Female Sexual Function Index (FSFI)

Abstract

The Female Sexual Function Index (FSFI) is a concise, 19-item, multidimensional self-report instrument developed to assess the key dimensions of female sexual function (FSF). It is widely utilized in clinical research, epidemiological studies, and therapeutic trials to evaluate the efficacy of interventions aimed at improving sexual health. The scale measures sexual functioning over the preceding four weeks and yields scores across six domains: Desire, Arousal, Lubrication, Orgasm, Satisfaction, and Pain. The FSFI has demonstrated robust psychometric properties, making it a gold standard for quantifying the severity of Female Sexual Dysfunction (FSD).

Keywords

Female Sexual Function Index, FSFI, female sexual dysfunction, FSD, sexual desire, sexual arousal, lubrication, orgasm, sexual satisfaction, dyspareunia, self-report instrument, psychometrics

Authors

Raymond Rosen, Caroline Brown, Julia Heiman, Sandra Leiblum, Cindy Meston, Rany Shabsigh, Donna Ferguson, Ralph D’Agostino, Jr.

Purpose

The primary purpose of the FSFI is to provide a standardized, validated, and comprehensive measure for assessing the quality and frequency of female sexual response. It was specifically developed to address the lack of reliable instruments available for objective measurement in clinical settings and pharmacological trials related to sexual health. By quantifying six distinct domains of sexual function, the FSFI allows clinicians and researchers to pinpoint specific areas of difficulty experienced by the respondent.

The scale is crucial for establishing baseline measures of sexual function, monitoring changes due to medical or psychological treatment, and determining the prevalence and incidence of female sexual dysfunction in diverse populations. Its multidimensional design ensures that both the physical and emotional components of sexual experience are captured, offering a holistic view of the respondent’s sexual health over the specified time frame of the past four weeks.

Construct

The FSFI measures the overarching construct of Female Sexual Function (FSF), operationalized through six distinct subscales or domains. This multidimensional approach recognizes that sexual function is a complex process involving psychological, physiological, and interpersonal components. The six domains are derived from clinical consensus regarding the core components necessary for a satisfying sexual experience in women.

The six domains and their corresponding items are:

• Desire (Items 1-2): Measures the frequency and level of sexual interest.
• Arousal (Items 3-6): Measures subjective feelings of sexual excitement and physical responsiveness.
• Lubrication (Items 7-10): Measures the physiological response of vaginal wetness and the difficulty in maintaining it.
• Orgasm (Items 11-13): Measures the frequency and satisfaction associated with reaching climax.
• Satisfaction (Items 14-16): Measures overall contentment with the sexual relationship, emotional closeness, and general sexual life.
• Pain (Items 17-19): Measures the frequency and degree of discomfort or pain experienced during or following vaginal penetration (dyspareunia).

Validity

The FSFI has demonstrated strong evidence of validity since its inception. Content validity was established through rigorous review and refinement by a panel of international experts in sexual medicine, ensuring that the items adequately cover the recognized domains of female sexual function. Construct validity is supported by the consistent finding of the six-factor structure across multiple studies and populations, confirming that the subscales measure their intended unique constructs.

Furthermore, the scale exhibits excellent discriminant validity, effectively differentiating between women identified as having sexual dysfunction and those who are sexually functional. Convergent validity is established through significant correlations between FSFI subscale scores and scores from other established measures of sexual health and relationship satisfaction. The scoring algorithm provides a total score that serves as a robust indicator of overall sexual function, often used to determine the clinical cutoff for FSD diagnosis.

Reliability

The reliability of the FSFI is considered high, supporting its use as a consistent and dependable measurement tool. The scale exhibits high internal consistency, meaning that items within each of the six domains are highly correlated and measure the same underlying construct. Initial studies by Rosen et al. (2000) reported strong Cronbach’s alpha coefficients for the total scale and for all six domains, confirming that the measure is internally coherent.

In addition to internal consistency, the FSFI has demonstrated robust test-retest reliability. Studies involving re-administration of the instrument over short intervals to stable populations have shown high correlation coefficients, confirming that the scale provides consistent results over time, provided the respondent’s sexual function status has not clinically changed. This stability is critical for using the FSFI to track therapeutic progress in longitudinal studies.

Factor Analysis

The foundational psychometric work on the FSFI, performed by the original authors, utilized factor analysis to confirm the underlying structure of the scale. The factor analysis strongly supported a six-factor model, corresponding precisely to the six domains: Desire, Arousal, Lubrication, Orgasm, Satisfaction, and Pain. This clear factor structure demonstrated that each domain represents a relatively independent component of female sexual function.

The results of the factor analysis confirmed the multidimensional nature of the instrument, validating the clinical decision to score the instrument not only as a total score but also through individual domain scores. This structure ensures that researchers and clinicians can identify specific dysfunctions (e.g., isolated lubrication problems versus generalized desire issues) rather than relying solely on a single global score.

Instrument

Test Type: Self-report questionnaire / Psychometric Scale

Format: 19 items, scored primarily on a 5-point Likert scale, with specific scoring adjustments (0 to 5) depending on the item and the inclusion of a “No sexual activity” option (scored as 0).

Language Available: English (Original), widely translated and validated in numerous languages globally (e.g., Spanish, Chinese, German, French, Arabic).

Population Group: Adult women

Age Group: Typically used with women aged 18 and older.

Population Details: Developed and validated initially across women with and without documented sexual dysfunction, covering diverse ethnic and clinical backgrounds.

Test Methodology: Respondents answer questions retrospectively, reflecting on their sexual feelings and responses during the past four weeks. Scores are calculated by summing weighted domain scores, resulting in a maximum total score of 36.

Keywords

Sexual health assessment, psychometric validation, self-report measure, sexual response cycle, female sexual medicine, clinical research tool

Authors

Author ORCID Identifier: N/A (Information not available in source content)

Affiliation Email addresses: N/A (Information not available in source content)

Correspondence Address: Raymond Rosen Ph.D., Department of Psychiatry: UMDNJ-Robert Wood Johnson Medical School, 675 Hoes Lane, Piscataway, NJ 08854 (as per original source)

Permissions & Fee and Test Year

The FSFI was first published and standardized in 2000. Information regarding current usage permissions and associated fees should be directed to the copyright holders or the official FSFI website.

The original PDF of the instrument, including instructions and scoring, is available online. The original PDF can be downloaded here: http://www.fsfi-questionnaire.com/FSFI%20questionnaire2000.pdf

Reference’s

ROSEN, R., BROWN, C., HEIMAN, J., LEIBLUM, S., MESTON, C., SHABSIGH, R., FERGUSON, D., & D’AGOSTINO, JR., R. (2000). The Female Sexual Function Index (FSFI): A Multidimensional Self-Report Instrument for the Assessment of Female Sexual Function. Journal of Sex & Marital Therapy, 26(2), 191–208.

Further information is available at the official website: http://www.fsfi-questionnaire.com/

Items of the Female Sexual Function Index (FSFI)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Subject Identifier ________________________ Date ________________

INSTRUCTIONS: These questions ask about your sexual feelings and responses during the past 4 weeks. Please answer the following questions as honestly and clearly as possible. Your responses will be kept completely confidential. In answering these questions the following definitions apply:

Sexual activity can include caressing‚ foreplay‚ masturbation and vaginal intercourse.

Sexual intercourse is defined as penile penetration (entry) of the vagina.

Sexual stimulation includes situations like foreplay with a partner‚ self-stimulation (masturbation)‚ or sexual fantasy.

CHECK ONLY ONE BOX PER QUESTION.

Sexual desire or interest is a feeling that includes wanting to have a sexual experience‚ feeling receptive to a partner’s sexual initiation‚ and thinking or fantasizing about ha‎ving sex.

1. Over the past 4 weeks‚ how often did you feel sexual desire or interest?

5=Almost always or always/ 4= Most times (more than half the time)/ 3=Sometimes (about half the time)/ 2=A few times (less than half the time)/ 1=Almost never or never

2. Over the past 4 weeks‚ how would you rate your level (degree) of sexual desire or interest?

5=Very high/ 4=High/ 3=Moderate/ 2=Low/ 1=Very low or none at all

Sexual arousal is a feeling that includes both physical and mental aspects of sexual excitement. It may include feelings of warmth or tingling in the genitals‚ lubrication (wetness)‚ or muscle contractions.

3. Over the past 4 weeks‚ how often did you feel sexually aroused (“turned on”) during sexual activity or intercourse?

0=No sexual activity/ 5=Almost always or always/ 4=Most times (more than half the time)/ 3=Sometimes (about half the time)/ 2=A few times (less than half the time)/ 1=Almost never or never

4. Over the past 4 weeks‚ how would you rate your level of sexual arousal (“turn on”) during sexual activity or intercourse?

0=No sexual activity/ 5=Very high/ 4=High/ 3=Moderate/ 2=Low/ 1=Very low or none at all

5. Over the past 4 weeks‚ how confident were you about becoming sexually aroused during sexual activity or intercourse?

0=No sexual activity/ 5=Very high confidence/ 4=High confidence/ 3=Moderate confidence/ 2=Low confidence / 1= Very low or no confidence

6. Over the past 4 weeks‚ how often have you been satisfied with your arousal (excitement) during sexual activity or intercourse?

0=No sexual activity/ 5=Almost always or always/ 4=Most times (more than half the time)/ 3=Sometimes (about half the time)/ 2=A few times (less than half the time)/ 1=Almost never or never

7. Over the past 4 weeks‚ how often did you become lubricated (“wet”) during sexual activity or intercourse?

0=No sexual activity/ 5=Almost always or always/ 4=Most times (more than half the time)/ 3=Sometimes (about half the time)/ 2=A few times (less than half the time)/ 1=Almost never or never

8. Over the past 4 weeks‚ how difficult was it to become lubricated (“wet”) during sexual activity or intercourse?

0=No sexual activity/ 1=Extremely difficult or impossible/ 2=Very difficult/ 3=Difficult/ 4=Slightly difficult/ 5=Not difficult

9. Over the past 4 weeks‚ how often did you maintain your lubrication (“wetness”) until completion of sexual activity or intercourse?

0=No sexual activity/ 5=Almost always or always/ 4=Most times (more than half the time)/ 3=Sometimes (about half the time)/ 2=A few times (less than half the time)/ 1=Almost never or never

10. Over the past 4 weeks‚ how difficult was it to maintain your lubrication (“wetness”) until completion of sexual activity or intercourse?

0=No sexual activity/ 1=Extremely difficult or impossible/ 2=Very difficult/ 3=Difficult/ 4=Slightly difficult/ 5=Not difficult

11. Over the past 4 weeks‚ when you had sexual stimulation or intercourse‚ how often did you reach orgasm (climax)?

0=No sexual activity/ 5=Almost always or always/ 4=Most times (more than half the time)/ 3=Sometimes (about half the time)/ 2=A few times (less than half the time)/ 1=Almost never or never

12. Over the past 4 weeks‚ when you had sexual stimulation or intercourse‚ how difficult was it for you to reach orgasm (climax)?

0=No sexual activity/ 1=Extremely difficult or impossible/ 2=Very difficult/ 3=Difficult/ 4=Slightly difficult/ 5=Not difficult

13. Over the past 4 weeks‚ how satisfied were you with your ability to reach orgasm (climax) during sexual activity or intercourse?

0=No sexual activity/ 5=Very satisfied/ 4=Moderately satisfied/ 3=About equally satisfied and dissatisfied/ 2=Moderately dissatisfied/ 1=Very dissatisfied

14. Over the past 4 weeks‚ how satisfied have you been with the amount of emotional closeness during sexual activity between you and your partner?

0=No sexual activity/ 5=Very satisfied/ 4=Moderately satisfied/ 3=About equally satisfied and dissatisfied/ 2=Moderately dissatisfied/ 1=Very dissatisfied

15. Over the past 4 weeks‚ how satisfied have you been with your sexual relationship with your partner?

5=Very satisfied/ 4=Moderately satisfied/ 3=About equally satisfied and dissatisfied/ 2=Moderately dissatisfied/ 1=Very dissatisfied

16. Over the past 4 weeks‚ how satisfied have you been with your overall sexual life?

5=Very satisfied/ 4=Moderately satisfied/ 3=About equally satisfied and dissatisfied/ 2=Moderately dissatisfied/ 1=Very dissatisfied

17. Over the past 4 weeks‚ how often did you experience discomfort or pain during vaginal penetration?

0=Did not attempt intercourse/ 1=Almost always or always/ 2=Most times (more than half the time)/ 3=Sometimes (about half the time)/ 4=A few times (less than half the time)/ 5=Almost never or never

18. Over the past 4 weeks‚ how often did you experience discomfort or pain following vaginal penetration?

0=Did not attempt intercourse/ 1=Almost always or always/ 2=Most times (more than half the time)/ 3=Sometimes (about half the time)/ 4=A few times (less than half the time)/ 5=Almost never or never

19.Over the past 4 weeks‚ how would you rate your level (degree) of discomfort or pain during or following vaginal penetration?

0=Did not attempt intercourse/ 1=Very high/ 2=High/ 3=Moderate/ 4=Low/ 5=Very low or none at all