International Urogynecology Journal (2019) 30:2109–2120
https://doi.org/10.1007/s00192-019-04049-x
ORIGINAL ARTICLE
Validation and translation of the Hungarian version of the Female
Sexual Function Index (FSFI-H)
Márta Hock 1 & Nelli Farkas 2 & István Tiringer 3 & Stefánia Gitta 1 & Zoltán Németh 4 & Bálint Farkas 5,6
Received: 15 April 2019 / Accepted: 10 July 2019 / Published online: 29 July 2019
# The Author(s) 2019
Abstract
Introduction and hypothesis The Female Sexual Function Index (FSFI) has been used for clinical and research purposes in many
countries. The aim of this study was to translate, adapt and perform a psychometric validation of a Hungarian version of the FSFI.
Methods The FSFI was translated into Hungarian, and its precision was ascertained through reverse translation by an expert
team. As a first step, 40 volunteers participated in an evaluation of the test-retest reliability of the Hungarian version over a 2week period. After that, 418 (331 control and 87 with pelvic organ prolapse) women who had been in a stable sexual relationship
in the previous 4 weeks participated in the study. The data were summarized using descriptive statistics. The structure validity
was examined by confirmatory factor analysis, with which we tested the hypothesized original factor structure, using maximum
likelihood model estimation. We calculated the Comparative Fit Index (CFI), root mean square error of approximation (RMSEA),
standardized root mean residual and Akaike information criterion (AIC). To test the internal consistency, Cronbach’s alpha
coefficients of the full scale were determined. Spearman’s rank correlation was used for testing divergent validity and MannWhitney U-test for examining discriminant validity.
Results The FSFI was easily understandable and acceptable as well as capable of adequately evaluating and measuring various
aspects of female sexual functioning. A high degree of internal consistency was demonstrated by the Cronbach’s alpha value
(0.963).
Conclusion The FSFI Hungarian version is a valid tool that measures the same functioning as the original English questionnaire.
Keywords FSFI . FSFI-H . Hungarian language adaptation . Sexual functioning . Validation
Introduction
The abstract of the manuscript has been submitted for presentation at the
2019 Hungarian Continence Society’s Scientific Meeting, held from 2—3
May at Pecs, Hungary.
* Bálint Farkas
dr.balint.farkas@gmail.com
1
Institute of Physiotherapy and Sport Sciences, Faculty of Health
Sciences, University of Pécs, Pécs, Hungary
2
University of Pécs, Institute of Bioanalysis, Pécs, Hungary
3
Institute of Behavioral Sciences, Medical School University of Pécs,
Pécs, Hungary
4
Department of Gynecology, Hospital St. John of God,
Vienna, Austria
5
Member of the MTA-PTE Human Reproduction Scientific Research
Group, Hungarian Academy of Sciences (MTA), Budapest, Hungary
6
Department of Obstetrics and Gynecology, University of Pécs, 17
Édesanyák str., Pécs H-7624, Hungary
Several benign and malignant gynecologic diseases have
negative impacts on different segments of life, which may
lead to sexual dysfunction. Sexual dysfunction can arise
from other physical, social and psychologic factors as
well [1]. These may cause problems during any phase of
the sexual response cycle, preventing the individual from
experiencing satisfaction during sexual activity. The prevalence of female sexual dysfunction (FSD) varies worldwide between 8 and 75% [2–7]. In Hungary, only a small
number of women seek professional help. These patients
usually meet gynecologists as a primary physician, and
then their treatment includes psychologists or sexologists;
therefore, outpatient gynecologic counseling provides an
important setting for conducting research, diagnosis and
treatment of FSD [8]. The Female Sexual Function Index
(FSFI) was designed to evaluate sexual function in a general population. The translation and validation of the FSFI
Int Urogynecol J (2019) 30:2109–2120
2110
allow the questionnaire to be applied in daily clinical
practice, for research purposes and to estimate women’s
sexual function. The aim of the study was to adapt the
FSFI questionnaire and to assess the reliability and validity of the Hungarian version among sexually active
women.
Materials and methods
Women aged between 18 and 77, who had been sexually
active and in a stable relationship for at least 4 weeks prior
to the study, were recruited as volunteers in the current crosssectional study design. The majority of the participants had
high school or university diplomas. Participants (n = 331)
were healthy university students (Institute of Physiotherapy
and Sport Sciences, Faculty of Health Sciences, University
of Pécs). After a short personal interview focusing on the
general health conditions and medical history (carried out by
MH and SG), the participants filled out online questionnaires.
The exclusion criteria were concurrent sexually transmitted
diseases (STD), prior or current malignancy, neurologic and
psychiatric diseases (depression, schizophrenia, mental disabilities), severe somatic diseases, e.g., thyroid dysfunction,
liver dysfunction, unstable coronary heart disease, addiction
to psychoactive substances and/or alcohol, use of medications
affecting sexual function (antipsychotics, antidepressants, antihistamines, benzodiazepines), pregnancy or being within
3 months postpartum, and illiteracy. The subjects were informed that their participation in the survey was anonymous
and completely voluntary. This study was approved by the
Institutional Review Board of the Faculty of Medicine,
University of Pécs, in 2017 (no. 6920).
FSFI
The FSFI is a 19-item self-report questionnaire of female sexual functioning [9] consisting of six dimensions: desire (Q1,
2), arousal (Q3, 4, 5, 6), lubrication (Q7, 8, 9, 10), orgasm
(Q11, 12, 13), satisfaction (Q14, 15, 16) and pain (Q17, 18,
19). The FSFI assesses sexual functioning over the past
4 weeks. The subscale scores range from 1 to 5 for items 1,
2, 15 and 16. For all other items, the range was from 0 to 5
with the supplementary option “no sexual activity.” The fullscale score ranges from 2.0 to 36.0, where the higher score is
associated with less severity of sexual dysfunction. The questionnaire showed a high degree of internal consistency
(Cronbach’s α values ≥ 0.82) and high test-retest reliability
for each domain (Spearman’s rho = 0.79–0.86). It has been
successfully cross-validated, and a diagnostic cutoff score of
26.55 has been determined for classification of total FSD [10].
Short form 36 (SF-36) survey
The SF-36 measures health-related quality of life (QoL) across
eight domains, which can be summarized as physical and
mental health. The eight domains are as follows: physical
functioning (10 items; Cronbach’s α 0.93); role limitations
due to physical health problems (4 items, Cronbach’s α
0.84); role limitations due to emotional problems (3 items;
Cronbach’s α 0.83); energy and vitality (4 items; Cronbach’s
α 0.86); mental health (5 items; Cronbach’s α 0.90); social
functioning (2 items; Cronbach’s α 0.85); bodily pain (2
items; Cronbach’s α 0.78); general health (5 items;
Cronbach’s α 0.78). These scores are transformed into a domain score ranging from 0 to 100, with a higher score
representing higher levels of health-related QoL [11, 12].
The four domain scores are averaged to a physical component
score (PCS), and four other domain scores are averaged to a
mental component score (MCS). An additional item with
health change is not integrated into the PCS or MCS scores
[13]. The Hungarian adaptation of the questionnaire and the
determination of normal values were carried out by
Czimbalmos et al. [14]. The SF-36 was completed at the same
time as the FSFI-H for comparison.
Translation of the FSFI into Hungarian (FSFI-H)
The linguistic validation was carried out in accordance with
the guidelines of linguistic validation processes [15]. The original FSFI was translated from English into Hungarian by two
physicians, who are fluent in both English and Hungarian
(version 1). The back translation of the FSFI-H into the original language was carried out by an independent bilingual
investigator and was reviewed by the author to obtain a reliable translation (version 2). The translation was further
reviewed by a ten-member expert committee, including gynecology specialists, PhD students, health sciences university
teachers and behavioral science specialists, to achieve a reliable Hungarian version of the FSFI questionnaire (version 3).
Then, a face-to-face interview was also conducted with women to check for any difficulties in understanding and
interpreting the questions. No major difficulties were noted.
Divergent validity
Since no validated Hungarian questionnaires that measure the
same context as the FSFI are available, the SF-36 questionnaire, a self-evaluated global quality-of-life measure, was applied as a benchmark.
Discriminant validity
To examine whether the Hungarian version of the FSFI can
detect differences between a general/healthy population and a
Int Urogynecol J (2019) 30:2109–2120
clinical population, we used retrospective data of a group of
women with pelvic organ prolapse (POP), which is known to
be correlated with decreased sexual quality of life because of
the altered genital anatomy, decreased lubrication, and involuntary intracoital urine or fecal incontinence [16]. Patients
(n = 87) were diagnosed in a urogynecologic outpatient clinic
(Győr, Hungary). All patients provided written informed consent and volunteered to be included. All women had ≥ stage 2
POP of the anterior, middle or posterior compartment, or a
combination of them. All reported a sensation of a bulge in
the vagina with or without symptoms of urinary, bowel or
sexual dysfunction. (All methods, definitions and units conform to the standards set by the International
Urogynecological Association and the International
Continence Society, except where specifically noted [17].)
Test-retest reliability
The final approved version was pretested in a pilot study on 40
women who were sexually active in a stable relationship
6 months prior to the study. The participants completed the
same questionnaire twice with a 2-week interval. During the
first visit, we conducted a face-to-face interview and collected
demographic data. Finally, the test-retest correlations were
evaluated by applying Spearman’s rank correlations and
Bland-Altman plots between individual domains as well as
in the full scales of the FSFI-H.
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Results
A total of 418 women were enrolled in the current study; 331
constituted the general/control group, with a mean age of
33.58 ± 8.94 years. (The majority, 47% of the participants,
had high school or university diplomas, and 71.9% lived in
urban areas.)
Eighty-seven women with pelvic organ prolapse (POP)
comprised the clinical group, with a mean age of 47.86 ±
12.27 years (POP stage II to IV, 64.5%, 17.5% and 1%, respectively), which was used for the discriminant validity.
Structure validity
Confirmatory factor analysis is a tool to verify a given theoretically based factor structure. Previous studies showed either
a six- or five-factor structure in the case of FSFI: desire, arousal, orgasm, lubrication, pain, satisfaction (desire and arousal
constitute a unique factor in the five-factor model) [21]. We
analyzed the five- and six-factor models, and the six-factor
model showed an acceptable [CFI = 0.957, RMSEA = 0.76
(CI: 0.66–0.85), SRMR = 0.514, AIC = 439.1] and superior
fit compared with the five-factor model [CFI = 0.949,
RMSEA = 0.81 (CI: 0.72-0.09), SRMR = 0.57, AIC =
505.1]. All factors except desire had acceptable standardized
regression weights (range 0.644–0.942). The answers to the
first item about the frequency of desire were different from the
answers given to the second item about the level of desire.
Spearman’s rho between item 1 and 2 was only 0.187 (p =
0.001). Correlations among factors were high (0.484–0.872).
Statistical analysis
Reliability
The data were summarized using descriptive statistics.
The structure validity was examined by confirmatory factor analysis (CFA), with which we tested the hypothesized
original factor structure, using maximum likelihood model estimation (Fig. 1). To determine which model had a
better fit to our data, we compared generally offered fit
indexes [Comparative Fit Index (CFI), root mean square
error of approximation (RMSEA) and standardized root
mean residual (SRMR)]. Acceptable values of the CFI
are ⋝ 0.95, of the RMSEA ⋜ 0.08 and of the SRMR ⋜
0.11 [18]. Additionally, on the basis of the Akaike information criterion (AIC), the six- and five-factor structures
were compared considering which had a better fit to our
data set [19]. To test the internal consistency, Cronbach’s
alpha coefficients were determined. Spearman’s rank correlation was used for testing divergent validity and the
Mann-Whitney U-test for examining discriminant validity
[20]. CFA was performed using AMOS (version 5); all
other analyses were carried out with the IBM-SPSS version 25 software package. The results were considered
significant if p < 0.05.
Cronbach’s α coefficients were determined for the total and
domain scores of the FSFI-H, which were high. In the subscales, they ranged from 0.423 to 0.981. The coefficient was
0.963 for the full scale. The total FSFI domain scores obtained
from the enrolled women are presented in Table 1.
Divergent validity
No significant correlations between the results of the FSFI-H
and SF-36 were found with Spearman’s rank correlation analyses among either the subscales or the total scores.
Discriminant validity
To establish differences between the control and POP patient
group, the total and subscale scores of both groups were compared. In the analysis we used an age-matched group (45 ±
5 years) from the original general control group. The results
showed significant differences in the case of arousal, lubrication, orgasm, satisfaction and the total score. (Table 2).
Int Urogynecol J (2019) 30:2109–2120
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Fig. 1 The six-factor model with
factor loadings, correlations between factors and error terms
Test-retest reliability
Discussion
To compare two clinical measurements, we applied
Bland-Altman plots. The values randomly fluctuated
around the mean difference ± 1.96 SD (Fig. 2) in all domains. The test-retest reliability also showed strong and
significant correlations between the domain and the fullscale scores (Spearman’s rho 0.490–0.903, p < 0.001)
(Table 3).
The FSFI is one of the most widely used and reliable questionnaires regarding sexual functioning in the female population. It has been translated and validated in about 30 languages
and is used to assess FSD in women with different medical
conditions, including vulvodynia, chronic pelvic pain, vulvar
intraepithelial neoplasia, breast cancer and urinary incontinence [21–25]. The present study results demonstrated a very
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Table 1
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Mean values and Cronbach’s α coefficients of the FSFI-H
Domains
Score range
Factor
Desire
1. Frequency
1.2–6.0a
1.0–5.0
0.6
2. Level
Arousal
3. Frequency
1.0–5.0
0.0–6.0a
0.0–5.0
4. Level
5. Confidence
0.0–5.0
0.0–5.0
6. Satisfaction
0.0–5.0
Lubrication
7. Frequency
8. Difficulty
0.0–6.0a
0.0–5.0
0.0–5.0
0.3
Mean ± SD
3.60 ± 1.01
3.10 ± 1.08
3.04 ± 0.97
4.02 ± 1.946
3.62 ± 1.73
Cronbach’s alpha
Number of items
0.423
2
0.973
4
0.981
4
0.898
3
0.931
3
0.971
3
0.963
19
3.19 ± 1.50
3.40 ± 1.61
0.3
3.58 ± 1.72
4.60 ± 2.11
3.85 ± 1.78
3.95 ± 1.76
9. Frequency of maintaining
0.0–5.0
3.86 ± 1.73
10. Difficulty in maintaining
Orgasm
11. Frequency
0.0–5.0
0.0–6.0a
0.0–5.0
4.05 ± 1.75
4.28 ± 2.03
3.65 ± 1.78
12. Difficulty
13. Satisfaction
0.0–5.0
0.0–5.0
Satisfaction
14. With closeness with partner
1.2–6.0a
1.0–5.0
15. With sexual relationship
16. With overall sex life
Pain
17. Frequency during vaginal penetration
1.0–5.0
1.0–5.0
0.0–6.0a
0.0–5.0
18. Frequency following vaginal penetration
19. Level during or following vaginal penetration
Full-scale score
0.0–5.0
0.0–5.0
5.2–36.0b
0.4
3.69 ± 1.80
4.18 ± 1.44
0.4
0.4
4.28 ± 1.46
4.33 ± 1.29
4.27 ± 1.34
3.98 ± 1.45
4.46 ± 2.12
3.77 ± 1.79
3.79 ± 1.78
3.86 ± 1.72
25.25 ± 9.27
SD standard deviation
a
The individual domain scores were calculated by adding the scores of the individual items that comprise the domain and multiplying the sum by the
domain factor
b
The full-scale score is calculated by adding the six domain scores
high internal consistency since the Cronbach’s alpha was
0.963 in the total scale. These high correlations are comparable to those reported by Rosen et al. in 2000 (≥ 0.82).
Table 2
Discriminant validity of the FSFI-H
General
Mean ± SD
Desire
Arousal
Lubrication
Orgasm
Satisfaction
Pain
FSFI
3.604
4.015
4.605
4.276
4.279
±
±
±
±
±
1.007
1.947
2.118
2.037
1.459
4.468 ± 2.13
25.246 ± 9.268
POP
Mean ± SD
3.889
2.868
1.976
2.612
2.627
±
±
±
±
±
P value
1.021
1.023
0.981
1.24
1.271
0.087
0.001
0.001
0.001
0.001
4.808 ± 1.449
16.155 ± 3.449
0.887
< 0.01
Data were calculated with Mann-Whitney U-test
POP Pelvic organ Prolapse, SD standard deviation
Furthermore, we also found a high level of test-retest reliability with a Pearson product-moment correlation coefficient of
0.992 in the control population. During the test-retest reliability analysis, the translation was found to be very appropriate;
the test-retest reliability showed significant correlation between domains and full-scale scores. Our CFA results showed
an acceptable fit to the six-factor model frequently found in
previous validation studies. All fit indices were in the acceptable range, indicating that the FSFI-H can measure the same
domains as the original questionnaire. By collecting data from
over 300 participants, we managed to examine both pre- and
postmenopausal women. The applicability of the desire factor
needs to be examined in a further study because the present
study did not exclude participants who had difficulties with
the desire caused by sexually related personal distress,
hypoactive desire disorders, etc., due to the lack of sexologists
in the research group. Nevertheless, we must also consider the
possibility of cultural differences [26, 27]. Based on the results
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Fig. 2 To compare two clinical measurements (test-retest), we used
Bland-Altman plots. The mean values ranged between −0.17 and 0.05,
and in all domains values fluctuated randomly between mean ± 1.96 SD,
where (a) represents desire, (b) arousal, (c) lubrication, (d) orgasm, (e)
satisfaction and (f) pain subscales
of the discriminant validity analysis, which included women
with pelvic organ prolapse and demonstrated considerably
lower total scores compared with healthy participants, it is
assumed that the FSFI-H would be applicable to detecting
sexual dysfunction as well.
this study has several limitations. First, our study population
failed to represent the average Hungarian female population,
since the majority of the respondents were highly educated
women living exclusively in urban areas. Our assumption is
that this may have an effect on the respondents of the current
study, who might be more open toward sexual issues compared with the average Hungarian woman. A further limitation
of the study is that no concurrent validity was applied to obtain
the cutoff point of the FSFI-H, unlike in other studies [28].
Finally, the results have a good statistical quality for
confirming the linguistic validation, but they cannot fully
Strengths and limitation
The strength of our study was the relatively high number of
participants and the high Cronbach’s alpha values. However,
Table 3
Results of the FSFI-H test-retest reliability
Domain
Phase
Mean
SD
Spearman rank correlation
P value
Desire
Test
Retest
Test
Retest
Test
Retest
Test
Retest
Test
Retest
Test
Retest
Test
Retest
4.485
4.560
5.063
5.235
5.490
5.633
5.190
5.270
5.530
5.480
4.950
4.900
30.708
31.078
0.744
0.778
0.656
0.596
0.627
0.534
0.669
0.730
0.579
0.709
0.767
0.751
2.185
2.248
0.851
< 0.001
0.884
< 0.001
0.540
< 0.001
0.704
< 0.001
0.490
0.001
0.903
< 0.001
0.848
< 0.001
Arousal
Lubrication
Orgasm
Satisfaction
Pain
Total scale
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confirm the psychometric properties of the FSFI. Despite
these limitations, the authors believe that the FSFI-H is a valid
and reliable instrument that can be used in settings to measure
sexual functioning in Hungarian women who are in relationships and have no serious diseases that could influence their
sexual activity.
Conclusion
In our current study, we successfully translated and adapted
the FSFI questionnaire into the Hungarian language (FSFI-H
can be found in the Appendix).
Acknowledgements We thank the medical assistants and nurses working
at the University of Pecs, Department of Obstetrics and Gynecology,
Pecs, Hungary, for their help and dedicated contributions toward the study
and our patients. We also thank Prof. Dr. Miklos Koppan for his support,
helpful comments and discussion.
Funding Information Open access funding provided by University of
Pécs (PTE).
Compliance with ethical standards
Conflicts of interest The corresponding author has multiple affiliations
and has received financial support from the Hungarian Academy of
Sciences (MTA), Budapest, Hungary. The remaining authors report no
conflicts of interest with the present study.
Appendix
FSFI-H
Női szexuális funkció index kérdőív
(Hungarian Version of Female Sexual Function Index, FSFI-H)
Kérjük, válaszoljon a következő kérdésekre, olyan egyértelműen amennyire csak lehetséges. Válaszait teljes mértékben
bizalmasan kezeljük!
A lent található kérdések az elmúlt 4 hetes időszakra vonatkoznak. Kérjük, hogy egy kérdésre egy választ adjon meg.
E kérdések megválaszolásakor a következő fogalom meghatározások érvényesek:
&
&
&
&
&
A szexuális tevékenység magába foglalja a simogatást, előjátékot, maszturbációt és hüvelyi kapcsolatot.
A szexuális közösülés: a férfi nemi szerv hüvelyi behatolása.
A szexuális stimuláció magában foglalja a partnerrel való előjátékot,
az önstimulációt (maszturbáció) vagy a szexuális fantáziát.
A szexuális vágy vagy érdeklődés olyan érzés, amely magában foglalja azt, hogy szexuális élményt szeretne,
fogékony a partner szexuális kezdeményezésére, gondolkodik vagy fantáziál a szexről.
A szexuális izgalom olyan érzés, amely magában foglalja a szexuális izgalom fizikai és szellemi aspektusait,
a nemi szervek melegségének vagy bizsergésének érzését, a nedvesedést, esetleg izom összehúzódásokat.
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Int Urogynecol J (2019) 30:2109–2120
Open Access This article is distributed under the terms of the Creative
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creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
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References
1.
2.
McCabe MP, Sharlip ID, Lewis R, et al. Risk factors for sexual
dysfunction among women and men: a consensus statement from
the fourth International Consultation on Sexual Medicine. J Sex
Med. 2016;13:153–67.
Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C,
Moreira E, et al. Sexual problems among women and men
2119
aged 40–80 y: prevalence and correlates identified in the global study of sexual attitudes and behaviors. Int J Impot Res.
2005;17:39–57.
3. Laumann EO, Glasser DB, Neves RC, Moreira ED, GSSAB
Investigators’ Group. A population-based survey of sexual activity,
sexual problems and associated help-seeking behavior patterns in
mature adults in the United States of America. Int J Impot Res.
2009;21:171–8.
4. Lewis RW, Fugl-Meyer KS, Corona G, et al. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med. 2010;7:1598–
607.
5. Laumann EO, Waite LJ. Sexual dysfunction among older adults:
prevalence and risk factors from a nationally representative US
probability sample of men and women 57–85 years of age. J Sex
Med. 2008;5:2300–11.
6. Ferenidou F, Kapoteli V, Moisidis K, et al. Presence of a sexual
problem may not affect women’s satisfaction from their sexual
function. J Sex Med. 2008;5:631–9.
Int Urogynecol J (2019) 30:2109–2120
2120
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Hayes RD, Dennerstein L, Bennett CM, Fairley CK. What is the
“true” prevalence of female sexual dysfunctions and does the way
we assess these conditions have an impact? J Sex Med. 2008;4:
777–87.
Kommentár SP. Szülészet Nőgyógy Továbbkép Sz. 2009;2:69-70.
Rosen R, Brown C, Heiman J, et al. The female sexual function
index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:
191–208.
Wiegel M, Meston C, Rosen R. The female sexual function index
(FSFI): cross-validation and development of clinical cutoff scores. J
Sex Marital Ther. 2005;31:1–20.
Waren JE, Sherbourne CD. The MOS-36 item short form health
survey (SF-36). I. Conceptual framework and item selection. Med
Care. 1992;30:473–83.
McHorney CA, Ware JE, Raczek AE. The MOS 36-item short-form
health survey (SF-36): II. Psychometric and clinical tests of validity
in measuring physical and mental health construct. Med Care.
1993;31:247–63.
Hays RD, Sherbourne CD, Mazel RM. The RAND 36-item health
survey 1.0. Health Econ. 1993;2(3):217–27.
Czimbalmos A, Nagy Z, Varga Z, Husztik P. Páciens
megelégedettségi vizsgálat SF-36 kérdőívvel, a magyarországi
normál értékek meghatározása. Népegészségügy. 1999;1:4–19.
Acquadro C, Kopp Z, Coyne KS, et al. Translating overactive bladder questionnaires in 14 languages. Urology. 2006;67(3):536–40.
Kammerer-Doak D. Assessment of sexual function in women with
pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct.
2009;20(Suppl 1):S45–50. https://doi.org/10.1007/s00192-0090832-y.
Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, et al.
An International Urogynecological Association (IUGA)/
International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J.
2016;27(2):165–94. https://doi.org/10.1007/s00192-015-2932-1.
Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance
structure analysis: conventional criteria versus new alternatives.
Struct Equ Model. 1999;6:1–55.
Vrieze SI. Model selection and psychological theory: a discussion
of the differences between the Akaike information criterion (AIC)
and the Bayesian information criterion (BIC). Psychol Methods.
2012;17(2):228–43.
20. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for
the process of cross-cultural adaptation of self-report measures.
Spine. 2000;25(24):3186–91.
21. Bartula I, Sherman KA. The female sexual functioning index
(FSFI): evaluation of acceptability, reliability, and validity in women with breast cancer. Support Care Cancer. 2015;23(9):2633–41.
22. Baser RE, Li Y, Carter J. Psychometric validation of the female
sexual function index (FSFI) in cancer survivors. Cancer.
2012;118:4606–18.
23. Verit FF, Verit A. Validation of the female sexual function index in
women with chronic pelvic pain. J Sex Med. 2007;4:1635–41.
24. Filocamo MT, Serati M, Frumenzio E, et al. The impact of midurethral slings for the treatment of urodynamic stress incontinence
on female sexual function: a multicenter prospective study. J Sex
Med. 2011;8:2002–8.
25. Masheb RM, Lozano-Blanco C, Kohorn EI, et al. Assessing sexual
function and dyspareunia with the female sexual function index
(FSFI) in women with vulvodynia. J Sex Marital Ther. 2004;30:
315–24.
26. Roslan NS, Jaafar NRN, Sidi H, et al. The bio-psycho-social dimension of women’s sexual desire: ‘argumentum ad novitatem.
C u r r D r u g Ta r g e t s . 2 0 1 7 . h t t p s : / / d o i . o r g / 1 0 . 2 1 7 4 /
138945011866617062209033.
27. Sun X, Li C, Jin L, et al. Development and validation of Chinese
version of female sexual function index in a Chinese population—a
pilot study. J Sex Med. 2011;8:1101–11. https://doi.org/10.1111/j.
1743-6109.2010.02171.x.
28. Sidi H, Naing L, Midin M, et al. The female sexual response cycle:
do Malaysian women conform to the circular model? J Sex Med.
2008;5:12359–8.
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