Global Sexual Functioning: A Single Summary Score for Nowinski and LoPiccolo’s Sexual History Form (SHF)

Abstract

The Global Sexual Functioning (GSF) score is a concise, single-summary measure derived from the 46-item Sexual History Form (SHF), originally developed by Nowinski and LoPiccolo (1979) and later modified by Schover and Jensen (1988). The original SHF was a comprehensive self-report questionnaire designed for clinical use and standardized diagnosis, evaluating multiple facets of sexual functioning, including desire, arousal, orgasm, pain, frequency of sexual activities, and overall sexual satisfaction for both men and women.

The GSF score was developed by Creti, Fichten, and colleagues (1987, 1988) to provide a single, accurate index reflecting the overall level of sexual functioning, thereby facilitating research into various populations, medical conditions, and therapeutic outcomes. This summary score is calculated based on a subset of 12 items from the full SHF, providing a standardized metric for global assessment.

Keywords

Sexual History Form (SHF), Global Sexual Functioning (GSF), Sexual Functioning, Sexual Desire, Arousal, Orgasm, Sexual Satisfaction, Psychometrics, Sexual Assessment, Sexual Dysfunction.

Authors

The original Sexual History Form (SHF) was developed by J. K. Nowinski and J. LoPiccolo. The Global Sexual Functioning (GSF) scoring system was developed and validated by Laura Creti, Catherine S. Fichten, Rhonda Amsel, William Brender, Leslie R. Schover, Dennis Kalogeropoulos, and Eva Libman.

Purpose

The primary purpose of the Sexual History Form (SHF) was to provide a standardized, item-by-item clinical tool for the diagnosis and research of sexual behaviors and problems. However, its original format lacked a single, overarching metric for overall sexual health.

The purpose of developing the Global Sexual Functioning (GSF) score was to overcome the limitations of item-by-item analysis by creating a concise and accurate single summary score. This summary score allows researchers and clinicians to quickly assess the overall level of an individual’s sexual functioning, track changes resulting from interventions (e.g., sex therapy), and evaluate the impact of chronic illness or medical procedures on sexuality in longitudinal studies.

Construct

The Global Sexual Functioning (GSF) score measures the global, underlying construct of overall sexual competence and satisfaction. It is a composite measure derived from specific items that represent key domains of sexual experience, combining frequency, physical response, and psychological components into a single index.

The domains contributing to the GSF score include: frequency of sexual activities, sexual desire, arousal (e.g., erectile abilities in males, subjective arousal in females), and orgasmic abilities. By synthesizing these core areas, the GSF aims to reflect a person’s general level of sexual health, distinguishing between sexually well-functioning and poorly functioning individuals.

Validity

The validity of the GSF score has been demonstrated across both male and female populations, indicating that it is a robust index of the underlying construct of sexual functioning.

For **Male Global Sexual Functioning**, the GSF score has shown strong criterion and construct validity. It successfully differentiates between sexually well-functioning and poorly functioning men and is sensitive to therapeutic change (Creti et al., 1987; Kalogeropoulos, 1991). Furthermore, the GSF score correlates logically and significantly with other measures of sexual health, including sexual satisfaction, sexual repertoire, sexual self-efficacy, sexual drive, sexual knowledge, and liberal attitudes (Creti et al., 1987; Creti & Libman, 1989). It is also sensitive to age differences in male sexual functioning.

For **Female Global Sexual Functioning**, the GSF score effectively distinguishes between women diagnosed with sexual dysfunction (M = .68, SD = .17) and those functioning well (M = .49, SD = .14). Younger women (age 21–46) typically report better scores than older women (age greater than 64), demonstrating sensitivity to age-related changes. Female GSF scores correlate significantly with measures of sexual harmony, sexual drive, diversity of sexual repertoire, sexual satisfaction (Creti et al., 1988), and sexual efficacy expectations for their partners. It has also been used to validate other instruments, such as the Pelvic Organ Prolapse—Urinary Incontinence Sexual Questionnaire (PISQ). Studies involving women with vaginismus or vulvar vestibulitis syndrome reported significantly worse GSF scores, and scores improved following cognitive-behavioral therapy (Bergeron et al., 2001).

Reliability

The GSF score demonstrates high temporal reliability (test-retest stability), suggesting the score is consistent over time. Temporal stability for the GSF has been reported to range from .92 (Creti et al., 1988) to .98 (Libman et al., 1989).

Internal consistency, measured using coefficient alpha, ranged from .50 to .70 (Creti et al., 1988). While this range is moderate, the psychometric properties overall suggest that the GSF provides a useful and reliable index for measuring overall sexual functioning in clinical and research settings.

Factor Analysis

The source documentation does not provide specific details regarding formal factor analysis (e.g., exploratory or confirmatory factor analysis) used in the development or validation of the Global Sexual Functioning score. The selection of the 12 items used to compute the GSF score was based on their representativeness of key domains of sexual dysfunction, including frequency, desire, arousal, and orgasmic/erectile abilities, rather than a statistical factor extraction method.

Instrument

Test Type: Self-report questionnaire / Clinical Assessment Tool (derived score)

Format: 46 multiple-choice items in the full SHF, with the GSF score calculated from 12 specific items. Items feature variable numbers of response options (e.g., 5, 6, or 9 options) and descriptive verbal anchors.

Language Available: English. The original 28-item version of the SHF has also been translated into French (Formulaire d’Histoire Sexuelle) and Spanish.

Population Group: Adult men and women, often used in clinical populations (e.g., those with chronic illness, sexual dysfunction, or undergoing therapy).

Age Group: Adults (studies cited include populations ranging from 21 to over 64).

Population Details: Used across various medical and psychological populations, including those undergoing prostatectomy, dealing with chronic illness, or presenting with specific sexual complaints like vaginismus or vulvar vestibulitis.

Test Methodology: Respondents circle the number corresponding to the most appropriate response. Completion time is approximately 15 minutes. The GSF score calculation involves converting the scores of the 12 selected items into proportions of the maximum possible value, summing these proportions, and dividing by the number of answered items (usually 12). Lower scores indicate better functioning.

Keywords

Sexual Health, Sexual Assessment, Sexual History Form, GSF Score, Erectile Dysfunction, Orgasm, Arousal, Sexual Therapy Outcome, Psychometric Validity, Temporal Reliability.

Authors

Author ORCID Identifier: Not specified in the source material.

Affiliation Email addresses: [email protected] (Laura Creti)

Correspondence Address: Laura Creti, ICFP, Jewish General Hospital, 4333 Chemin de la Cote Ste Catherine, Montreal, Quebec, Canada, H3T 1E4.

Permissions & Fee and Test Year

The Global Sexual Functioning (GSF) scoring system was introduced in 1987–1988, based on the original Sexual History Form (SHF) published in 1979. Specific information regarding permissions for use, licensing fees, or commercial availability is not provided in the source material. However, the measure has been widely utilized in subsequent academic research and clinical practice.

Reference’s

• Ávila Escribano, J. J., Perez Madruga, A., Olazabal Ulacia, J. C., & Lopez Fidalgo, J. (2004). Disfunciones sexuales en el alcoholismo. Adiccones, 16(4), 1–6.
• Bergeron, S., Binik, Y. B., Khalifé, S., Pagidas, A., Glazer, H. I., Meana M., et al. (2001). A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain, 91, 297–306.
• Brown, R., Balousek, S., Mundt, M., & Fleming, M. (2005). Methadone maintenance and male sexual dysfunction. Journal of Addictive Diseases, 24(2), 91–106.
• Creti, L., Fichten, C. S., Amsel, R., Brender, W., Schover, L. R., Kalogeropoulos, D., et al. (1998). Global sexual functioning: A single summary score for Nowinski and LoPiccolo’s Sexual History Form (SHF). In C. M. Davis, W. L. Yarber, R. Bauserman, G. Schreer, & S. L. Davis (Eds.), Handbook of sexuality-related measures (pp. 261– 267). Thousand Oaks, CA: Sage.
• Creti, L., Fichten, C. S., Libman, E., Amsel, R., & Brender, W. (1988, June). Female sexual functioning: A global score for Nowinski and LoPiccolo’s Sexual History Form. Paper presented at the annual convention of the Canadian Psychological Association, Montreal. (Abstracted in Canadian Psychology, 29[2a], Abstract 164).
• Creti, L., Fichten, C. S., Libman, E., Kalogeropoulos, D., & Brender, W. (1987, November). A global score for the “Sexual History Form” and its effectiveness. Paper presented at the 21st annual convention of the Association for Advancement of Behavior Therapy, Boston.
• Creti, L., & Libman, E. (1989). Cognitions and sexual expression in the aging. Journal of Sex and Marital Therapy, 15, 83–101.
• Desrosiers, M., Bergeron, S., Meana, M., Leclerc, B., Binik, Y. B., & Khalifé, S. (2008). Psychosexual characteristics of vestibulodynia couples: Partner solicitousness and hostility are associated with pain. Journal of Sexual Medicine, 5, 418–427.
• Kalogeropoulos, D. (1991). Vasoactive intracavernous pharmacotherapy for erectile dysfunction: Its effects on sexual, interpersonal, and psychological functioning. Unpublished doctoral dissertation, Concordia University, Montreal.
• Libman, E., Fichten, C. S., Creti, L., Weinstein, N., Amsel, R., & Brender, W. (1989). Transurethral prostatectomy: Differential effects of age category and presurgery sexual functioning on postprostatectomy sexual adjustment. Journal of Behavioral Medicine, 12, 469–485.
• Libman, E., Fichten, C. S., Rothenberg, P., Creti, L., Weinstein, N., Amsel, R., et al. (1991). Prostatectomy and inguinal hernia repair: A comparison of the sexual consequences. Journal of Sex and Marital Therapy, 17, 27–34.
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• Nowinski, J. K., & LoPiccolo, J. (1979). Assessing sexual behaviors in couples. Journal of Sex and Marital Therapy, 5, 225–243.
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• Reissing, E. D., Binik, Y. M., Khalif, S., Cohen, D., & Amsel, R. (2003). Etiological correlates of vaginismus: Sexual and physical abuse, sexual knowledge, sexual self-schema, and relationship adjustment. Journal of Sex and Marital Therapy, 29, 47–59.
• Rogers, R. G., Coates, K. W., Kammerer-Doak, D., Khalsa, E. S., & Qualls, E. C. (2003). A short form of the Pelvic Organ Prolapse/ Urinary Incontinence Sexual Questionnaire (PISQ-12). International Urogynecology Journal and Pelvic Floor Dysfunction, 14, 164–168.
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• Schover, L. R., Friedman, J. M., Weiler, J., Heiman, J. R., & LoPiccolo, J. (1982). Multiaxial problem-oriented system for sexual dysfunctions: An alternative to DSM-III. Archives of General Psychiatry, 39, 614–619.
• Schover, L. R., & Jensen, S. B. (1988). Sexuality and chronic illness: A comprehensive approach. New York: Guilford.
• Weber, A. M., Walters, M. D., Schover, L. R., Church, J. M., & Piedmonte, M. R. (1999). Functional outcomes and satisfaction after abdominal hysterectomy. American Journal of Obstetrics and Gynecology, 181, 530–535.

Items of the Global Sexual Functioning: A Single Summary Score for Nowinski and LoPiccolo’s Sexual History Form (SHF)

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

1. How frequently do you and your mate have sexual intercourse or activity?

   1. more than once a day 6) once every two weeks

   2. once a day 7) once a month

   3. 3 or 4 times a week 8) less than once a month

   4. twice a week 9) not at all

   5. once a week

2. How frequently would you like to have sexual intercourse or activity?

   1. more than once a day 6) once every two weeks

   2. once a day 7) once a month

   3. 3 or 4 times a week 8) less than once a month

   4. twice a week 9) not at all

   5. once a week

3. Who usually initiates sexual intercourse or activity?

   1. I always do 4) my mate usually does

   2. I usually do 5) my mate always does

   3. my mate and I initiate about equally often

4. Who would you ideally like to initiate sexual intercourse or activity?

   1. myself, always 4) my mate, usually

   2. myself, usually 5) my mate, always

   3. my mate and I equally often

5. When your mate makes sexual advances, how do you usually respond?

   1. I usually accept with pleasure 3) often refuse

   2. accept reluctantly 4) usually refuse

6. How often do you experience sexual desire (this may include wanting to have sex, planning to have sex, feeling frustrated due to lack of sex, etc.)?

   1. more than once a day 6) once every two weeks

   2. once a day 7) once a month

   3. 3 or 4 times a week 8) less than once a month

   4. twice a week 9) not at all

   5. once a week

7. How often do you masturbate (bring yourself to orgasm in private)?

   1. more than once a day 6) once every two weeks

   2. once a day 7) once a month

   3. 3 or 4 times a week 8) less than once a month

   4. twice a week 9) not at all

   5. once a week

8. For how long do you and your mate usually engage in sexual foreplay (kissing, petting, etc.) before having intercourse?

   1. less than 1 minute 5) 11 to 15 minutes

   2. 1 to 3 minutes 6) 16 to 30 minutes

   3. 4 to 6 minutes 7) 30 minutes to one hour

   4. 7 to 10 minutes

9. How long does intercourse usually last, from entry of the penis to the male’s orgasm/climax?

   1. less than 1 minute 6) 11 to 15 minutes

   2. 1 to 2 minutes 7) 15 to 20 minutes

   3. 2 to 4 minutes 8) 20 to 30 minutes

   4. 4 to 7 minutes 9) more than 30 minutes

   5. 7 to 10 minutes

10. Does the male ever reach orgasm while he is trying to enter the vagina with his penis?

    1. never 4) sometimes (50% of the time)

    2. rarely (less than 10% of the time) 5) usually (75% of the time)

    3. seldom (less than 25% of the time) 6) nearly always (over 90% of the time)

11. Do you feel that premature ejaculation (rapid climax) is a problem in your sexual relationship?

    1. yes 2) no

12. How satisfied are you with the variety of sexual activities in your current sex life? (This includes the different types of kissing and caressing with a partner, different positions for intercourse, etc.)

    1. extremely satisfied 4) slightly unsatisfied

    2. moderately satisfied 5) moderately unsatisfied

    3. slightly satisfied 6) extremely unsatisfied

13. Would you like your lovemaking to include more:

    Breast caressing 1) yes 2) no

    Hand caressing of your genital area 1) yes 2) no

    Oral caressing (kissing) of your genital area 1) yes 2) no

    Different positions for intercourse 1) yes 2) no

14. If you would like a certain kind of sexual caress or activity, which way do you typically let your partner know?

    1. I wait to see if my partner will do what I like without my asking

    2. I show my partner what I would like by moving their hand or changing my own position

    3. I tell my partner exactly what I would like

15. How have you typically learned about your partner’s sexual likes and dislikes?

    1. From my partner telling me exactly what they want

    2. From my partner moving my hand or changing their position to signal what they would like me to do

    3. From watching my partner’s reactions during sex

    4. From intuition

16. When you have sex with your mate do you feel sexually aroused (e.g., feeling “turned on,” pleasure, excitement)?

    1. nearly always (over 90% of the time) 4) seldom (about 25% of the time)

    2. usually (about 75% of the time) 5) never

    3. sometimes (about 50% of the time)

17. When you have sex with your mate, do you have negative emotional reactions (e.g., fear, disgust, shame or guilt)?

    1. never 4) sometimes (50% of the time)

    2. rarely (less than 10% of the time) 5) usually (75% of the time)

    3. seldom (less than 25% of the time 6) nearly always (over 90% of the time)

18. Does the male have any trouble getting an erection before intercourse begins?

    1. never 4) sometimes (50% of the time)

    2. rarely (less than 10% of the time) 5) usually (75% of the time)

    3. seldom (less than 25% of the time) 6) nearly always (over 90% of the time)

19. Does the male have any trouble keeping an erection once intercourse has begun?

    1. never 4) sometimes (50% of the time)

    2. rarely (less than 10% of the time) 5) usually (75% of the time)

    3. seldom (less than 25% of the time) 6) nearly always (over 90% of the time)

20. If the male loses an erection, when does that usually happen?

    1. before penetrating to start intercourse

    2. while trying to penetrate

    3. after penetration, during the thrusting of intercourse

    4. not applicable, losing erections is not a problem

21. What is the male’s typical degree of erection during sexual activity?

    1. 0 to 20% of a full erection 4) 60% to 80% of a full erection

    2. 20% to 40% of a full erection 5) 80% to 100% of a full erection

    3. 40% to 60% of a full erection

22. Does the male ejaculate (climax) without having a full, hard erection?

    1. never 4) sometimes (50% of the time)

    2. rarely (less than 10% of the time) 5) usually (75% of the time)

    3. seldom (less than 25% of the time) 6) nearly always (over 90% of the time)

23. If you try, is it possible to reach orgasm (sensation of climax) through masturbation?

    1. nearly always (over 90% of the time) 4) seldom (about 25% of the time)

    2. usually (about 75% of the time) 5) never

    3. sometimes (about 50% of the time) 6) have never tried to

24. If you try, is it possible for you to reach orgasm (sensation of climax) through having your genitals caressed by your mate?

    1. nearly always (over 90% of the time) 4) seldom (about 25% of the time)

    2. usually (about 75% of the time) 5) never

    3. sometimes (about 50% of the time) 6) have never tried to

25. If you try, is it possible for you to reach orgasm (sensation of climax) through sexual intercourse?

    1. nearly always (over 90% of the time) 4) seldom (about 25% of the time)

    2. usually (about 75% of the time) 5) never

    3. sometimes (about 50% of the time) 6) have never tried to

26. Can you reach orgasm (sensation of climax) through stimulation of your genitals by an electric vibrator or any other means (i.e., running water, rubbing with some object, etc.)?

    1. nearly always (over 90% of the time) 4) seldom (about 25% of the time)

    2. usually (about 75% of the time) 5) never

    3. sometimes (about 50% of the time) 6) have never tried to

27. (Women only) Can you reach orgasm during sexual intercourse if, at the same time, your genitals are being caressed (by yourself or your mate with a vibrator, etc.)?

    1. nearly always (over 90% of the time) 4) seldom (about 25% of the time)

    2. usually (about 75% of the time) 5) never

    3. sometimes (about 50% of the time) 6) have never tried to

28. Have you noticed a change in the intensity and pleasure of your orgasm?

    1. much more intense and pleasurable than in the past 4) somewhat less intense and pleasurable than in the past

    2. somewhat more intense and pleasurable than in the past 5) much less intense and pleasurable than in the past

    3. the same as in the past

29. Is the female’s vagina so “dry” or “tight” that intercourse cannot occur?

    1. never 4) sometimes (50% of the time)

    2. rarely (less than 10% of the time) 5) usually (75% of the time)

    3. seldom (less than 25% of the time 6) nearly always (over 90% of the time)

30. Do you feel pain in your genitals (sexual parts) during intercourse?

    1. never 4) sometimes (50% of the time)

    2. rarely (less than 10% of the time) 5) usually (75% of the time)

    3. seldom (less than 25% of the time) 6) nearly always (over 90% of the time)

31. How often does pain (genital or nongenital) interfere with your ability to feel sexual pleasure?

    1. never 4) sometimes (50% of the time)

    2. rarely (less than 10% of the time) 5) usually (75% of the time)

    3. seldom (less than 25% of the time) 6) nearly always (over 90% of the time)

32. Have you noticed a change in the sensitivity to touch of your genitals?

    1. much more sensitive than in the past 4) somewhat less sensitive than in the past

    2. somewhat more sensitive than in the past 5) much less sensitive than in the past

    3. about as sensitive as in the past

33. Overall, how satisfactory to you is your sexual relationship with your mate?

    1. extremely unsatisfactory 4) slightly satisfactory

    2. moderately unsatisfactory 5) moderately satisfactory

    3. slightly unsatisfactory 6) extremely satisfactory

34. Overall, how satisfactory do you think your sexual relationship is to your mate?

    1. extremely unsatisfactory 4) slightly satisfactory

    2. moderately unsatisfactory 5) moderately satisfactory

    3. slightly unsatisfactory 6) extremely satisfactory

35. Do you feel that your partner plays a part in causing a problem in your sex life?

    1. yes 2) no

36. If your lovemaking does not go well, how does your partner usually react?

    1. accepting and understanding 3) anxious and blaming self

    2. frustrated or annoyed 4) neutral or uncaring

37. (Women only, men go on to Question 38) When you have sex with your mate (including foreplay and intercourse) do you notice some of these things happening: your breathing and pulse speed up, wetness in your vagina, pleasurable sensations in your breasts and genitals?

    1. nearly always (over 90% of the time) 4) seldom (about 25% of the time)

    2. usually (about 75% of the time) 5) never

    3. sometimes (about 50% of the time) 6) have never tried to

38. (Men only) How often do you wake from sleep with a firm erection (including times when you wake up needing to urinate)?

    1. daily 5) once a month

    2. 3–4 times a week 6) less than once a month

    3. 1–2 times a week 7) never

    4. once every 2 weeks

39. (Men only) How often do you wake from sleep with a partial (semisoft) erection?

    1. daily 5) once a month

    2. 3–4 times a week 6) less than once a month

    3. 1–2 times a week 7) never

    4. once every 2 weeks

40. (Men only) How often are you able to get and keep a firm erection in your own masturbation (self-touch in private)?

    1. nearly always, over 90% of the time 5) rarely, less than 10% of the time

    2. usually, 75% of the time 6) never

    3. sometimes, 50% of the time 7) have not tried masturbation in the past 6 months

    4. seldom, less than 25% of the time

41. (Men only) What is your typical degree of erection during masturbation (self-touch in private?

    1. 0% to 20% of a full erection 4) 60% to 80% of a full erection

    2. 20% to 40% of a full erection 5) 80% to 100% of a full erection

    3. 40% to 60% of a full erection

42. (Men only) Do you feel your erect penis has an abnormal curve to it, or have you noticed a lump or “knot” on your penis?

    1. yes 2) no

43. (Men only) Do you believe your penis is abnormally small?

    1. yes 2) no

44. (Men only) How does the amount of ejaculate (liquid or semen) now compare to the amount you ejaculated in the past?

    1. much greater than in the past 4) somewhat less than in the past

    2. somewhat greater than in the past 5) much less than in the past

    3. about the same as in the past 6) I do not know

45. (Men only) Do you ever have the sensation of orgasm (climax) without any ejaculation of fluid?

    1. never 4) sometimes, about 50% of the time

    2. rarely, less than 10% of the time 5) usually, about 75% of the time

    3. seldom, less than 25% of the time 6) nearly always, over 90% of the time

46. (Men only) Do you ever have pain and/or burning during or after ejaculation?‌

    1. never 5) usually, about 75% of the time

    2. rarely, less than 10% of the time 6) nearly always, over 90% of the time

    3. seldom, less than 25% of the time 7) I do not ejaculate

    4. sometimes, about 50% of the time