Changes in Sexual Function Questionnaire

Abstract

The Changes in Sexual Functioning Questionnaire (CSFQ) was developed by Anita H. Clayton and Elizabeth L. McGarvey to provide a brief, valid, and reliable assessment instrument for evaluating sexual functioning in both clinical and research environments. The scale originated from documented patient complaints regarding sexual difficulties and the known sexual side effects associated with psychotropic medications.

The initial version, the CSFQ-I (Clinical Interview), was extensive (35 items for females, 36 for males) and designed for diagnosing and managing sexual dysfunction, particularly addressing the underrepresented symptoms of female sexual problems, such as lack of desire. Shorter, self-report versions—the 14-item CSFQ-14-F (Female) and CSFQ-14-M (Male)—were subsequently derived and validated, focusing on the five core domains of the sexual response cycle: sexual desire, sexual frequency, sexual satisfaction, sexual arousal, and sexual completion (orgasm). The CSFQ is widely used across various psychiatric and medical populations.

Keywords

Sexual Functioning, Sexual Dysfunction, CSFQ, Sexual Response Cycle, Psychotropic Medications, Sexual Desire, Sexual Arousal, Sexual Orgasm, Psychometric Properties, Clinical Assessment, Self-Report Questionnaire.

Authors

Anita H. Clayton, Elizabeth L. McGarvey.

Purpose

The primary purpose of the CSFQ is to provide a standardized, gender-specific tool for the assessment of sexual functioning across the full spectrum of the sexual response cycle. It is designed for use in general clinical practice, particularly in psychiatric settings where medication side effects are common, and in research studies examining sexual health outcomes.

A crucial function of the original CSFQ-I was its ability to document changes in sexual patterns over time, allowing clinicians to differentiate between lifelong sexual dysfunction, current dysfunction, or changes specifically related to medication, illness, or relationship factors, thereby guiding strategically targeted treatment strategies.

Construct

The CSFQ measures the construct of Sexual Functioning, conceptualized across five distinct domains that map onto the human sexual response cycle:

• Sexual Desire: Measured both as frequency of activity and interest (thoughts/fantasies).
• Sexual Frequency: How often the individual engages in sexual activity.
• Sexual Satisfaction/Pleasure: Overall enjoyment of sexual life.
• Sexual Arousal/Excitement: The ability to become and remain aroused (e.g., vaginal lubrication in females, erection in males).
• Sexual Completion/Orgasm: Frequency, ability, and pleasure derived from orgasms.

The scale was specifically developed to capture nuances in sexual problems, such as reduced quality of life stemming from lack of desire, which were often overlooked by instruments focusing primarily on male issues like erectile dysfunction.

Validity

Face Validity was established during the development process by having physicians, clinicians, and researchers review the items for accuracy and clarity regarding the five core aspects of sexual functioning. This ensured the instrument appeared relevant and appropriate for its intended clinical and research use.

Concurrent Validation for the CSFQ-I (Clinical Interview) was demonstrated through correlation with scores obtained from the Derogatis Interview for Sexual Functioning (DISF) (Derogatis, 1997), confirming that the CSFQ measures similar constructs to established instruments.

Reliability

The psychometric properties of the CSFQ demonstrate strong reliability. For the initial CSFQ-I, alpha coefficients and item total correlations ranged from 0.45 to 0.60, and high test-retest reliability was reported (Clayton, McGarvey, Clavet, & Piazza, 1997).

Regarding Internal Reliability, the 14-item short-form versions showed excellent internal consistency. The total score demonstrated a Cronbach’s alpha coefficient of .90 for the CSFQ-14-F (Females) and .89 for the CSFQ-14-M (Males) (Keller et al., 2006).

Factor Analysis

The CSFQ structure is conceptually grounded in the five key domains of the sexual response cycle, which are reflected in the established subscales derived from the 14 scored items. These domains allow for detailed analysis of specific areas of dysfunction rather than relying solely on a global score.

The established subscales and the items used to calculate them are:

• Pleasure/Overall Satisfaction (Item 1)
• Desire/Frequency (Items 2 + 3)
• Desire/Interest (Items 4 + 5 + 6)
• Arousal/Excitement (Items 7 + 8 + 9)
• Orgasm/Completion (Items 11 + 12 + 13)

Items 10 and 14 are included in the calculation of the total score but are not assigned to a specific subscale dimension in the primary scoring protocol.

Instrument

Test Type: Clinical Interview (CSFQ-I) and Self-Report Questionnaire (CSFQ-14-F/M)

Format: The 14-item short form (CSFQ-14) uses a 5-point scale. A score of “1” typically indicates Never or No Enjoyment or Pleasure, while a score of “5” indicates Every Day or Always. Some items (e.g., Item 10 and 14) are reverse-scored to reflect symptom presence.

Language Available: English (Original) and 51 linguistically validated translations, including a validated Spanish version with established norms (Bobes et al., 2000).

Population Group: Clinical and Non-Clinical populations, with specific versions for males and females.

Age Group: Adults (typically used in studies involving psychopathology, medication effects, and conditions like menopause or cancer).

Population Details: The CSFQ has been administered across over 75 studies involving psychiatric populations (e.g., Major Depressive Disorder, Schizophrenia, Bipolar Illness, OCD, ADHD, Alcohol Dependence) and patients with various medical illnesses (e.g., cancer, obesity, diabetes mellitus/metabolic syndrome, rheumatologic illness, spinal cord injury, BPH, and vulvar pain).

Test Methodology: The full CSFQ-I requires a clinician interview lasting between 30 and 45 minutes. The CSFQ-14 short forms are self-scored and require only 4 to 5 minutes to complete.

Keywords

Clinical Psychiatry, Sexual Health, Female Sexual Dysfunction, Male Sexual Dysfunction, Psychopharmacology, Virginia School of Medicine, Cronbach’s Alpha, Test-Retest Reliability.

Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: [email protected] (Dr. Anita H. Clayton)

Correspondence Address: Anita H. Clayton, MD, David C. Wilson Professor, Department of Psychiatry and Neurobehavioral Science, University of Virginia, 2955 Ivy Road, Suite 210, Charlottesville, VA 22903.

Permissions & Fee and Test Year

All versions of the CSFQ are protected under copyright to Anita H. Clayton, MD. Use of the measures for clinical purposes is typically provided upon request to Dr. Clayton. Use for research may be approved with or without charge, depending upon the type of project being undertaken. Citation of use is always required.

Test Year (Initial Publication): 1997.

Reference’s

• Bobes, J., Gonzalez, M. P., Rico-Villademoros, R., Bascaran, M. T., Sarasa, P., & Clayton, A. (2000). Validation of the Spanish version of the Changes in Sexual Functioning Questionnaire-CSFQ. Journal of Sex and Marital Therapy, 26, 119–131.
• Clayton, A. H., McGarvey, E. L., & Clavet, G. J. (1997). The Changes in Sexual Functioning Questionnaire (CSFQ): Development, reliability, and validity. Psychopharmacology Bulletin, 33, 731–745.
• Clayton, A. H., McGarvey, E. L., Clavet, G. J., & Piazza, L. (1997). Comparison of sexual functioning in clinical and non-clinical populations using the Changes in Sexual Functioning Questionnaire (CSFQ). Psychopharmacology Bulletin, 33, 747–753.
• Clayton, A. H., Pradko, J. F., Croft, H. A., Montano, C. B., Leadbetter, R. A., Bolden-Watson, C., et al. (2002). Prevalence of sexual dysfunction among newer antidepressants. Journal of Clinical Psychiatry, 63, 357–366.
• Derogatis, L. R. (1997). The Derogatis Interview for Sexual Functioning (DISF/DISF-SR): An introductory report. Journal of Sex and Marital Therapy, 23, 291–304.
• Keller, A., McGarvey, E. L., & Clayton, A. H. (2006). Reliability and construct validity of the Changes in Sexual Functioning Questionnaire Short-Form (CSFQ-14). Journal of Sex and Marital Therapy, 32, 43–52.
• Lagana, L., McGarvey, E. L., Classen, C., & Koopman, C. (2001). Psychosexual dysfunction among gynecological cancer survivors. Journal of Clinical Psychology in Medical Settings, 8, 73–84.
• Warnock, J. K., Swanson, S. G., Boren, R. W., Zipfel, L. M., & Brennan, J. J. (2005). Combined esterified estrogen and methyltestosterone versus esterified estrogens alone in the treatment of loss of sexual interest in surgically-menopausal women. Menopause, 12, 374–84.

Items of the Changes in Sexual Functioning Questionnaire

Changes in Sexual Functioning Questionnaire for Females (CSFQ-F-C)

Note: This is a questionnaire about sexual activity and sexual function. By sexual activity, we mean sexual intercourse, masturbation, sexual fantasies, and other activity.

1. Compared with the most enjoyable it has ever been, how enjoyable or pleasurable is your sexual life right now?

   D 1 No Enjoyment or Pleasure D 2 Little Enjoyment or Pleasure D 3 Some Enjoyment or Pleasure D 4 Much Enjoyment or Pleasure D 5 Great Enjoyment or Pleasure

2. How frequently do you engage in sexual activity (sexual intercourse, masturbation, etc.) now?

   D 1 Never

   D 2 Rarely (once a month or less)

   D 3 Sometimes (more than once a month, up to twice a week)

   D 4 Often (more than twice a week)

   D 5 Every Day

3. How often do you desire to engage in sexual activity?

   D 1 Never

   D 2 Rarely (once a month or less)

   D 3 Sometimes (more than once a month, up to twice a week)

   D 4 Often (more than twice a week)

   D 5 Every Day

4. How frequently do you engage in sexual thoughts (thinking about sex, sexual fantasies) now?

   D 1 Never

   D 2 Rarely (once a month or less)

   D 3 Sometimes (more than once a month, up to twice a week)

   D 4 Often (more than twice a week)

   D 5 Every Day

5. Do you enjoy books, movies, music, or artwork with sexual content?

   D 1 Never

   D 2 Rarely (once a month or less)

   D 3 Sometimes (more than once a month, up to twice a week)

   D 4 Often (more than twice a week)

   D 5 Every Day

6. How much pleasure or enjoyment do you get from thinking about and fantasizing about sex?

   D 1 No Enjoyment or Pleasure D 2 Little Enjoyment or Pleasure D 3 Some Enjoyment or Pleasure D 4 Much Enjoyment or Pleasure D 5 Great Enjoyment or Pleasure

7. How often do you become sexually aroused?

   D 1 Never

   D 2 Rarely (once a month or less)

   D 3 Sometimes (more than once a month, up to twice a week)

   D 4 Often (more than twice a week)

   D 5 Every Day

8. Are you easily aroused?

   D 1 Never

   D 2 Rarely (much less than half the time)

   D 3 Sometimes (about half the time)

   D 4 Often (much more than half the time)

   D 5 Always

9. Do you have adequate vaginal lubrication during sexual activity?

   D 1 Never

   D 2 Rarely (much less than half the time)

   D 3 Sometimes (about half the time)

   D 4 Often (much more than half the time)

   D 5 Always

10. How often do you become aroused and then lose interest?

    D 5 Never

    D 4 Rarely (much less than half the time)

    D 3 Sometimes (about half the time)

    D 2 Often (much more than half the time)

    D 1 Always

11. How often do you experience an orgasm?

    D 1 Never

    D 2 Rarely (much less than half the time)

    D 3 Sometimes (about half the time)

    D 4 Often (much more than half the time)

    D 5 Always

12. Are you able to have an orgasm when you want to?

    D 1 Never

    D 2 Rarely (much less than half the time)

    D 3 Sometimes (about half the time)

    D 4 Often (much more than half the time)

    D 5 Always

13. How much pleasure or enjoyment do you get from your orgasms?

    D 1 No Enjoyment or Pleasure D 2 Little Enjoyment or Pleasure D 3 Some Enjoyment or Pleasure D 4 Much Enjoyment or Pleasure D 5 Great Enjoyment or Pleasure

14. How often do you have painful orgasm?

D 5 Never

D 4 Rarely (once a month or less)

D 3 Sometimes (more than once a month, up to twice a week)

D 2 Often (more than twice a week)

D 1 Every Day

       = Pleasure (Item 1)

       = Desire/Frequency (Item 2 + Item 3)

       = Desire/Interest (Item 4 + Item 5 + Item 6)

       = Arousal/Excitement (Item 7 + Item 8 + Item 9)

       = Orgasm/Completion (Item 11 + Item 12 + Item 13)

       = Total CSFQ Score (Items 1 to 14)

Changes in Sexual Functioning Questionnaire for Males (CSFQ-M-C)—sample items only

Note: This is a questionnaire about sexual activity and sexual function. By sexual activity, we mean sexual intercourse, masturbation, sexual fantasies, and other activity.

• How often do you have an erection related or unrelated to sexual activity?

D 1 Never

D 2 Rarely (once a month or less)

D 3 Sometimes (more than once a month, up to twice a week)

D 4 Often (more than twice a week)

D 5 Every Day

• Do you get an erection easily?

D 1 Never

D 2 Rarely (much less than half the time)

D 3 Sometimes (about half the time)

D 4 Often (much more than half the time)

D 5 Always