is a valid and reliable measure for assessing dysfunctional sexual beliefs, and its use is recommended, in both clinical context and research fields. Further studies should be conducted in order to better understand the specificities of sexual beliefs in Iran as well as to test its role on sexual health among Iranian men and women. Acknowledgments
This study was a part of dissertation for receiving PhD degree in Psychology that was supported by Faculty of Human Sciences, Tarbiat Modares University, Tehran, Iran. We appreciate this institution for facilitating the study sampling and least but not least all of the participants. Corresponding Author: Parviz Azadfallah, PhD, Department of Psychology, Faculty of Human Sciences, Tarbiat Modares University, Chamran Highway JalaleHighway, Al-e-Ahmad, Tehran 14115-111, Iran. Tel: +9821-82884658; Fax: +9821-82883676; E-mail: [email protected] Conflict of Interest: The author(s) report no conflicts of interest. Statement of Authorship
Category 1 (a) Conception and Design Atefe Abdolmanafi; Parviz Azadfallah; Ladan Fata (b) Acquisition of Data Atefe Abdolmanafi; Mohsen Roosta (c) Analysis and Interpretation of Data Atefe Abdolmanafi; Maria Manuela Peixoto; Pedro Nobre
Category 2 (a) Drafting the Article Atefe Abdolmanafi; Maria Manuela Peixoto; Pedro Nobre (b) Revising It for Intellectual Content Atefe Abdolmanafi; Maria Manuela Peixoto; Pedro Nobre
Category 3 (a) Final Approval of the Completed Article Atefe Abdolmanafi; Parviz Azadfallah; Ladan Fata; Maria Manuela Peixoto; Pedro Nobre
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