Review articleInstruments to measure sexual dysfunction in community and psychiatric populations
Introduction
Historically, sexual dysfunction is underdetected and undertreated, although it significantly impairs quality of life. Difficulties in this area are not only prevalent in community populations but are also associated with various psychiatric and physical disorders, as well as numerous medications. In community surveys, more than 40% of women and 30% of men report some form of sexual difficulty, with loss of libido in women and premature ejaculation (PE) in men being the most common [1], [2], [3]. The prevalence of sexual dysfunction is also consistently higher in patients with major depressive disorder (MDD) than in the general population [4], [5], [6]. In a prospective study carried out in Switzerland, depressed patients were twice as likely to experience sexual problems compared to healthy controls (50% vs. 24%) [4]. In addition, treatment-emergent sexual dysfunction remains a significant issue for depressed patients, occurring in 30–50% of medicated patients [7], [8].
Despite the prevalence of sexual dysfunction, individuals are often reluctant to discuss sexual difficulties with their physician. Among individuals who reported sexual difficulties in the Global Study of Sexual Attitudes and Behaviors study (N=27,500), less than 20% sought advice or professional help [2]. In a follow-up report “embarrassment” was the main reason for not seeking help in 23% of respondents who acknowledged sexual dysfunction [9]. Other reports show that depressed individuals are more likely to report sexual problems on direct questioning compared to reliance on spontaneous reports (69% vs. 35%) [10]. This lack of reporting poses a specific issue for clinicians and researchers and supports the use of direct assessment methods to evaluate sexual function, especially for primary sexual disorders and other disorders that are associated with higher prevalence rates for sexual dysfunction.
The goal of this review is to outline the various scales available for measurement of sexual dysfunction and assess their psychometric properties. While many physical conditions, including diabetes, heart disease, hormonal imbalances, and chronic diseases such as renal or hepatic failure, are associated with sexual function, the focus of this review will be on instruments that primarily measure dysfunction in community and psychiatric populations.
Section snippets
Method
Literature searches using PubMed and Medline (1970–2009) of English-only scale studies were conducted. Specified keywords were “sexual dysfunction,” “sexual function,” “scale,” “validity,” “reliability,” “male,” “female,” “depression,” “major depression,” and “major depressive disorder.” Textbooks of scales were also used to devise the list of instruments [11]. Scales were then categorized according to primary use (e.g., sexual dysfunction in males or MDD populations). Upon compiling the list
Results
A total of 27 scales were identified that fall into the following categories: general measures of sexual dysfunction, measures of sexual dysfunction in depressed populations, as well as female-specific and male-specific scales. Only scales included in at least one study assessing sexual function were reviewed (Table 1, Table 2, Table 3, Table 4).
General measures of sexual dysfunction
General measures of sexual dysfunction provide a valid means of assessment in community samples and may be useful for comparisons across different clinical populations. However, some may not be able to detect unique aspects of sexual function related to specific disease groups. Several scales are widely used in research and clinical settings for individuals, while others are designed to evaluate dysfunction in couples.
Measures of sexual dysfunction in depressed populations
Considering the high rates of treatment-emergent sexual dysfunction, it is important to establish a baseline of dysfunction using a valid and reliable rating scale before assessing the impact of pharmacotherapy on sexual function [28], [29]. A review of randomized controlled clinical trials revealed that among 79 randomized controlled trials, 75% relied on spontaneous reports of sexual side-effects, while only 8% used specific instruments [30]. Of the studies using specific sexual function
Gender-specific scales
Given the variation in sexual dysfunction between men and women, several scales have been developed to focus on gender-specific aspects of sexual functioning (Table 3, Table 4). Some of these sex scales have subsequently been adapted for use in both men and women, while others are exclusively for use in one sex only.
Discussion
Sexual dysfunction and its assessment are important clinical issues for both research and clinical care. Although many instruments have been developed to assess sexual dysfunction, some have been used infrequently and overlap considerably with others. The primary purpose of this review was to describe the reliability and validity of data for the key instruments used to measure sexual dysfunction in community and depressed populations, including gender-specific instruments. A scale must
Conclusions
While the measurement of sexual dysfunction should be an essential aspect of clinical management and antidepressant trials, there are several key factors for scale validation and selection. It is important to be able to interpret the tests from reliability and validity studies as well as specifically determine the goals of any research or clinical questions in order to determine the most appropriate scale for use. Clinicians and researchers are encouraged to select one or two instruments that
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