Derogatis Sexual Functioning Inventory

Abstract

The Derogatis Sexual Functioning Inventory (DSFI) is an omnibus self-report measure designed to quantify the quality of an individual’s current sexual functioning. It is inherently multidimensional, reflecting the understanding that successful human sexual functioning is a highly multidetermined behavior resulting from a complex interplay of endocrine, emotional, cognitive, and experiential factors. The DSFI provides a comprehensive profile by quantifying ten principal dimensions of the patient’s sexual experience, thereby offering critical insight into both the nature and magnitude of any identified sexual dysfunction. The inventory integrates measures of core sexual constructs (e.g., drive, sexual satisfaction) with assessments of general well-being, utilizing components such as the Brief Symptom Inventory (BSI) and the Derogatis Affects Balance Scale (DABS).

Keywords

DSFI, Sexual Functioning, Sexual Dysfunction, Psychosexual Assessment, Sexual Functioning Index (SFI), Self-Report Inventory, Body Image, Psychological Symptoms, Affects Balance.

Authors

Leonard R. Derogatis

Purpose

The primary purpose of the Derogatis Sexual Functioning Inventory (DSFI) is to provide a comprehensive, standardized, and psychometric assessment of an individual’s current level and nature of sexual functioning. It is conceptualized around the central evaluative question in the clinical assessment of sexual disorder, allowing clinicians and researchers to move beyond simple enumeration of sexual episodes or orgasms.

Since its introduction in the mid-1970s, the DSFI has been widely utilized as an objective outcome measure in multiple empirical studies of sexual functioning. The instrument’s dimension and global scores have proven sufficiently sensitive to discriminate differences across various clinical groups, including large effect sizes (e.g., gender-dysphoric patients versus normal heterosexuals) and more demanding clinical comparisons (e.g., sexual functioning in diabetic versus normal women).

Construct

The DSFI measures the construct of successful human sexual functioning, viewing it as a complex, multidetermined behavior. The inventory specifically assesses constructs fundamental to sexual health, such as drive, body image, and sexual satisfaction, while simultaneously measuring basic indicators of general well-being, including affects balance and psychological distress.

The scale is composed of 10 substantive dimensions judged to reflect the principal components of sexual behavior. By focusing on the individual respondent, the DSFI ensures that the quality of sexual functioning is ultimately appreciated and quantified based on the individual’s subjective experience, regardless of context.

Validity

The DSFI is supported by published studies from the author and numerous other independent investigators suggesting it is a highly valid measure of the construct of sexual functioning.

Over four dozen published studies exist demonstrating the instrument’s effectiveness as a measure of functional discrimination and outcomes across a broad variety of medical treatment populations. The majority of these studies show the DSFI to be highly sensitive to naturally occurring and disease-induced interference with sexual functioning, as well as to positive treatment effects resulting from interventions such as penile implant surgery (inflatable vs. noninflatable prostheses).

Reliability

The DSFI exhibits high levels of reliability, both in terms of internal consistency and test-retest stability. Derogatis and Melisaratos (1979) reported internal consistency reliability coefficients based on an N of 325 that ranged between 0.60 and 0.97.

Test-retest coefficients, measured across a 14-day interval, were consistently strong, ranging predominantly from the high 0.70s to the low 0.90s. Further validation by Howell et al. (1987) reported test-retest coefficients over a 14-day period that were all greater than 0.70.

Factor Analysis

The DSFI is structured around 10 substantive dimensions that constitute the principal components of sexual behavior. While the overall scale structure is multidimensional, two of its constituent subtests are complete, validated, and multidimensional instruments themselves: the Psychological Symptoms subtest utilizes the Brief Symptom Inventory (BSI), which has nine underlying dimensions (e.g., Depression, Anxiety), and the Affects subtest uses the Derogatis Affects Balance Scale (DABS), which measures positive and negative affects. This integrated structure ensures that both sexual and general psychological factors contribute to the overall psychometric assessment.

Instrument

Test Type: Omnibus self-report inventory for psychosexual assessment.

Format: The inventory consists of 254 items arranged into 10 distinct subtests. Response formats vary significantly, ranging from simple endorsements of yes or no to multiple-point Likert-type scales.

Language Available: Arabic, Chinese, English, French, French Canadian, Indian, Korean, Norwegian, Spanish, and Turkish.

Population Group: Adults undergoing clinical assessment for sexual disorders, as well as non-clinical populations for research purposes.

Age Group: Adults (The normative sample had a mean age of 32).

Population Details: Norms for the DSFI were developed using a sample of 230 individuals attending university continuing education classes. The sample was largely homogeneous, with 80% identifying as White, a mean age (M) of 32, and most possessing some college education. Approximately 60% were married, and 75% came from middle-class or upper-middle-class backgrounds.

Test Methodology: The DSFI generates two primary global scores: the Sexual Functioning Index (SFI) and the Global Sexual Satisfaction Index (GSSI). The SFI is a total summary score calculated by summing the 10 subtest scores after they are transformed to area t-scores (μ = 50; SD = 10). The GSSI is a separate measure reflecting the individual’s subjective perception of the quality of their sexual behavior on a 9-point scale.

Keywords

Sexual Satisfaction, Drive, Body Image, Attitudes, Affects, Psychological Symptoms, Gender Role Definition, Fantasy, Clinical Psychometric Research Inc., Outcome Measure.

Authors

Author ORCID Identifier: Not specified in source content.

Affiliation Email addresses: [email protected]

Correspondence Address: Leonard R. Derogatis, Johns Hopkins Department of Psychiatry and Behavioral Sciences––Center for Sexual Medicine at Sheppard Pratt, Baltimore, MD 21285.

Permissions & Fee and Test Year

The conceptual basis for the DSFI was outlined by Leonard R. Derogatis in 1976, with the preliminary scoring manual published in 1975. The DSFI is distributed exclusively by Clinical Psychometric Research, Inc. (www.derogatis-tests.com).

Reference’s

• Conte, H. R. (1989). Development and use of self-report techniques for assessing sexual function: A review and critique. Archives of Sexual Behavior, 12, 555–576.

• Derogatis, L. R. (1975). Derogatis Sexual Functioning Inventory (DSFI): Preliminary scoring manual. Baltimore, MD: Clinical Psychometric Research Inc.

• Derogatis, L. R., Meyer, J. K., & Dupkin, C. N. (1976). Discrimination of organic versus psychogenic impotence with the DSFI (Derogatis Sexual Functioning Inventory). Journal of Sex & Marital Therapy, 2, 229–240.‌

• Derogatis, L. R. (1980). Psychological assessment of psychosexual functioning. In J. K. Meyer (Ed.), The Psychiatric Clinics of North America Symposium on Sexuality (pp. 113–131). Philadelphia: Saunders.

• Derogatis, L. R. (1993). Brief Symptom Inventory: Administration, scoring, and procedures manual (3rd ed.). Minneapolis, MN: National Computer Systems.

• Derogatis, L. R., & Rutigliano, P. J. (1996). Derogatis Affects Balance Scale. In B. Spiker (Ed.), Quality of life and pharmacoeconomics in clinical trials (2nd ed., pp. 160–177). Philadelphia: Lippincott- Raven.

• Derogatis, L. R., Lopez, M. C., & Zinzeletta, E. M. (1988). Clinical applications of the DSFI in the assessment of sexual dysfunctions. In R. Brown & E. Roberts (Eds.), Advances in the understanding and treatment of sexual disorders. New York: PNA Publishing.

• Derogatis, L. R., & Melisaratos, N. (1979). The DSFI: A multidimensional measure of sexual functioning. Journal of Sex and Marital Therapy, 5, 244–281.

• Derogatis, L. R., Schmidt, C. W., Fagan, P. J., & Wise, T. N. (1989). Subtypes of anorgasmia via mathematical taxonomy. Psychosomatics, 30, 166–173.

• Howell, J. R., Reynolds, C. F., Thase, M. E., Frank, E., Jennings, J. R., Houck, P. R., et al. (1987). Assessment of sexual function, interest, and activity in depressed men. Journal of Affective Disorders, 13, 61–66.

Items of the Derogatis Sexual Functioning Inventory

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

Information. The Information subtest consists of a 26- item subtest in true-false format that measures the level of accurate information possessed by the respondent concerning the physiology, anatomy, and other aspects of sexual functioning. A single information score is determined as the sum of the number of correct responses.

Experiences. The Experiences subtest consists of a list of 24 sexual behaviors ranging from very fundamental behaviors to various forms of sexual intercourse and oral-genital activities. The respondent indicates which behaviors he/ she has experienced lifetime, and which experiences have occurred during the past 60 days. The Experiences score is the sum of lifetime experiences.

Drive. The Drive subtest is a composite summary measure of libidinal erotic interests expressed in the five behavioral domains of sexual intercourse, masturbation, kissing and petting, sexual fantasy, and ideal frequency of intercourse. The respondent indicates the frequencies of these behaviors during the current period. A single Drive score is developed by summing across domains.

Attitudes. Based upon work showing liberal and conservative sexual attitudes to be predictive of quality of sexual functioning, the Attitudes subtest is comprised of 30 items (15 liberal items and 15 conservative items) represented on 5- point Likert-type scales. The respondent indicates the degree to which he/she is in agreement with each item. Liberal, conservative, and total attitude scores are generated.

Psychological Symptoms. Psychological distress is measured by the 53 items of the Brief Symptom Inventory (BSI). Each symptom of the BSI is represented on a 5- point scale from not at all (0) to extremely (4). Scores are summed across items to achieve a single Symptoms score. The BSI may optionally be scored for the nine dimensions (e.g., Depression, Anxiety) and global scores that underlie the items of the BSI.

Affects. The Affects subtest is also a complete multi- dimensional test termed the Derogatis Affects Balance Scale (DABS). The DABS measures affect and mood through 40 adjective items endorsed by the respondent. Twenty items represent positive affects, and 20 items reflect negative affects. Scores include a Positive Affects total, a Negative Affects total and the overall Affects Balance Index. The latter is used as the affects measure for the DSFI.

Gender Role Definition. Consistent with the concept that masculinity and femininity are components of all individuals’ gender role definitions, the two primary components of gender role are each measured in terms of 15 adjective items that the respondent endorses in varying degrees. A Masculinity score, a Femininity score, and a Gender Role Definition score are determined.

Fantasy. This subtest consists of 20 major sexual themes that have been culled from research on normal sexual fantasies as well as fantasies arising from clinical variations on routine sexual behaviors. The Fantasy score consists of a simple summation of the items endorsed.

Body Image. Body image has been demonstrated to be an integral aspect of self-concept and, as such, is an important determinant of successful sexual functioning. It is measured in the DSFI in terms of 15 items, 10 common and 5 gender- keyed, that reflect the individual’s level of appreciation of his/her body. A single Body Image score is developed.

Sexual Satisfaction. The Sexual Satisfaction subtest is itself multidimensional in nature, being comprised of a number of distinct components (e.g., frequency of intercourse, quality of communication, quality of orgasm). Ten true-false items comprise the Satisfaction subtest, each reflecting whether the respondent is satisfied with that specific aspect of his/her sexual functioning. A single Satisfaction score is calculated as a sum of endorsements indicating satisfaction with a particular component.

SFI: The DSFI total score. The Sexual Functioning Index (SFI) is the total or global summary score of the DSFI. It is calculated as a direct unweighted linear combination of the 10 subtest or principal dimension scores. Because subtest scores are calculated along very different score continua, and some are gender-keyed (i.e., distinct for men and women), subtest scores are first transformed to area t- scores (μ = 50; SD = 10) before being summed to achieve the SFI. Because the transformation is a normalizing, area (under the curve) type, the actuarial characteristics of the resulting standardized distribution are retained.

The Global Sexual Satisfaction Index (GSSI). The GSSI is the second global measure of the DSFI, and it is quite different in nature from the SFI or DSFI total score. Whereas the DSFI total score reveals the respondent’s quality of sexual functioning in psychometric terms, the GSSI reflects the individual’s subjective perception of his/her sexual behavior. The GSSI represents quality of sexual functioning on a 9-point scale anchored at the lower extreme by 0, could not be worse to 8, could not be better at the upper limit. Each scale point is characterized by a descriptive phrase, and the respondent is provided an opportunity to globally summarize his/her perception of the quality of sexual behavior in straightforward terms.