Female Sexual Distress Scale—Revised

Abstract

The Female Sexual Distress Scale—Revised (FSDS-R) is a widely used, self-administered psychometric instrument designed to measure personal distress specifically related to sexual difficulties in women. It serves as a crucial tool for diagnosing and assessing the impact of conditions such as Hypoactive Sexual Desire Disorder (HSDD) and other forms of sexual dysfunction (FSD). The FSDS-R is an expansion of the original 12-item Female Sexual Distress Scale (FSDS), incorporating a critical 13th item that focuses exclusively on distress caused by low sexual desire. This revision ensures that the instrument accurately captures the emotional component necessary for a clinical diagnosis of HSDD, as stipulated by diagnostic guidelines.

Keywords

Female Sexual Distress Scale—Revised, FSDS-R, HSDD, Female Sexual Dysfunction, FSD, sexual distress, psychometric scale, low sexual desire.

Authors

Leonard R. Derogatis, Robert Pyke, Julie McCormack, Adria Hunter, and Gale Harding.

Purpose

The primary purpose of the FSDS-R is to quantify the level of personal, sex-related distress experienced by women, which is essential for determining the clinical significance of a sexual complaint. The scale is designed to differentiate between women who experience sexual difficulties without distress and those whose difficulties cause clinically significant emotional burden. This distinction is vital in both clinical practice and pharmacological trials targeting sexual dysfunction.

Specifically, the introduction of Item 13 distinguishes the FSDS-R from its predecessor, allowing for a focused assessment of distress related to diminished sexual desire, a core component of HSDD. The instrument is validated for use in both pre- and postmenopausal women across various clinical settings.

Construct

The FSDS-R measures the psychological construct of sex-related personal distress. This construct encompasses the negative cognitive and emotional reactions women experience concerning their sexuality or sexual problems. It includes feelings such as guilt, frustration, inadequacy, worry, and dissatisfaction stemming from sexual issues.

The 13 items comprehensively cover various facets of distress, moving beyond mere physical symptoms of sexual difficulty to capture the subjective emotional impact. The scale effectively operationalizes the distress criterion required for a clinical diagnosis of FSDs, emphasizing that sexual problems must cause “marked distress or interpersonal difficulty” to be considered a disorder.

Validity

The validity of the FSDS-R was rigorously established in a multicenter study involving women with generalized acquired HSDD, other FSDs (such as Female Sexual Arousal Disorder [FSAD] or Female Orgasmic Disorder [FOD]), and women with no FSD.

• Discriminant Validity: The scale demonstrated strong discriminant validity. Mean FSDS-R total scores and Item 13 scores were significantly higher in women diagnosed with HSDD or other FSD compared to women without sexual dysfunction (p < .001 at all time points). Receiver operating characteristic (ROC) analyses further supported the ability of the FSDS-R total scores to accurately distinguish between clinical and non-clinical populations.

• Content Validity: Content validity was assessed using saturation interviewing and cognitive debriefing among women with generalized acquired HSDD. Participants rated the relevancy, clarity, and comprehensiveness of the instrument. Item 13 (“Bothered by low sexual desire”) was rated as the most relevant item (mean rating of 3.33 out of 4). Overall, the majority of respondents found the items clear and easy to understand (88%–100% clarity for most items), confirming the instrument’s strong content validity for measuring distress related to decreased sexual desire.

Reliability

The reliability of the FSDS-R was established in a 4-week, nontreatment validation study. The scale demonstrated excellent internal consistency and satisfactory test-retest reliability across different sexual function groups.

• Internal Consistency: Internal consistency was measured using Cronbach’s coefficient alpha. The FSDS-R consistently showed high internal consistency across subjects with HSDD, other FSD, and no FSD, with alpha values exceeding .88 on days 0, 7, and 28. This indicates that the 13 items reliably measure the same underlying construct of sexual distress.

• Test-Retest Reliability: The test-retest reliability was estimated using the Intraclass Correlation Coefficient (ICC) between baseline (Day 0) and Day 28. For all subjects combined, the ICC for the FSDS-R total score was .88, and the ICC for the crucial Item 13 score was .83, both demonstrating good temporal stability.

• Recall Period Consistency: Studies confirmed that a version of the FSDS-R utilizing a 7-day recall period yielded results equivalent in reliability to the standard 30-day recall version.

Factor Analysis

The provided source material describes extensive validity and reliability testing, but it does not explicitly detail the results of a formal factor analysis (e.g., exploratory or confirmatory factor analysis) used to confirm the unidimensionality or multidimensional structure of the FSDS-R items. The scale is generally treated as a unidimensional measure of global sexual distress based on its high internal consistency.

Instrument

Test Type: Self-administered questionnaire (Psychometric Scale)

Format: 13 items rated on a 5-point Likert scale.

Language Available: English (validated primarily in North American populations).

Population Group: Women experiencing sexual difficulties or dysfunction.

Age Group: Adult women (pre- and postmenopausal).

Population Details: Used extensively in clinical trials involving women diagnosed with HSDD, Female Sexual Arousal Disorder (FSAD), Female Orgasmic Disorder (FOD), or other specified Female Sexual Dysfunctions (FSD).

Test Methodology: Respondents rate the frequency of distress or bother caused by each problem over a specified recall period (typically the past 30 days, or sometimes 7 days in research settings). Scoring is simple summation.

• Scoring Range: 0 to 52.

• Clinical Cut-off: A total score of 11 or greater (≥ 11) is typically used to indicate a clinically significant level of sexual distress.

• Response Options: 0=Never, 1=Rarely, 2=Occasionally, 3=Frequently, 4=Always.

Keywords

FSDS-R, sexual health assessment, clinical outcome measure, Female Sexual Dysfunction, psychometrics, sexual desire, distress scale, validation study.

Authors

Author ORCID Identifier: Not specified in the provided source material.

Affiliation Email addresses: [email protected] (for Leonard Derogatis)

Correspondence Address: Leonard 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 Female Sexual Distress Scale—Revised (FSDS-R) is copyrighted by the American Foundation for Urological Disease, Inc. (AFUD). The initial version (FSDS) was developed around 2000/2002, and the revised version (FSDS-R) was validated in 2008. The scale may not be used without explicit permission from the copyright holder (American Foundation for Urological Disease, Inc.).

Reference’s

• Derogatis, L. R., Clayton, A., Lewis-D’Agostino, D., Wunderlich, G., & Fu, Y. (2008). Validation of the Female Sexual Distress Scale— Revised for assessing distress in women with Hypoactive Sexual Desire Disorder. Journal of Sexual Medicine, 5, 357–364.

• Derogatis, L. R., Pyke, R., McCormack, J., Hunter, A., & Harding, G. (2008, December). Content validity of the Female Sexual Distress Scale—Revised (FSDS-R) in women with Hypoactive Sexual Desire Disorder (HSDD). Poster presented at the Joint Congress of the European and International Societies for Sexual Medicine, Brussels, Belgium.

• Derogatis, L. R., Rosen, R., Leiblum, S., Burnett, A., & Heiman, J. (2002). The Female Sexual Distress Scale (FSDS): Initial validation of a standardized scale for assessment of sexually related personal distress in women. Journal of Sex and & Marital Therapy, 28, 317–330.

Items of the Female Sexual Distress Scale—Revised

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

Instructions: Below is a list of feelings and problems that women sometimes have concerning their sexuality. Please read each item carefully, and circle the number that best describes HOW OFTEN THAT PROBLEM HAS BOTHERED YOU OR CAUSED YOU DISTRESS DURING THE PAST 30 DAYS INCLUDING TODAY. Circle only one number for each item, and take care not to skip any items. If you change your mind, erase your first circle carefully. Read the example before beginning, and if you have any questions please ask about them.

Example: How often did you feel: Personal responsibility for your sexual problems.

Response Options:

HOW OFTEN DID YOU FEEL:

Copyright © 2000 by American Foundation for Urological Disease Inc.