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ORIGINAL RESEARCH—DESIRE Validation of the Swedish Version of the Female Sexual Function Index (FSFI) in Women with Hypoactive Sexual Desire Disorder Elsa Lena Ryding, MD, PhD* and Carina Blom, MSc, Lic. Psychologist, Lic. Psychotherapist† *Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden; †Department of Psychology, Stockholm University, Stockholm, Sweden DOI: 10.1111/jsm.12778

ABSTRACT

Introduction. The Female Sexual Function Index (FSFI) has been validated for use in many countries. It has been used for clinical and research purposes in Sweden, but the reliability and validity of the Swedish version have never been tested. Aim. The aim of this study was to investigate the psychometric properties of the Swedish version of the FSFI. Methods. After informed consent, 50 women with a diagnosis of hypoactive sexual desire disorder (HSDD) and 58 age-matched healthy volunteers completed the questionnaires. Main Outcome Measures. Reliability was tested by Cronbach’s alpha and test–retest by Pearson’s correlation, convergent validity by correlation of the FSFI and the Sexual Function Questionnaire (SFQ), divergent validity by correlation of FSFI and the Symptoms Checklist-90-Revised (SCL-90-R), and discriminant validity by Student’s t-test and chi-square test to assess differences between women with and without HSDD. Results. Cronbach’s alpha was 0.90–0.96 and test–retest reliability was good (r = 0.86–0.93) for all domains in the whole sample; reliability was low for lubrication and pain in the control group. Correlations between all corresponding domains of the FSFI and the SFQ were high for the whole sample (r = 0.74–0.87) and moderate to high for both the clinical and the control group. There was no correlation between most FSFI domains and the SCL-90-R. Discriminant validity was very good for each of the FSFI domains (P = 0.001, t = 7.05–15.58), although the controls reported relatively low scores on the desire domain. The total FSFI score was 31.37 (standard deviation [SD] 2.66) for the clinical group and 17.47 (SD 5.33) for the controls (P = 0.001, t = 15.99). Conclusion. The Swedish version of the FSFI can be used as a validated and reliable instrument for assessing sexual function in women with HSDD. Ryding EL and Blom C. Validation of the Swedish version of the Female Sexual Function Index (FSFI) in women with hypoactive sexual desire disorder. J Sex Med 2015;12:341–349. Key Words. FSFI; HSDD; Validation; Swedish

Introduction

H

ypoactive sexual desire disorder (HSDD) is the most frequently experienced sexual problem among women. Laumann et al. [1] found that 31% of the female population had experienced lack of sexual interest for at least several months in the past year. In a Swedish epidemiological study, low sexual desire was the most frequent sexual complaint in women (29%) [2]. If women experience problems with sexual desire, © 2014 International Society for Sexual Medicine

they usually report problems in some other sexual area. Among women with HSDD, 41% also described one or more additional sexual dysfunctions [3]. The Female Sexual Function Index (FSFI) [4] is the most widely used questionnaire used for studying female sexual dysfunction. A Swedish version of the FSFI has been used in research [5] and for clinical purposes, but has not been validated. More recent studies of the FSFI have been trying to establish cutoff scores for women with J Sex Med 2015;12:341–349

342 and without sexual dysfunctions. Wiegel et al. [6] found that a total score of 26.55 or more was the optimal cutoff score for differentiating women with and without sexual dysfunction, and proposed a total score of ≤26 for diagnostic classification. According to that classification, 70.7% of women with sexual dysfunction and 88.1% of women without sexual dysfunction were correctly classified. Gerstenberger et al. [7] defined a total sum of 5 or less on the desire domain as a cutoff score for women with a sexual desire disorder. A total score of 6 or more represented absence of sexual desire problems. Aims

The main aim of the present investigation was to test reliability and validity of the Swedish translation of the FSFI. One additional purpose of this study was to evaluate how well the cutoff scores defined by Wiegel et al. [6] and Gerstenberger et al. [7] could differentiate women with and without sexual dysfunction and desire dysfunction. Methods

Participants and Procedure The clinical group consisted of 50 women with HSDD, recruited from two sexology clinics (n = 35) and from a website (n = 15). The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV [8] diagnosis was made during a faceto-face interview with an authorized specialist in clinical sexology. Many of the women reported secondary problems with arousal (19), orgasm (9), or dyspareunia (4). Two more women were first included, but were removed from the analysis because of clinical depression that could explain the lack of desire. The control group comprised 58 age-matched healthy volunteers, most of them students at Stockholm University or Karolinska Institutet. The control group should be healthy and have reported no obvious sexual problems, factors that were assessed in a telephone interview. Two more volunteers had been removed from analysis, one because of a primary orgasm disorder that was not reported in the interview and one who had not filled in the questionnaire properly. The inclusion criteria were sexually active Swedish-speaking woman in a stable heterosexual relationship. The clinical group should not have had an illness as primary cause of the HSDD. J Sex Med 2015;12:341–349

Ryding and Blom All women filled in FSFI, Sexual Function Questionnaire (SFQ), Symptom Checklist-90Revised (SCL-90 R), and questions about socioeconomic status and medication. Two weeks later, they filled in a retest of the FSFI. In the clinical group, treatment did not start until after the study. Those women with HSDD who were recruited from a website were offered a free counseling session. All participants gave their informed consent. Formal approval of the regional ethical committee was obtained.

Questionnaire The FSFI is a multidimensional self-report instrument for assessing important aspects of sexual function in women. It has 19 items, scoring 0 to 5 or 6. Factor analysis resulted in a scoring system for six key domains of female sexuality: desire, arousal, lubrication, orgasm, satisfaction, and pain [4]. It has shown good reliability and validity for women with hypoactive sexual arousal disorder and sexual arousal disorder [4,9,10], various sexual dysfunctions [11], and for cancer survivors [12]. The FSFI was validated for translations into more than 20 languages [13]. The former pharmaceutical company Organon (now Schering-Plough) made the Swedish translation. The SFQ is another multidimensional scale for assessing sexual function in women [14]. It has 34 items, measuring sexual function in seven different domains: desire, arousal-sensation, arousallubrication, orgasm, pain, enjoyment, and partnerrelated issues. The pharmaceutical company Pfizer, Inc. made the Swedish translation. The SFQ was validated in connection with two randomized controlled trials evaluating treatment with sildenafil for women [15]. The SCL-90-R [16] has been used extensively to measure mental and physical health status during the last week. It can be used to screen for psychopathology and for group comparisons. The SCL-90-R includes 90 items, each scoring from 0 to 4. There are nine subscales: somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, aggression, phobic anxiety, paranoia, and psychoticism. The SCL-90-R has been validated for Swedish conditions [17]. We chose the subscales of depression and anxiety because previous studies have shown these symptoms to have a relation to sexuality [18,19]. Somatization was chosen because it seemed reasonable that somatic symptoms could covariate with sexual function.

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Validation of Swedish FSFI Table 1

Socioeconomic characteristics of women with HSDD (n = 50) and women without sexual problems (n = 58)

Age; M (SD) Civil status cohabiting; n (%) Born outside Sweden; n (%) College education; n (%) Income < 15,000 SKR/month; n (%) Any children; n (%) On antidepressant; n (%) Sexual activity 1–2 times/month; n (%) Sexual activity 1–2 times/week; n (%) Sexual activity 3–4 times/month; n (%) Sexual activity >4 times/month; n (%)

Cases

Controls

P*

32.56 (9.71) 35 (70) 6 (12) 30 (60) 16 (32) 22 (44) 12 (24) 26 (52) 20 (40) 4 (8) 0

30.86 (9.29) 41 (70.7) 8 (13.8) 49 (84.5) 38 (66.5) 16 (27.6) 5 (8.6) 7 (12) 25 (43.1) 17 (29.3) 9 (15.5)

0.830 0.938 0.782 0.011 0.000 0.075 0.029 0.000

*Student’s t-test for age; chi-square test for all dichotomized variables HSDD = hypoactive sexual desire disorder; SD = standard deviation

The general severity index (GSI) means the total SCL score divided by 90, showing a general symptom load that might also covariate with sexual function. Additionally, questions were asked about age, marital status, country of origin, education, income, number of children, use of antidepressant medication, and frequency of sexual activities.

Statistical Analyses Frequency analyses, cross-tabulation, and Pearson’s chi-square test were used to study sample proportions and demonstrate differences in sociodemographic characteristics and sexual activity and other dichotomized variables. We used weighted values for the various domains of the FSFI, a scoring system introduced by Rosen and colleagues [4]. Pearson’s product moment correlation, at α = 0.05, as well as Student’s t-test, two-sided at α = 0.01, was used for reliability and validity testing of the scale. Because the data were not always normally distributed, we redid all the analyses by nonparametric methods (Spearman’s correlation and Mann–Whitney U-test, respectively). We chose to present the results, as done in most previous validation papers, only from the parametric analyses, if there was not a difference in the level of significance. The statistical program PASSW 21 (IBM Corp., Armonk, NY, USA) was used.

assessed comparing the clinical group with the healthy controls by means of Student’s t-test. After dichotomization of the FSFI total score with the cutoff of ≤26, the case group and the control group were compared by the chi-square test. Results

The characteristics of the study participants are presented in Table 1. Age, civil status (married/ cohabiting or seeing a boyfriend), country of origin, and number of children did not differ between the groups. More women in the control group were graduate students with a very low income. More women in the clinical group used antidepressant medication. Not surprisingly, the women in the control group were more sexually active than the women with HSDD.

Reliability The internal consistency was high overall for the various domains in both the clinical group and the control group (Table 2). The exception was moderate values concerning the satisfaction domain in the clinical group (α = 0.53) and the pain domain in the control group (α = 0.67). Test–retest reliability of the different FSFI domains (Table 3) was good for the whole sample Table 2

Main Outcome Measures Internal consistency was measured using Cronbach’s alpha. Test–retest reliability and convergent validity between the FSFI and the SFQ were assessed by Pearson’s correlation. Divergent validity was assessed by correlation of the total FSFI scale, as well as the various domains, with the SCL subscales of depression, anxiety, and somatization and the GSI. Discriminant validity was

FSFI reliability: internal consistency*

FSFI domain

All

Cases

Controls

Desire Arousal Lubrication Orgasm Satisfaction Pain Total score

0.93 0.93 0.96 0.90 0.85 0.96 0.96

0.83 0.82 0.92 0.84 0.53 0.92 0.88

0.77 0.67 0.80 0.78 0.89 0.67 0.81

*Cronbach’s alpha FSFI = Female Sexual Function Index

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344 Table 3

Ryding and Blom FSFI test–retest reliability*

FSFI domain

All

Cases

Controls

Desire Arousal Lubrication Orgasm Satisfaction Pain Total score

0.89† 0.90† 0.85† 0.86† 0.86† 0.89† 0.95†

0.67† 0.74† 0.84† 0.65† 0.65† 0.90† 0.87†

0.72† 0.62† 0.35† 0.82† 0.82† 0.10 0.77†

*Pearson’s product moment correlation † P < 0.01 FSFI = Female Sexual Function Index

(r = 0.86–0.93). In the HSDD group, moderate to high test–retest values were found (r = 0.65–0.90). It was low to high in the control group (r = 0.10– 0.82). The pain domain showed the lowest test– retest correlation.

Convergent Validity Correlations between corresponding domains of the FSFI and the SFQ (Table 4) were high for the whole sample (r = 0.74–0.87). Among women with HSDD, high correlations were found on the orgasm scales (r = 0.80) and the lubrication domain compared with the SFQ arousal lubrication domain (r = 0.75). The pain domains on the Table 4

FSFI and the SFQ and the FSFI arousal and the SFQ arousal sensation showed quite high correlations (r = 0.60 and 0.61, respectively). Moderate correlations in the HSDD group were found on the FSFI satisfaction domain compared with the SFQ enjoyment domain (r = 0.43) and also between the FSFI and the SFQ desire domain (r = 0.49). In the control group, high correlations were found between the desire domains (r = 0.83), the orgasm domains (r = 0.80), and the FSFI satisfaction and SFQ enjoyment domains (r = 0.67). Moderate correlations were found on the FSFI arousal and the SFQ arousal sensation (r = 0.58), on the FSFI lubrication and the SFQ arousal lubrication (r = 0.55), and also between the domains measuring pain (r = 0.55).

Divergent Validity The correlations between the various FSFI domains and the SCL subscales of depression, anxiety, and somatization, and GSI (Table 5) were very low in women with HSDD, with the exception of the orgasm domain being weakly negatively correlated to depression (r = −0.30) and GSI (r = −0.30). Within the control group, weak significant negative correlations were found between the arousal domain and SCL-90-R GSI (r = −0.27),

Convergent validity of corresponding domains of FSFI and SFQ*

SFQ

Desire

ArousalS

ArousalL

Orgasm

Enjoyment

Pain

Cases (n = 50) FSFI Desire Arousal Lubrication Orgasm Satisfaction Pain

0.49 0.61 0.75 0.80 0.43 0.60

Controls (n = 58) FSFI Desire Arousal Lubrication Orgasm Satisfaction Pain

0.83 0.58 0.55 0.80 0.67 0.55

All (N = 108) FSFI Desire Arousal Lubrication Orgasm Satisfaction Pain

0.87 0.78 0.83 0.88 0.81

*Pearson’s product moment correlation, all significant P < 0.01 ArousalS = arousal sensitivity; arousalL = lubrication; FSFI = Female Sexual Function Index; SFQ = Sexual Function Questionnaire

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0.74

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Validation of Swedish FSFI Table 5

Discussion

Divergent validity of FSFI vs. SCL

SCL domain

GSI

Depression

Anxiety

Somatization

−0.06 −0.14 −0.11 −0.30* −0.14 −0.03 −0.17

0.06 −0.18 −0.09 −0.31* −0.06 −0.16 −0.21

0.09 0.00 −0.06 −0.14 −0.15 0.01 −0.07

−0.12 −0.08 −0.08 −0.17 −0.19 0.04 −0.08

0.02 −0.27* −0.22 −0.09 −0.09 −0.02 −0.21

0.02 −0.27* −0.20 −0.11 −0.13 −0.05 −0.23

0.06 −0.29* −0.27* −0.11 −0.14 0.02 −0.24

−0.03 0.32* −0.17 −0.25 −0.22 −0.02 −0.31*

Cases FSFI domain Desire Arousal Lubrication Orgasm Satisfaction Pain Total score Controls FSFI domain Desire Arousal Lubrication Orgasm Satisfaction Pain Total score

*Pearson’s product moment correlation, significant P < 0.05 FSFI = Female Sexual Function Index; GSI = general severity index; SCL = Symptom Checklist

depression (r = −0.27), and anxiety (r = −0.29), and between the lubrication domain and anxiety (r = −0.27). A weak positive correlation was found between the arousal domain and SCL-90-R somatization (r = 0.32).

Discriminant Validity The ability of the FSFI to discriminate between clinical and healthy populations is presented in Table 6. Statistically significant differences were observed for the total scale and for all of the domains. There was also a significant difference in the number of women with a total score lower than 26 [6], P = 0.000. Only 2 out of 50 women in the clinical group had a slightly higher score than 26 (27.1 and 28.1). Two out of 58 women in the control group had a lower score than 26 (22.9 and 25.8). This gives a sensitivity of 96% to include all women with HSDD and a specificity of 97% to exclude all women with no sexual problems, when this recommended cutoff was used. Gerstenberger et al.’s [7] cutoff score for the desire domain was ≤5, using raw scores. This corresponds to ≤3 using weighted scores. In our study, no woman in the clinical group scored over 3. In the control group, 17 women scored 3 or less. This corresponds to a sensitivity of 100% and a specificity of 61%. With a lower cutoff of 2.4, six women in the clinical group scored over 2.4. In the control group, three women scored 2.4, and none less. With this cutoff, the sensitivity is 88% and the specificity 95%.

The aim of the present study was to investigate the reliability and validity of the FSFI in women with a primary clinical diagnosis of HSDD in a Swedish population. High to moderate internal consistency was observed for the six domain scores among women with HSDD; inter-item values ranged from 0.53 to 0.92. Alpha values greater than 0.70 are considered acceptable [20]. The satisfaction domain showed a moderate alpha value of 0.53 in the clinical group. The response style was to score high on the question asking about emotional closeness to the partner during sexual activity, to score lower on the question about satisfaction with the sexual relationship with the partner, and to score very low on the question of satisfaction with sex life in general. The moderate alpha value suggests that the three-item FSFI satisfaction domain may not be a reliable indicator of sexual satisfaction among this population. Those Swedish women who were motivated to seek help for HSDD seem to be able to feel emotional closeness during sex, even though they have complaints about desire and sexual satisfaction in general. Earlier studies validating the FSFI with HSDD [4], female orgasmic disorder [9], women with vulvodynia [10], women with sexual complaints [11], and women with chronic pelvic pain [21] have shown alphas ranging from 0.58 to 0.97 on the satisfaction domain. Test–retest reliability was good for the HSDD group (Table 3). Also, the control group showed high correlations between baseline and retest with the exception of the pain domain. This is interpreted as lack of variation in the scoring procedure among the women. The women answered almost exactly the same on all three questions and also when retested. Because correlation is dependent on variation, a correlation failed to show. When Spearman’s rank correlation was used, the pain domain showed a weak correlation of 0.24. One Table 6

FSFI discriminant validity*

FSFI domain

Cases (mean)

SD

Controls (mean)

SD

t

Desire Arousal Lubrication Orgasm Satisfaction Pain Total score

1.68 2.57 3.38 3.14 3.03 3.77 17.47

0.66 1.02 1.61 1.62 1.03 1.99 5.33

3.95 5.22 5.22 5.42 5.22 5.78 31.57

0.87 0.68 0.68 0.75 0.98 0.40 2.66

15.35 15.68 9.76 9.15 11.30 7.05 15.99

*Student’s t-test; all significant P < 0.001 FSFI = Female Sexual Function Index; SD = standard deviation

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346 could argue that for the nonclinical group, the questions measure not different aspects of pain but one aspect of pain, meaning that one question could be enough to cover the domain. Earlier validation studies have shown high test–retest reliability: 0.68–0.87 for clinical groups and 0.77–0.91 in control groups [4,21]. Conclusions taken from the overall result indicate that the Swedish version of the FSFI has good convergent validity when comparing it with another instrument measuring sexual functioning. Divergent validity, measured by comparing correlations between the FSFI and the SCL-90-R, was good. The overall statistical dissociation between FSFI scores and the related construct of psychiatric problems lends support for the construct validity of the FSFI among women with HSDD. Women in the clinical group with a coexisting orgasm problem reported depressive symptoms somewhat more often, which is no surprise. The orgasm problems may be caused by antidepressant use. In the control group, small negative associations were found on the arousal domain with depression, anxiety, somatization, and GSI, indicating that higher levels of psychological dysfunction infer to some extent the feeling of being aroused even in women who report no sexual dysfunction. Significant differences between women with HSDD and controls were observed for all FSFI domains and for the total scores (P < 0.001). Only 4% of the women with HSDD had total scale scores above the cutoff score defined by Wiegel and colleagues [6]. In the nonclinical group, 3% of the sample was found below the cutoff score. Conclusively, the Swedish version of the FSFI has a good ability to differentiate between clinical and nonclinical groups of women. Comparing our results on the desire domain with the proposed cutoff score of 5 (raw scores) for differentiating women with and without sexual desire problems according to Gerstenberger et al. [7] suggests consideration of a lower cutoff point. The cutoff point should be chosen according to the purpose of the measurement. In a population of Swedish women, the lower cut-point of 4 (2.4 weighted value) may be used when it is important to exclude as many false-positive individuals as possible. When looking at the results from the control group and the desire domain, we found a quite low mean score of 3.95 (max score: 6; min score: 1.2). Comparing this result with earlier studies, their weighted mean scores were between 4.02 and 4.76 [4,9–11,21]. The scoring procedure of weighted J Sex Med 2015;12:341–349

Ryding and Blom means makes the domains comparable with the same minimum and maximum score. In the nonclinical group, the other domains showed a much higher result than the desire domain, with mean values of 5.22–5.78. This pattern is the same in earlier studies with the lowest results always in the nonclinical group for the desire domain [4,9– 11,21]. Nonclinical groups may confirm in this way newer theories on women’s sexual cycle that they referred to as responsive rather than phase specific [6] (Basson [22]; Basson [23]). This study implies that the domain that needs the most reconsideration is the desire domain. Only two items seem to be too few for such a multifaceted problem, and perhaps more items could be added. If the desire domain should be congruent with these newer theories on female sexual desire, the items should focus more on asking how confident the woman feels about being able to get sexually interested when presented with a sexual stimulus, as in the Sexual Interest and Desire Inventory– Female [24], and about how confident she is that she can present herself with stimuli and fantasies when she feels like wanting to be turned on. This study has limitations. The samples are relatively small. A power calculation using data from previous research [9] had revealed that our sample size was adequate to show discriminate validity. Principal component analysis has been used in several recent validation studies [25–27]. Our material was too small for that. We chose to use the domains first described by Rosen and colleagues [4]. With the exception of one woman in each group, the women are premenopausal. Only Swedish speakers could participate, and because we wanted to compare our results with previous validations of the FSFI, we included only women living in heterosexual relationships. Further validation may be needed for scientific use in groups not included in the present study. Our data were collected before the publishing of DSM-V [28], so we were not able to use the new diagnosis of female sexual interest/arousal disorder (FSIAD). The questionnaire may need to be further evaluated in groups of women who meet the criteria of FSIAD. Conclusions

This is the first validation study of the FSFI in a Swedish population. Findings suggest that the FSFI is a reliable and valid measure of sexual function in the Swedish HSDD population. Given the small samples, further validation studies are recommended. The questionnaire may need to be

Validation of Swedish FSFI further evaluated in groups of women who meet the criteria of the new DSM-V diagnosis of FSIAD. Corresponding Author: Elsa Lena Ryding, MD, PhD, Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm 171 76, Sweden. Tel: +46708763980; E-mail: [email protected] Conflict of Interest: The authors report no conflicts of interest.

Statement of Authorship

Category 1 (a) Conception and Design Carina Blom; Elsa Lena Ryding (b) Acquisition of Data Elsa Lena Ryding; Carina Blom (c) Analysis and Interpretation of Data Elsa Lena Ryding; Carina Blom

Category 2 (a) Drafting the Article Elsa Lena Ryding (b) Revising It for Intellectual Content Carina Blom

Category 3 (a) Final Approval of the Completed Article Elsa Lena Ryding; Carina Blom

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Appendix

Female Sexual Function Index (FSFI) Datum för ifyllande:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . år mån dag Frågeformulär angående kvinnors sexuella funktion Instruktion: Dessa frågor handlar om dina sexuella känslor och reaktioner under de senaste fyra veckorna. Var vänlig besvara följande frågor så ärligt och tydligt som möjligt. Dina svar kommer att hållas helt konfidentiella. Vid besvarandet av frågorna gäller följande definitioner: Sexuell vaginalt Samlag penis. Sexuell partner,

aktivitet kan omfatta smekningar, onani, förspel eller samlag. kan definieras som penetration (intrång i) slidan med stimulering omfattar situationer som förspel med en onani eller sexuell fantasi.

Kryssa endast en ruta per fråga. Sexuell lust eller sexuellt intresse är en känsla som omfattar lusten att ha en sexuell upplevelse, känslan av att vara mottaglig för en partners sexuella initiativtagande, samt tankar och fantasier om att ha samlag. 1. Under de senaste fyra veckorna, hur ofta har du känt sexuell lust eller sexuellt intresse? Nästan alltid eller alltid □ Större delen av (mer än halva) tiden □ Delar av (ungefär halva) tiden □ Några gånger (mindre än halva tiden) □ Nästan aldrig eller aldrig □ 2. Under de senaste fyra veckorna, hur skulle du bedöma din nivå (grad) av sexuell lust eller sexuellt intresse? Mycket hög □ Hög □ Måttlig □ Låg □ Mycket låg eller ingen alls □ Sexuell upphetsning är en känsla som innebär både fysiska är en känsla som och mentala aspekter. Det kan innebära känslor av värma eller pirrande i könsorgan, fuktighet eller muskelsammandragningar. 3. Under de senaste fyra veckorna, hur ofta har du känt dig sexuellt upphetsad (“kåt”) vid sexuell aktivitet eller samlag? Ingen sexuell aktivitet □ Nästan alltid eller alltid □ Mer än hälften av gångerna □ Ungefär hälften av gångerna □ Mindre än hälften av gångerna □ Nästan aldrig eller aldrig □ 4. Under de senaste fyra veckorna, hur skulle du bedöma din nivå (grad) av sexuell upphetsning vid sexuell aktivitet eller samlag? Ingen sexuell aktivitet □ Mycket hög □ Hög □ Måttlig □ Låg □ Mycket låg eller ingen alls □

J Sex Med 2015;12:341–349

5. Under de senaste fyra veckorna, hur säker var du på att bli sexuellt upphetsad vid sexuell aktivitet eller samlag? Ingen sexuell aktivitet □ Väldigt säker □ Mycket säker □ Måttligt säker □ Ganska osäker □ Mycket osäker eller fullständigt osäker □ 6. Under samma tid, hur ofta har du varit tillfredsställd med din känsla av upphetsning vid sexuell aktivitet eller samlag? Ingen sexuell aktivitet □ Nästan alltid eller alltid □ Mer än hälften av gångerna □ Ungefär hälften av gångerna □ Mindre än hälften av gångerna □ Nästan aldrig eller aldrig □ 7. Under de senaste fyra veckorna, hur ofta har du blivit fuktig (“våt”) vid sexuell aktivitet eller samlag? Ingen sexuell aktivitet □ Nästan alltid eller alltid □ Mer än hälften av gångerna □ Ungefär hälften av gångerna □ Mindre än hälften av gångerna □ Nästan aldrig eller aldrig □ 8. Under de senaste fyra veckorna, hur svårt har det varit att bli fuktig (“våt”) vid sexuell aktivitet eller samlag? Ingen sexuell aktivitet □ Extremt svårt eller omöjligt □ Mycket svårt □ Svårt □ Lite svårt □ Inte svårt □ 9. Under de senaste fyra veckorna, hur ofta har du bibehållit din fuktighet till dess att sexuell aktivitet eller samlag har fullbordats? Ingen sexuell aktivitet □ Nästan alltid eller alltid □ Mer än hälften av gångerna □ Ungefär hälften av gångerna □ Mindre än hälften av gångerna □ Nästan aldrig eller aldrig □ 10. Under de senaste fyra veckorna, hur svårt har det varit att bibehålla din fuktighet till dess att sexuell aktivitet eller samlag har fullbordats? Ingen sexuell aktivitet □ Extremt svårt eller omöjligt □ Mycket svårt □ Svårt □ Lite svårt □ Inte svårt □ 11. Under de senaste fyra veckorna, hur ofta har fått orgasm genom sexuell stimulans eller samlag? Ingen sexuell aktivitet □ Nästan alltid eller alltid □ Mer än hälften av gångerna □ Ungefär hälften av gångerna □ Mindre än hälften av gångerna □ Nästan aldrig eller aldrig □ 12. Under de senaste fyra veckorna, hur svårt har det varit att få orgasm genom sexuell stimulans eller samlag? Ingen sexuell aktivitet □ Extremt svårt eller omöjligt □ Mycket svårt □ Svårt □ Lite svårt □ Inte svårt □

Validation of Swedish FSFI 13. Under de senaste fyra veckorna, hur tillfredsställd har du varit med din förmåga att få orgasm genom sexuell stimulans eller samlag? Ingen sexuell aktivitet □ Mycket tillfredsställd □ Måttligt tillfredsställd □ Lika tillfredsställd som otillfredsställd □ Något otillfredsställd □ Mycket otillfredsställd □ 14. Under de senaste fyra veckorna, hur tillfredsställd har du varit med den känslomässiga närheten mellan dig och din partner vid sexuell aktivitet? Ingen sexuell aktivitet □ Mycket tillfredsställd □ Måttligt tillfredsställd □ Lika tillfredsställd som otillfredsställd □ Något otillfredsställd □ Mycket otillfredsställd □ 15. Under de senaste fyra veckorna, hur tillfredsställd har du varit med ditt sexuella förhållande med din partner? Mycket tillfredsställd □ Måttligt tillfredsställd □ Lika tillfredsställd som otillfredsställd □ Något otillfredsställd □ Mycket otillfredsställd □

349 17. Under de senaste fyra veckorna, hur ofta har du upplevt obehag eller smärta vid vaginalt samlag? Inga försök till samlag □ Nästan alltid eller alltid □ Mer än hälften av gångerna □ Ungefär hälften av gångerna □ Mindre än hälften av gångerna □ Nästan aldrig eller aldrig □ 18. Under de senaste fyra veckorna, hur ofta har du upplevt obehag eller smärta efter vaginalt samlag? Inga försök till samlag □ Nästan alltid eller alltid □ Mer än hälften av gångerna □ Ungefär hälften av gångerna □ Mindre än hälften av gångerna □ Nästan aldrig eller aldrig □ 19. Under de senaste fyra veckorna, hur skulle du bedöma din nivå (grad) av obehag eller smärta vid eller efter vaginalt samlag? □ Inga försök till samlag Mycket hög □ Hög □ Måttlig □ Låg □ Mycket låg eller ingen alls □

16. Under de senaste fyra veckorna, hur tillfredsställd har du varit med ditt sexliv i allmänhet? Mycket tillfredsställd □ Måttligt tillfredsställd □ Lika tillfredsställd som otillfredsställd □ Något otillfredsställd □ Mycket otillfredsställd □

J Sex Med 2015;12:341–349

Validation of the Swedish version of the Female Sexual Function Index (FSFI) in women with hypoactive sexual desire disorder.

The Female Sexual Function Index (FSFI) has been validated for use in many countries. It has been used for clinical and research purposes in Sweden, b...
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