Quality of Life Research 13: 1643–1658, 2004.

1643
Ó 2004 Kluwer Academic Publishers. Printed in the Netherlands.

Questionnaires to measure sexual quality of life

Renata Arrington1, Joseph Cofrancesco2 & Albert W. Wu2,3

1
Departments of Internal Medicine and Pediatrics, University of Cincinnati School of Medicine, and
Children’s Hospital Medical Center, Cincinnati, OH (E-mail: awu@jhsph.edu); 2Department of Medicine,
School of Medicine, The Johns Hopkins University; 3Departments of Health Policy and Management, and
Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

Accepted in revised form 9 January 2004

Abstract

Context: Sex is important to quality of life. There are a number of questionnaires to measure sexual-
function, but many lack applicability and usefulness to certain groups. Objective: To identify questionnaires
measuring sexual function, determine the domains most commonly assessed, and examine evidence for their
usefulness in different populations. Data sources: Computerized literature search using Medline, PubMed
and PsychLit, reference lists, and unpublished reports, published in English between 1957 and 2001. MESH
terms included sexual function, sexual dysfunction, sexual satisfaction, quality of life, and questionnaire.
Articles were excluded if the questionnaire did not measure sexual function from the patient perspective.
Data extraction: Questionnaires were grouped as general questionnaires that include a sexual function
domain, and sexual-function-specific questionnaires. Questionnaires were evaluated for domains, appli-
cability to different populations, and evidence for reliability, validity and responsiveness. Data synthesis:
Literature search yielded 62 questionnaires, 57 which assessed sexual function from the patient perspective;
12 were general and 45 specific. Six domains were commonly represented, including interest and desire,
satisfaction/quality of experience, excitement/arousal, performance, attitude/behavior, and relationship.
Only 28% could be used in homosexual patients, and 52% were applicable to both genders; 57% were
designed for use in chronic disease populations. Only nine questionnaires had evidence for both adequate
reliability and validity. Conclusions: Current measures of sexual functioning often exclude important do-
mains, lack applicability to gender and sexual preference groups, or lack adequate testing of validity and
testing in important populations. Future questionnaires should take into account these concerns.

Key words: Quality of life, Questionnaire, Sexual dysfunction, Sexual function, Sexual satisfaction

‘Sex, a great and mysterious force in human life, has indis- being and overall quality of life [1–3]. When it is
putably been a subject of absorbing interest to mankind good, sex can impart pleasure, contentment and
through the ages’.
Justice William J. Brennan,
emotional closeness. Studies have shown a rela-
Associate Justice, US Supreme Court tionship between sexual dysfunction and worse
quality of life in patients with a variety of disorders
[4–22]. Even short-term disruptions to sexual-
functioning can create frustration and distress, and
Introduction chronic disruption can lead to anxiety and depres-
sion, damage relationships with sexual partners,
Sex is a basic human function and a fundamental and disrupt functioning in other aspects of life.
part of life. Sex involves physical, psychological Sexual dysfunction extends across all age
and emotional factors and affects general well- groups. It has been estimated to affect 43% of
1644

women and 31% of men in the US aged 18– feelings of guilt, inadequacy or anxiety, as a result
59 years old [11–14, 16–18, 23]. After adulthood, of a hysterectomy or mastectomy. Altered self-
increasing age is related to decreased desire, libido, perception may be even more important in shaping
sensitivity and pleasure [12–14, 20, 23–25]. The sexual attitude in some individuals [61]. This can
Massachusetts Male Aging Study group report result in the inability to be aroused and achieve a
estimated a crude incidence of erectile dysfunction climax, and can impact negatively on self-esteem,
(ED) in 2.4/100 men every year, with an estimated quality of life, and interpersonal relationships [12,
900,000 new cases every year in the US. Sexual- 16–18]. These factors can result in fear of impo-
function decreases with increasing age among male tence, inability to discuss sexuality, and unwill-
veterans, despite sustained interest [13]. Nonethe- ingness to participate in sexual activity.
less, studies have shown that a full sexual func- Patients are increasing inclined to discuss sexual
tioning is possible in advanced age [23, 24, 26]. problems with their physicians [18]. Factors
Masters and Johnson [3] demonstrated that the encouraging this may include increased adoption
human sexual response involves sequential stages of patient-centered care, and the availability of
of excitement-arousal, plateau, orgasm, and reso- effective treatments. Accompanying this, there has
lution. During sexual arousal, vasocongestion and been greater attention to the assessment of sexual
muscular tension increase, primarily in the geni- functioning as an outcome measure in clinical
talia. If stimulation continues, the excitement studies [21, 34, 43, 45, 46, 52, 62, 63].
intensifies into a plateau phase, accompanied by a Although there are a number of methods to
high state of sexual interest. This plateau may be assess sexual functioning, many are not well tested,
short or long, but culminates in a rapid release of and none are used in general clinical practice. The
vasocongestion and muscular tension, or the or- best way to measure sexual function is uncertain.
gasm [27–29] coinciding with a subjective satis- Devices and laboratory tests are available to
faction. A variety of physiologic, medical and measure certain aspects of sexual functioning.
psychological factors can contribute to sexual Direct measures such as the Nocturnal Penile
dysfunction including illness [4, 6, 19, 20, 22, 30– Tumescence (NPT) device, intracavernosal injec-
37], pharmacologic agents [15, 21, 38–46], and tion with prostaglandinE1, penile brachial pres-
psychosocial factors [18, 22, 47]. Physiologic sure indices, doppler studies, and sacral evoked
abnormalities can result in inability to achieve or potentials are used to assess erectile function in
maintain an erection or in ejaculatory disorders in men [62, 64]. In women, direct physiologic mea-
males, and decreased lubrication in females. In surements include genital blood peak systolic
females, shortening of the vaginal vault, loss of velocity, vaginal pH, intravaginal compliance, and
rugal folds, thinning of the vaginal mucosa and genital vibratory perception thresholds [20]. These
lowered acidity of the vaginal secretions may give direct measures are correlated with indirect mea-
rise to dyspareunia [2, 16, 23, 24, 27, 48, 49]. sures such as levels of estrogen, LH, testosterone
Medications such as sedatives [50], selective sero- and prolactin. Self-report measures are used to
tonin uptake inhibitor antidepressants [21, 40–44], assess many aspects of sexual function [65]. Kap-
and antihypertensives [4, 46, 51–53] have a direct lan suggested evaluating the psycho-physiological
action on the nervous system and may increase component of sex from the perspective of desire,
anhedonia, or impair libido, orgasm and erection. while Levine recommended measuring sexual sat-
Many diseases can adversely affect sexual function isfaction. There are a number of questionnaires
by affecting circulatory or neurologic function, used to measure aspects of sexual function
hormonal balance or systemic health [54]. The including: attitudes toward sex [66, 67]; arous-
mechanism of disruption is often multifactorial [5– ability [68–70]; behavior [67, 71]; adjustment [72,
9, 48, 55–57]. 73]; and function [4, 74, 75]. There is no consensus
Despite the potential impact of medical illness in the literature about what methods are best, and
on sexual functioning, some authors have postu- for what purposes.
lated that the majority of sexual dysfunction arises We conducted a structured literature review to
from psychological processes [58–60]. Vaginismus identify specific questionnaires intended to mea-
can be a conditioned response engendered by sure sexual function, either independently or as a
 1645

dimension of patient reported overall health sta- siveness. We organized the domains based on the
tus. Our purpose was to make recommendations first three of Masters and Johnson’s [3] physio-
about available measures to researchers and health logical stages of the sexual response (excitement-
care providers involved in treating patients with arousal, plateau, and orgasm) and by the most
sexual dysfunction. Our specific aims were: (1) to frequent domains in published reviews of available
identify questionnaires that have been used clini- sexual-function questionnaires [65, 76].
cally to measure sexual function, (2) to determine Each questionnaire was categorized according
what domains have been most commonly assessed, to whether it was intended for use or had been
and how they have been defined, and (3) to used in chronic medical or general populations,
examine the evidence for the usefulness of the and for applicability in heterosexual and homo-
questionnaires in different populations. sexual males and females. In addition, question-
naires were reviewed for patient input in their
development. We noted if instruments had
Methods undergone psychometric testing – defined as of
tests of reliability (including test–retest reliability),
Questionnaires available to measure sexual func- internal consistency using Cronbach’s a [77] or
tion were identified via a computerized literature KR-20 (an a of >0.70 was considered to indicate
search using Medline, PubMed and PsychLit. We adequate reliability); validity (content validity,
used the MESH headings ‘Sexual function,’ construct validity, and criterion validity); and
‘quality of life,’ ‘sexual dysfunction,’ ‘question- responsiveness (sensitivity to change). The opera-
naires,’ and ‘sexual satisfaction.’ We circulated tional definitions used are shown in Appendix 1.
abstracts of articles to researchers and clinicians Questionnaires were grouped as having had (1) no
interested in sexual functioning for additional evaluation; (2) an adequate evaluation, but low
citations and unpublished reports. All articles were reliability (i.e., Cronbach’s a <0.70); and (3) evi-
reviewed to identify patient-reported sexual-func- dence for adequate reliability and validity.
tion questionnaires.
Articles were included if they focused on pa-
tient-reported sexual function, or included sexual Results
function as a component of a general or disease-
specific quality of life questionnaire. We defined Identification of articles and instruments
‘questionnaire’ as one or more questions that
described or evaluated one or more aspects of The literature search yielded 139 citations
sexual function. All articles were published be- addressing sexual function and dysfunction. We
tween 1957 and 2001 and were written in English. excluded 77 articles because they did not describe
Articles were excluded if a questionnaire was not or use a patient-reported sexual-function ques-
intended to measure sexual function, or if sexual tionnaire. Five of the remaining 62 questionnaires
function was not measured from the patient’s were excluded because sexual function was exam-
perspective. ined exclusively from the perspective of the spouse;
of the 57 remaining questionnaires, 45 were sexual
specific questionnaires and 12 were general
Assessment of the questionnaires questionnaires with a sexual-function domain
(Table 1).
Questionnaires were divided into two groups: Overall, there was a secular trend in the design
general questionnaires that included a sexual- of the instruments. Instruments developed from
function domain (General), and sexual function- the mid- 1950’s to the early 1970’s were designed
specific (Specific) questionnaires designed solely to to measure satisfaction with specific sexual activi-
measure sexual function. Each questionnaire was ties, usually using simple behavioral checklists [59,
evaluated with regard to sexual function domains 60, 86], but did not relate these activities to overall
it included, applicability to different populations, satisfaction. Sexual activities were defined either
and evidence for reliability, validity and respon- from the perspective of heterosexual couples, who
Table 1. Questionnaires to assess sexual functioning

1646
Instrument Interest/desire - Excitement/ Performance Satisfaction/ Change in Importance of Medical use Applications
Drive/Libido arousal quality behavior/ sexual activity and usage
frequency in relationship

1. Brief Index of SF for Women [78] Y Y Y

2. Brief Sexual Function Y Y Y Y Y Y NI NI

Questionnaire for Men [79]
3. Deragotis Sexual Function Y Y Y
Inventory [DSFI] [71]
4. Deragotis Interview for
Sexual Function [59, 80]
5. Female Sexual Arousability Y Y Y Y
Index [SAI] [68]
6. Florida Sexual History Y Y Y Y NI NI
Questionnaire [FSHQ] [81]
7. General Information Y Y Y NI
Form [GIF] [82]
8. Golombok Rust Inventory Y Y Y
of Sexual Satisfaction [GRISS] [74]
9. Hanson Assessment of Y Y Y Y NI NI
Sexual Health [83]
10. Heterosexual Behavioral Y
Assessment Females [84]
11. Heterosexual Behavioral Y
Assessment Males [85]
12. Heterosexual Scale Y
[86, 87]
13. Homosexual Scale [86, 87]

14. Hypogonadism and Y Y Y Y

Sexual Function [88]
15. Index of Sexual Y Y Y Y NI
Satisfaction [ISS] [89]
16. International Index of Y Y Y Y NI NI
Erectile Function [IIEF] [90]
17. JAMA Patient Page, Y Y Y Y NI NI
Sexual Dysfunction [18]
18. Jewish General Hospital Y Y
Sexual Self-Monitoring Form [91]
19. Leiden Impotence Y Y NI NI
Questionnaire [52, 53]
20. McCoy Female Y Y Y
Sexuality Questionnaire [92]
21. Multiaxial Problem-oriented Y Y Y NI NI
Diagnostic System of SF [78]
22. Potency and Prostatectomy [93] Y Y Y Y Y Y Y NI NI

23. Radical Prostatectomy Y Y Y NI NI

Questionnaire [16, 17]
24. Sabbatsberg Sexual Y Y Y Y Y NI NI
Rating Scale Revised [16, 17]
25. Scalability of Sexual
Experience [94]
26. Segraves Sexual Y Y Y NI NI
Symptomatology Interview [95]
27. Sexual Activity of Y Y Y NI NI
Men presenting Prostatism
and Prostatectomy [95]
28. Sexual Adjustment Y Y Y Y Y
Questionnaire [SAQ] [96]
29. Sexual Dysfunction Y Y Y
in HIV+ Men [97]
30. Sexual Dysfunction in Y Y Y Y
HIV+ Men [w/neuropathy] [56]
31. Sexual Dysfunction Y Y Y Y NI NI
Schizophrenia [50]
32. Sexuality Experience Scale [98] Y Y Y NI NI

33. Sexual Function Scale [99, 100] Y Y Y Y NI NI

34. Sexual Interaction Inventory Y Y Y Y

Scale (partner) [SII] [82, 101]
35. Sexual Interaction Y Y Y
System Scale [102]
36. Sexual Interest and NI
Satisfaction Scale [103]
37. Sexual Interest Y
Questionnaire [SIQ] [66]
38. Sexual Inventory [SI] [104] Y Y Y Y

39. Sexual Orientation Y Y

Methods and Anxiety [SOMA] [105]
40. Sexual Self-Efficacy in Y Y Y Y Y
Erectile Functioning [SSES-E] [91]
41. Sexual Symptom Y Y Y NI NI
Distress Scale [52, 53]
42. The Clark Sexual History Y
Questionnaire [SHQ] [69]
1647
1648

were often married, or as a ‘pathologic’ case, de-

Applications and

fined as a homosexual male. In other instruments

NI

NI
such as the Clark Sexual History Questionnaire
[69] and the Sex Inventory used for screening of
usage

sex offenders [104] sexual activities were designed

NI

NI

to serve as direct measures of sexual behavior and

thereby indirect measures to functioning and sat-
Medical use

isfaction. In the early 1970’s questionnaires began

to incorporate a broader definition of sexual-
Y

function and satisfaction. This resulted in ques-

[ ] = Reference number.

tionnaires designed to measure sexual function

in relationship
Importance of
sexual activity

NI = Not indicated

across genders and sexual preferences.

Domains
Change in

frequency
behavior/

Aspects of sexual function assessed in the 57

questionnaires included satisfaction, interest, fre-
quency, importance, performance, desire, worry,
arousal, current behavior, orgasmic capacity, libi-
Performance Satisfaction/

do, urologic problems and feelings of femininity

and masculinity (Table 1). Six domains were rep-
quality

resented repeatedly: interest, desire and libido

Y

(grouped under interest/desire); satisfaction with

quality of an erection, ejaculation or orgasm and
pain/discomfort with sex (satisfaction/quality);
physical evidence of an erection, including morn-
Y

ing erections, excitement without an erection, and

Grey shaded = Yes

sufficient vaginal lubrication for intercourse

Excitement/

No color = No

(excitement/arousal) and the ability to maintain an

arousal

erection in order to achieve an orgasm (perfor-

mance); attitudes or behaviors of the respondent
Y

and his or her partner such as feelings of avoid-

Interest/desire -

ance, embarrassment and change in frequency of

Drive/Libido

sexual intercourse (attitude/behavior); and the

impact of sexual functioning on the relationships
(relationship). Most questionnaires included sev-
Y

eral of these domains.

Development of most of the specific instruments
was based on clinical experience, literature review
in Women with Cervical CA [48]
44. Vaginal changes and Sexuality

and previous questionnaires. The questions in-

Explanation of boxed quadrants:
43. Urge-Incontinence Impact

cluded in the general questionnaires were taken

45. Watts Sexual Functioning
Questionnaire [IIQ] [106]

either from clinical experience or previously

developed specific questionnaires. Three ques-
Questionnaire [4]
Table 1. (Continued)

tionnaires used patient input in the development of

Female
Hetero Homo

the questions – a specific questionnaire, the Inter-

national Index of Erectile Function (IIEF) [90] and
Instrument

two general questionnaires – the UCLA Prostate

Male

Cancer Index [8, 9] and the Medical Outcomes

Study (MOS) sexual-function subscale [107].
 1649

Assessment of the questionnaires both reliability and validity and for 24% both were
demonstrated to be adequate.
Sexual functioning-specific questionnaires
(Specific) General questionnaires with a sexual-function
domain
There were 45 specific questionnaires. Within these
questionnaires, the excitement/arousal domain Sexual function was included as a component in 12
was most frequently included (71%). Interest/de- general quality of life questionnaires, all of which
sire was included in 53%, while performance and were designed for use in chronic diseases. Three
satisfaction/quality, were included in 38 and 51%, questionnaires used a single item to assess sexual
respectively. function, while the remaining nine used one or
Fifteen questionnaires can measure sexual more multi-item scales. Interest/desire was mea-
function in homosexuals: three exclusively in sured most frequently (75%), excitement/arousal
homosexuals and 12 in both homosexuals and was included in 67%, performance in 50%, satis-
heterosexuals. Overall, 11 could be used in faction/quality in 50% and importance in 42%.
homosexual women and 12 in homosexual men. Sexual preference and gender orientation varied
There were a few gender-specific questionnaires. among questionnaires. None of the questionnaires
Twenty-eight (62%) were designed for use in fe- were designed exclusively for use in homosexual
males, with five (11%) designed for use in females males. The HAT-QoL [112, 115] questionnaire
alone. Ten (22%) of these instruments had been examined sexual function in both homosexual
designed for use among women with chronic med- (male and female) and heterosexual adults with
ical illness. Of these, only three questionnaires were HIV. None of the questionnaires was designed
designed to measure sexual function in exclusively for use in homosexual males. Seven
both homosexual and heterosexual females. Thirty- questionnaires (58%) could be used in females;
nine (87%) of the questionnaires could be used in none were designed for use in females alone.
men, with sixteen (36%) designed exclusively for Eight of the 12 general questionnaires were
use in males. Seventeen (38%) were intended for use tested for reliability, validity or responsiveness. All
in individuals with chronic disease. Four ques- eight tested for reliability and had undergone tests
tionnaires where designed to measure sexual-func- for validity, one tested for responsiveness and two
tion in both homosexual and heterosexual males. had patient input into the development.
Thirty-three (Table 2) of the specific question- The UCLA Prostate Cancer Index [9] is an
naires had undergone at least some psychometric example of a disease-specific quality of life ques-
testing. Content validity, a precursor to instrument tionnaire that includes assessment of sexual func-
development, had been evaluated in 15 of the spe- tioning. Development incorporated focus groups
cific measures. Construct validity was tested against to determine the areas of sexual function most
NPT, testosterone levels, disease severity, clinician important to patients. The questionnaire demon-
assessment, clinical data, and other measures of strated adequate internal consistency and evidence
related concepts. For example, the IIEF [90] for construct validity. Another, the MOS, Sexual
showed evidence for content validity from patient Functioning Scale is a subscale of larger battery of
focus groups and construct validity from compar- questions [107]. This scale is useful for measuring
isons with responses from clinical interviews. The sexual function in men and women, and has
Sabbatsberg Rating Scale [16, 17], designed for demonstrated good reliability (Cronbach’s a
women, was shown to have construct validity coefficient for men 0.95 and women 0.84), con-
compared to scores for the SF-36 and the Hospital struct validity, and responsiveness in the general
Anxiety and Depression scales. Overall 27 of the 33 population and patients with chronic disease.
questionnaires (82%) had been tested for reliability
(39% demonstrated adequate reliability), 25 (76%) Summary of testing
for validity, only 14 (42%) tested for both content
and construct validity and 6% for responsiveness. Overall, most questionnaires were not designed for
Sixty-three percent [18] had undergone testing for use among homosexual males or females. Twenty-
Table 2. Evidence for Reliability and Validity of Sexual Functioning Questionnaires

1650
Instrument Evaluation Reliability Content Construct Responsiveness Patient input
test–retest Cronbach’sP0.70 validity validity

Brief Index of SF for Women [78] Y Over 1 month Y

interval, Pearson
correlation coefficent
(range 0.68–0.78;
internal consistency 0.83)
Brief Sexual Function Y Y
Questionnaire for Men [79]
Cancer Rehabilitation Evaluation Y 0.67–0.78 Y
Systems-Short Form [CARES-SF] [108]
Deragotis Sexual Function Y Cronbach 0.74–0.80; Y
Inventory [DSFI] [71] test–retest over 1 week
interval 0.84–0.92
Female Sexual Arousal Index [68] Y 0.92 Y
Florida Sexual History 0.90 Y Y
Questionnaire [FSHQ] [81]
Functional Capacity Index [FCI] [109] Y Y Y
General Information Form [82] Y
Golombok Rust Inventory of Y Y Y
Sexual Satisfaction [GRISS] [74]
Hanson Assessment of Sexual Health [83] 0.60 Y
Health-Related Quality of Life Y 0.75–0.96 Y
Measure for Multiple Sclerosis [110]
Health-Related Quality of Life P0.74 Y
Prostate Cancer [HRQoL] [111]
Heterosexual Behavioral Y
Assessment Males [85]
Heterosexual Scale [86, 87] Y Y
HIV/AIDS Targeted Quality 0.52 Y Y
of Life [HAT- QoL] [112]
Homosexual Scale [86, 87] Y
Index of Sexual Satisfaction (ISS) [89] 0.93, 0.99, 0.92 Y Y
(in one repeated sample)
International Index of Erectile Y P0.73 for each and Y Y Y Y
Function [90] P0.91 for total
Leiden Impotence Questionnaire [52, 53] Y
McCoy Female Sexuality Questionnaire [92] Y 0.83 (range 0.69–0.95 over Y Y
2 week interval);
Cronbach’s)0.77.
Medical Outcomes Study [MOS] [107] Men: 0.95; Women: 0.84 Y Y Y
Table 2. (Continued)
Multiaxial problem-oriented Not indicated
diagnostic system of SF [78]
Paraplegia [103] 0.96
Positive Negative Evaluation [PNE] [111] 0.51–0.77 Y
Sabbatsberg Sexual Rating Scale 0.61–0.87 Y Y
Revised [16, 17]
Scalability of Sexual Experience [94] Y
Segraves Sexual Symptomatology Y
Interview [95]
Sexual Adjustment Questionnaire [SAQ] [96] Y Y Y
Sexual Dysfunction in Stroke Patients [113] Not indicated
Sexual Dysfunction Scale [50] 0.61–0.71
Sexuality Experience Scale [98] Not indicated
Sexual History Questionnaire [SHQ] [69] Y Y
Sexual Interaction System Scale [102] 0.90 Y Y
Sexual Interest Questionnaire [SIQ] [66] Y
Sexual Inventory [SI] [104] Y P0.795 Y Y
Sexual Orientation Method and Y Y Y
Anxiety [SOMA] [105]
Sexual Symptoms Distress Scale [52, 53] Y 0.94 Y Y Y
The SSES-E: A Measure of Sexual Y Y Y
Self-Efficacy in Erectile Functioning [91]
UCLA Prostate Cancer Index [114] Y 0.93 Y Y Y
Urge-Incontinence Impact Y Internal consistency Y
Questionnaire [IIQ] [106] 0.91; test–retest reliability,
content, criterion
Watts Sexual Functioning Questionnaire [4] Y 0.65 Y Y
1651
1652

eight percent of the questionnaires were designed Related Measures [76], Sexual Life: A Clinician’s
for use among homosexuals. Fifty-two percent of Guide [117], and Tools for Primary Care Research
the questionnaires measured sexual function [118]. Similar to our findings, other reviews have
among both males and females, while only 9% found a variety of self-assessment questionnaires
were designed to measure sexual function in used to measure sexual function. However, most
females alone. Only 57% of all questionnaires reviews have focused broadly, presenting ques-
were designed for use in medical populations. tionnaires across populations, ranging from chil-
There was no uniformity of psychometric testing dren and childhood sexual experience to condoms
among questionnaires. Only 18 of the question- or have been limited to specific populations. In
naires (both sexual-function specific and generic addition, some of the reviews did not examine the
questionnaires) had evidence of sufficient reliabil- questionnaires or the evidence of psychometric
ity (Cronbach’s> 0.70). When validity was exam- performance.
ined, convergent validity was tested most often. Many of the commonly used instruments are
Only 17 questionnaires had evidence for content aimed at a specific patient population. The
validity. Nine questionnaires, (including the Sab- strength of such questionnaires is their ability to
batsberg Sexual Rating Scale, the IIEF and the reflect issues applicable to that group by being
UCLA Prostate Cancer Index) had evidence for designed solely to quantify and to measure sex-
adequate reliability, content and construct valid- ual function in a study population. A weakness
ity. is a lack of a clinical foundation for question
application before evidence of psychometric
testing.
Discussion Our review did not yield a single questionnaire
universally useful for researchers or clinicians who
This structured review of patient-reported ques- wish to measure sexual function. No questionnaire
tionnaires identified and evaluated measures of can be applied to both genders, all sexual prefer-
sexual functioning that are available for use in ences, and both healthy and chronically ill popu-
clinical research and practice. The 57 question- lations. However, the Watts [4], the Sabbatsberg
naires identified tended to assess several common Sexual Rating Scale [16, 17], the International
dimensions, including interest, desire, excitement/ Index of Erectile Function [90], the UCLA Pros-
arousal, frequency, performance, importance and tate Cancer Index [9] and Derogatis Interview for
satisfaction. However, there was no apparent Sexual Function [59, 60, 80] all have advantages,
consensus on what domains were crucial, perhaps each within a limited range of applications.
in part because few incorporated patient input in For patients with chronic disease, such as
their design. Some were designed specifically to hypertension, the Watts Scale [4] has been used for
assess sexual functioning, while other included both heterosexual and homosexual men and wo-
sexual function among in a battery of scales to men. The Watts Scale was initially designed to
measure health-related quality of life. Few ques- measure sexual-function in individuals on therapy
tionnaires were applicable across genders and for hypertension. Content validity was established
sexual preferences. Further complicating the pic- using a panel that incorporated patient input in
ture, evidence for psychometric performance was designing items, and later via panel of experts.
patchy, with only few instruments demonstrating Internal consistency has been relatively low (0.65),
adequate reliability and validity. Little testing has limiting measurement precision, but the question-
compared questionnaire to other measures of naire has demonstrated construct validity. In
sexual functioning. addition, the questionnaire consists of 17 items in
There have been a few reviews of sexual-func- a simple format. It was developed for use among
tion questionnaires. In 1986 [65], Conte reviewed hypertensive clients on complex drug regimens and
self-report questionnaires useful in measuring has been widely used.
sexual function. Since that time, reviews have been The Sabbatsberg Sexual Rating Scale [16, 17]
included in the Handbook of Family Measurement was designed to reflect sexual dysfunction among
Techniques [116], The Handbook of Sexuality- women with gynecological problems and has
 1653

shown good internal consistency. It has been used The Brief Index of Sexual Function for wo-
repeatedly among women with chronic gyneco- men [90] is a brief, sexual specific questionnaire,
logical conditions, with evidence for construct measures a broad range of domains (desire,
validity and adequate responsiveness. Unlike the arousal, orgasm, satisfaction), while placing mini-
Golombok and Rust Inventory of Sexual Satis- mal burden on the tester. This questionnaire had
faction, the Sabbatsberg Sexual Self-Rating Scale performed well with respect to reliability and
is unintrusive and is relatively brief. validity (both convergent and discriminant con-
The International Index of Erectile Function struct validity), but has yet to be used in a major
[90] encompasses relevant domains for men with study.
erectile dysfunction. The questionnaire is 15-items For patients with stroke, Monga and colleagues
long, included patient input in its development, [73, 113] designed a questionnaire that includes a
and it has been used in several studies of men with broad range of domains, including areas of general
erectile dysfunction. It has been linguistically val- attitude about sexual functioning and fear of
idated in 10 languages using a process that incor- impotence, libido, frequency, erectile capacity,
porated forward and backward translation of vaginal lubrication, satisfaction, and orgasmic
items. It has shown adequate test–retest reliability, ability. Some evidence for validity was provided by
an acceptable Cronbach’s a, and content and comparisons to the Geriatric Depression Scale
construct validity, and it has been shown to be (Table 3).
responsive to changes inspired by clinical inter- There are limitations to current measures of
ventions. The main limitation of this questionnaire sexual quality of life and functioning. These
is that it covers few domains. questionnaires often do not include domains
For men with prostate cancer or those who have important in measuring sexual function, perhaps
completed therapy for prostate cancer, the UCLA because of limited patient input in their develop-
Prostate Cancer Index [9] has been useful to ment. General questionnaires tend not to address
quantify sexual dysfunction. The questionnaire the entire concerns particular to that population
was designed from the perspective of the patients, and may not be as sensitive to change as specific
using focus groups and patient surveys to deter- measures. In addition, some questionnaires are
mine the areas they deemed most important. It has lengthy and intrusive, limiting their usefulness,
shown adequate test–retest and internal consis- despite adequate psychometric properties. Finally,
tency reliability, and construct validity by com- there are limitations inherent to sexological
paring sexual-function in patients with and research, including the limited capacity for exter-
without cancer. It is fairly long, even if not nal validation, and the tendency of subjects to give
counting questions about the patients’ job status, socially desirable responses.
race and age. Although sex and sexual function are an integral
The Derogatis Interview for Sexual Function part of human behavior, research in measuring
[59, 60, 80] is a self-report questionnaire designed sexual function is not far advanced. There are
to measure sexual functioning across multiple many populations in which sexual function has not
populations, including males, females, heterosex- been measured, e.g., pregnant or post-partum
ual and homosexual populations. Norms have women, patients with organ transplant, obese
been developed which are gender specific for dif- patients, patients with end-organ disease such as
ferent sexual preference groups. In addition to individuals with end-stage liver disease, or ado-
adequately measuring reliability, this measure has lescents and young adults and women with chronic
been used among clinical practice for years. In a illnesses. More research is needed to design ques-
recent study of prostate disease [119], the Dero- tionnaires appropriate to various populations.
gatis questionnaire detected differences between When designing questionnaires to measure sexual
functional, marginally functional and impotent function, we recommend the following: (1) the
groups. A drawback of this instrument has been domains should be reflect current sexual func-
used primarily in company-sponsored clinical drug tioning concerns; (2) the development of ques-
trials, making most of the data unavailable for tionnaires should occur from the perspective
evaluation. of patients, by using patient input and (3) the
1654

Table 3. Questionnaire name and reference number

Questionnaire name Reference number

Sexual Function – Specific

1. Brief Index for SF Form Women [78]
2. Brief Sexual Function Questionnaire for Men [79]
3. Deragotis Sexual Function Inventory (DSFI) [71]
4. Derogatis interview for Sexual Function [59, 80]
5. Female Sexual Arousability Index [68]
6. Florida Sexual History Questionnaire (FSHQ) [81]
7. General Information Form (GIF) [82]
8. Golombok Rust Inventory of Sexual Satisfaction (GRISS) [74]
9. Hanson Assessment of Sexual Health [83]
10. Heterosexual Behavior Assessment Females [84]
11. Heterosexual Behavior Assessment Males [85]
12. Heterosexual Zuckerman [86, 87]
13. Homosexual Zuckerman [86, 87]
14. Hypogonadism and Sexual Function [88]
15. Index of Sexual Satisfaction (ISS) [89]
16. International Index of Erectile Function [90]
17. Jewish General Hospital Sexual Self-Monitoring Form [91]
18. Leiden Impotence Questionnaire [52, 53]
19. McCoy Female Sexuality Questionnaire [92]
20. Multiaxial Problem-oriented Diagnostic System of SF [78]
21. Potency and Prostatectomy [93]
22. Radical Prostatectomy Questionnaire [120]
23. Sabbastberg Sexual Rating Scale (revised) [16, 17]
24. Scalability of Sexual Experience [121]
25. Segraves Sexual Symptomatology Interview [94]
26. Sexual Activity of Men presenting Prostatism and Prostatectomy [95]
27. Sexual Adjustment Questionnaire (SAQ) [96]
28. Sexual Dysfunction (Silence Hurts) [18]
29. Sexual Dysfunction in HIV+ Men (assoc w/ neuropathy/CD4 count) [56]
30. Sexual Dysfunction in HIV+ Men [97]
31. Sexual Dysfunction in Schizophrenic Patients [50]
32. Sexual Function Scale [99, 100]
33. Sexual Interaction Inventory (SII) [82, 101]
34. Sexual Interaction System Scale [102]
35. Sexual Interest and Satisfaction Scale [99]
36. Sexual Interest Questionnaire (SIQ) [66]
37. Sexual Inventory (SI) [104]
38. Sexual Orientation Method and Anxiety(SOMA) [105]
39. Sexual Self-Efficacy Scale for Erectile Disorder (SSES-E) [91]
40. Sexual Symptom Distress Scale [52, 53]
41. Sexuality Experience Scale [98]
42. The Clark Sexual History Questionnaire [69]
43. Urge-incontinence Impact Questionnaire [106]
44. Vaginal Changes and Sexuality in Women with Cervical CA [48]
45. Watts Sexual Function Questionnaire [4]
QoL General Questionnaire with Sexual Function Domain
1. BPH-Specific Quality of Life Instrument [32]
2. Cancer Rehabilitation Evaluation System - Short Form [108]
3. Functional Capacity Index [109]
4. Health Related Quality of Life measure for Multiple Sclerosis [110]
5. Health Related Quality of Life Prostate Cancer [111]
6. HIV/AIDS Targeted Quality of Life (HAT-QoL) [112, 115]
7. Limb-sparring QoL Sarcoma Patients
8. MOS Sexual Function Subscale [107]
9. Positive Negative Evaluation [111]
10. Sickness Index Profile/Nottingham Health Profile [119]
11. Stroke Patients Questionnaire [60, 121]
12. UCLA Prostate Cancer Index [8, 9]
 1655

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