Top

Published in:

Open Access 01-12-2023 | Multiple Sclerosis | Research

Reliability, validity and distribution of the Spanish female sexual function index in women with relapsing multiple sclerosis

Authors: Sara Gil-Perotin, Salma Reddam, Cristina González-Mingot, Anna Gil-Sánchez, Inés González-Suarez, Silvia Peralta, Patricia Escrivá, Lucas Barea-Moya, Beatriz Sánchez-Sánchez

Published in: BMC Women's Health | Issue 1/2023

Abstract

Background

The Female Sexual Function Index (FSFI) is a widely recognized tool for assessing sexual dysfunction (SD). However, its validation for Spanish women suffering from multiple sclerosis (MS) has not yet been conducted.

Aim

The study aimed to examine the psychometric properties of the 19-item Spanish version of the FSFI (svFSFI) in women with relapsing MS.

Method

A total of 137 women with relapsing MS from three Spanish centers participated in the study and completed the svFSFI. The psychometric properties of the questionnaire were evaluated. The prevalence of SD in the study cohort was determined, and its association with clinical and sociodemographic variables was analyzed using bi- and multivariate regression analyses.

Results

The svFSFI demonstrated excellent test-retest reliability and substantial-to-excellent internal consistency in the context of relapsing MS. There was significant convergent validity in the intercorrelations of domains. Discriminant validity showed differences in SD between women with high and low neurological disability, as measured by the Expanded Disability Status Scale (EDSS) scores. An exploratory factor analysis indicated a five-factor structure for the svFSFI. The prevalence of SD in the MS cohort was found to be 42.6%, with the ‘desire’ and ‘arousal’ domains being the most affected. Factors such as EDSS score, fatigue, depression, and having a stable partner were found to influence the total svFSFI score.

Conclusion

The study validates the svFSFI as a reliable and valid instrument for evaluating sexual dysfunction in Spanish women with MS.

Defining sexual health Report of a technical consultation on sexual health 28–31 January 2002. Geneva: World Health Organization (WHO); 2006. https://www3.paho.org/hq/index.php?option=com_content&view=article&id=2136:2009-defining-sexualhealth&Itemid=0&lang=es.

Rosen RC, Leiblum SR, Taylor JF, Bachmann GA. Prevalence of sexual dysfunction in women: results of a survey study of 329 women in an outpatient gynecological clinic. J Sex Marital Ther. 1993;19:171–88. https://doi.org/10.1080/00926239308404902.CrossRef

McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD, et al. Incidence and prevalence of sexual dysfunction in women and men: a Consensus statement from the fourth international consultation on sexual medicine 2015. J Sex Med. 2016;13:144–52. https://doi.org/10.1016/J.JSXM.2015.12.034.CrossRefPubMed

Association AAP. Diagnostic and statistical manual of mental disorders: DSM-IV 1994.

Nortvedt MW, Riise T, Myhr K-M, Landtblom A-M, Bakke A, Nyland HI. Reduced quality of life among multiple sclerosis patients with sexual disturbance and bladder dysfunction. Mult Scler. 2001;7:231–5. https://doi.org/10.1177/135245850100700404.CrossRef

Schairer LC, Foley FW, Zemon V, Tyry T, Campagnolo D, Marrie RA, et al. The impact of sexual dysfunction on health-related quality of life in people with multiple sclerosis. Mult Scler J. 2014;20:610–6. https://doi.org/10.1177/1352458513503598.CrossRef

McCabe MP, McDonald E, Deeks AA, Vowels LM, Cobain MJ. The impact of multiple sclerosis on sexuality and relationships. J Sex Res. 1996;33:241–8. https://doi.org/10.1080/00224499609551840.CrossRef

Bronner G, Elran E, Golomb J, Korczyn AD. Female sexuality in multiple sclerosis: the multidimensional nature of the problem and the intervention. Acta Neurol Scand. 2010;121:289–301. https://doi.org/10.1111/J.1600-0404.2009.01314.X.CrossRefPubMed

Foley F, Werner M. Multiple sclerosis: the questions you ask, the answers you need. In: Kalb RC, editor. Sexuality and intimacy. 2nd ed. New York: Desmos Vermonde Press; n.d.

10.

Çelik DB, Poyraz EÇ, Bingöl A, Idiman E, Özakbaş S, Kaya D. Sexual dysfunction ın multiple sclerosis: gender differences. J Neurol Sci. 2013;324:17–20. https://doi.org/10.1016/J.JNS.2012.08.019.CrossRefPubMed

11.

Dupont S. Multiple sclerosis and sexual functioning - a review. Clin Rehabil. 1995;9:135–41.CrossRef

12.

‘t Hoen LA, Groen J, Scheepe JR, Reuvers S, Diaz DC, Fernández BP, et al. A quality assessment of patient-reported outcome measures for sexual function in neurologic patients using the Consensus-based standards for the selection of health measurement instruments checklist: a systematic review. Eur Urol Focus 2017;3:444–456. https://doi.org/10.1016/J.EUF.2016.06.009.CrossRefPubMed

13.

Gumus H, Akpinar Z, Yilmaz H. The effects of multiple sclerosis on women’s sexuality: a controlled study. J Neurol Sci. 2013;333:e363–4. https://doi.org/10.1016/j.jns.2013.07.1330.CrossRef

14.

Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, 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;26:191–205. https://doi.org/10.1080/009262300278597.CrossRefPubMed

15.

Sánchez-Sánchez B, Navarro-Brazález B, Arranz-Martín B, Sánchez-Méndez Ó, de la Rosa-Díaz I, Torres-Lacomba M. The female sexual function index: transculturally adaptation and psychometric validation in Spanish women. Int J Environ Res Public Health. 2020:17. https://doi.org/10.3390/ijerph17030994.

16.

Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018; https://doi.org/10.1016/S1474-4422(17)30470-2.

17.

Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60:34–42. https://doi.org/10.1016/j.jclinepi.2006.03.012.CrossRefPubMed

18.

Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983; https://doi.org/10.1212/wnl.33.11.1444.

19.

Fisk JD, Ritvo PG, Ross L, Haase DA, Marrie TJ, Schlech WF. Measuring the functional impact of fatigue: initial validation of the fatigue impact scale. Clin Infect Dis. 1994;18:S79–83. https://doi.org/10.1093/CLINIDS/18.SUPPLEMENT_1.S79.CrossRefPubMed

20.

Kos D, Kerckhofs E, Carrea I, Verza R, Ramos M, Jansa J. Evaluation of the modified fatigue impact scale in four different European countries. Mult Scler. 2005;11:76–80. https://doi.org/10.1191/1352458505MS1117OA.CrossRefPubMed

21.

Flachenecker P, Kümpfel T, Kallmann B, Gottschalk M, Grauer O, Rieckmann P, et al. Fatigue in multiple sclerosis: a comparison of different rating scales and correlation to clinical parameters. Mult Scler. 2002;8:523–6. https://doi.org/10.1191/1352458502MS839OA.CrossRefPubMed

22.

Beck AT, Steer RA, Brown GK. Manual for the Beck depression inventory-II. San Antonio: Psychological Corporation; 1996.

23.

Streiner DL, Norman GR, Cairney J. Health Measurement Scales: A practical guide to their development and use. Case Studies in Clinical Psychological Science: Bridging the Gap from Science to Practice 2014:1–7. https://doi.org/10.1093/MED/9780199685219.001.0001.

24.

Davidson CL, Grant DMM, Byrd-Craven J, Mills AC, Judah MR, Lechner WV. Psychometric properties of the co-rumination questionnaire. Pers Individ Dif. 2014;70:171–5. https://doi.org/10.1016/J.PAID.2014.07.002.CrossRef

25.

Izquierdo I, Olea J, Abad FJ. Exploratory factor analysis in validation studies: uses and recommendations. Psicothema. 2014;26:395–400. https://doi.org/10.7334/PSICOTHEMA2013.349.CrossRefPubMed

26.

Kaiser HF. An index of factorial simplicity. 1974.

27.

Ferguson E, Cox T. Exploratory factor analysis: a Users’Guide. Int J Sel Assess. 1993;1:84–94. https://doi.org/10.1111/J.1468-2389.1993.TB00092.X.CrossRef

28.

Mokkink LB, Prinsen CAC, Bouter LM, de Vet HCW, Terwee CB. The COnsensus-based standards for the selection of health measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther. 2016;20:105–13. https://doi.org/10.1590/BJPT-RBF.2014.0143.CrossRefPubMedPubMedCentral

29.

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. https://doi.org/10.1080/00926230590475206.CrossRefPubMed

30.

Opperman EA, Benson LE, Milhausen RR. Confirmatory factor analysis of the female sexual function index. J Sex Res. 2013;50:29–36. https://doi.org/10.1080/00224499.2011.628423.CrossRefPubMed

31.

DSM-5 Changes in Diagnostic Criteria of Sexual Dysfunctions n.d. https://www.longdom.org/open-access/dsm-5-changes-in-diagnostic-criteria-of-sexual-dysfunctions-2161-038X.1000122.pdf (accessed June 8, 2023).

32.

Neijenhuijs KI, Hooghiemstra N, Holtmaat K, Aaronson NK, Groenvold M, Holzner B, et al. The female sexual function index (FSFI)-a systematic review of measurement properties. J Sex Med. 2019;16:640–60. https://doi.org/10.1016/J.JSXM.2019.03.001.CrossRefPubMed

33.

Meston CM, Derogatis LR. Validated instruments for assessing female sexual function. J Sex Marital Ther. 2002;28:155–64. https://doi.org/10.1080/00926230252851276.CrossRefPubMed

34.

Graham CA, Sanders SA, Milhausen RR, McBride KR. Turning on and turning off: a focus group study of the factors that affect women’s sexual arousal. Arch Sex Behav. 2004;33:527–38. https://doi.org/10.1023/B:ASEB.0000044737.62561.FD.CrossRefPubMed

35.

Prause N, Janssen E, Hetrick WP. Attention and emotional responses to sexual stimuli and their relationship to sexual desire. Arch Sex Behav. 2008;37:934–49. https://doi.org/10.1007/S10508-007-9236-6.CrossRefPubMed

36.

Carvalheira AA, Brotto LA, Leal I. Women’s motivations for sex: exploring the diagnostic and statistical manual, fourth edition, text revision criteria for hypoactive sexual desire and female sexual arousal disorders. J Sex Med. 2010;7:1454–63. https://doi.org/10.1111/J.1743-6109.2009.01693.X.CrossRefPubMed

37.

Sungur MZ, Gündüz A. A comparison of DSM-IV-TR and DSM-5 definitions for sexual dysfunctions: critiques and challenges. J Sex Med. 2014;11:364–73. https://doi.org/10.1111/JSM.12379.CrossRefPubMed

38.

Gierhart BS. When does a “less than perfect” sex life become female sexual dysfunction? Obstet Gynecol. 2006;107:750–1. https://doi.org/10.1097/01.AOG.0000204866.43734.22.CrossRefPubMed

39.

Balon R, Segraves RT, Clayton A. Issues for DSM-V: sexual dysfunction, disorder, or variation along normal distribution: toward rethinking DSM criteria of sexual dysfunctions. Am J Psychiatry. 2007;164:198–200. https://doi.org/10.1176/AJP.2007.164.2.198.CrossRefPubMed

40.

Foley FW, Zemon V. The multiple sclerosis intimacy and sexuality Questionnaire-19 (MSISQ-19). Sex Disabil. 2000; https://doi.org/10.1023/A:1005421627154.

41.

Sand M, Rosen R, Meston C, Brotto LA. The female sexual function index (FSFI): a potential “gold standard” measure for assessing therapeutically-induced change in female sexual function. Fertil Steril. 2009;92:S129. https://doi.org/10.1016/j.fertnstert.2009.07.1173.CrossRef

42.

Mirmosayyeb O, Barzegar M, Nafari A, Mahdi Hosseinabadi A, Malekzadeh A, Ghasemi M, et al. Sexual dysfunction in women with Neuromyelitis Optica Spectrum disorders and multiple sclerosis. Sex Disabil. 2022;40:381–92. https://doi.org/10.1007/S11195-022-09731-5/METRICS.CrossRef

43.

Le Breton F, Chesnel C, Lagnau P, Haddad R, Lacroix P, Miget G, et al. Is there a relationship between overactive bladder and sexual dysfunction in women with multiple sclerosis? J Sex Med. 2022;19:729–37. https://doi.org/10.1016/j.jsxm.2022.02.019.CrossRefPubMed

44.

Borello-France D, Dusi J, O’Leary M, Misplay S, Okonski J, Leng W, et al. Test-retest reliability of the urge-urinary distress inventory and female sexual function index in women with multiple sclerosis. Urol Nurs. 2008;28(1):30–5.PubMed

45.

Zorzon M, Zivadinov R, Bragadin LM, Moretti R, De Masi R, Nasuelli D, et al. Sexual dysfunction in multiple sclerosis: a 2-year follow-up study. J Neurol Sci. 2001;187:1–5.CrossRefPubMed

46.

Hulter BM, Lundberg PO. Sexual function in women with advanced multiple sclerosis. J Neurol Neurosurg Psychiatry. 1995;59:83–6. https://doi.org/10.1136/JNNP.59.1.83.CrossRefPubMed

47.

Valleroy ML, Kraft GH. Sexual dysfunction in multiple sclerosis. Arch Phys Med Rehabil. 1984;65:125–8.PubMed

48.

Barka Bedrane Z, Bouchenak KD. Sexual dysfunction in women with relapsing remitting multiple sclerosis in West Algeria. Mult Scler J. 2020;26:656. https://doi.org/10.1177/1352458520974937.CrossRef

49.

Nazari F, Shaygannejad V, Mohammadi Sichani M, Mansourian M, Hajhashemi V. Sexual dysfunction in women with multiple sclerosis: prevalence and impact on quality of life. BMC Urol. 2020:20. https://doi.org/10.1186/s12894-020-0581-2.

50.

Abdo S, Abdel-Naseer M, Elmehdawy K, Adly M, Al-Faqeeh A, Hassan A, et al. Sexual dysfunction in women with early multiple sclerosis. Mult Scler Relat Disord. 2020:37. https://doi.org/10.1016/j.msard.2019.11.007.

51.

Carnero Contentti E, Pettinicchi JP, Caride A, Lopez PA. Sexual dysfunction in patients with multiple sclerosis: association with disability, anxiety, depression and fatigue. Mult Scler J. 2018;24:780. https://doi.org/10.1177/1352458518798592.CrossRef

52.

Bartnik P, Wielgoś A, Kacperczyk J, Pisarz K, Szymusik I, Podlecka-Piętowska A, et al. Sexual dysfunction in female patients with relapsing-remitting multiple sclerosis. Brain Behav. 2017:7. https://doi.org/10.1002/brb3.699.

53.

Konstantinidis C, Tzitzika M, Bantis A, Nikolia A, Samarinas M, Kratiras Z, et al. Female sexual dysfunction among Greek women with multiple sclerosis: correlations with organic and psychological factors. Sex Med. 2019;7:19–25. https://doi.org/10.1016/j.esxm.2018.11.003.CrossRefPubMedCentral

54.

Afshar B, Amini L, Hasani M, Jahanfar S, Nabavi SM. The most effective sexual function and dysfunction interventions in individuals with multiple sclerosis: a systematic review and meta-analysis. Int J Reprod Biomed. 2022;20:241–54. https://doi.org/10.18502/ijrm.v20i4.10897.CrossRefPubMedPubMedCentral

55.

Baghbanian SM, Khalili B, Bakhshi A, Azizi H, Ghazaeian M. The effects of bupropion on sexual dysfunction in female patients with multiple sclerosis: a double-blind randomized clinical trial. Mult Scler Relat Disord. 2023:69. https://doi.org/10.1016/j.msard.2022.104399.

56.

Yeni K, Tulek Z, Terzi M. Assessment of sexual dysfunction and related factors in female patients with multiple sclerosis. Mult Scler J. 2021;27:260–1. https://doi.org/10.1177/13524585211044667.CrossRef

57.

Tzitzika M, Daoultzis CC, Konstantinidis C, Kordoutis P. The multiple sclerosis intimacy and sexuality questionnaire (MSISQ-15): validation and cross-cultural adaptation of the Greek version in MS patients. Sex Disabil. 2021;39:495–506. https://doi.org/10.1007/s11195-020-09635-2.CrossRef

58.

Altmann P, Leutmezer F, Leithner K, Monschein T, Ponleitner M, Stattmann M, et al. Predisposing factors for sexual dysfunction in multiple sclerosis. Front Neurol. 2021:12. https://doi.org/10.3389/fneur.2021.618370.

59.

Novotna K, Friedova L, Motyl J, Vaneckova M, Horakova D, Andelova M. Lack of association between sexual dysfunction and spinal cord pathology in women with multiple sclerosis. Mult Scler J. 2020;26:610–1. https://doi.org/10.1177/1352458520974937.CrossRef

60.

Altmann P, Leutmezer F, Leithner K, Monschein T, Zrzavy T, Ponleitner M, et al. Sexual dysfunction in multiple sclerosis: who is at risk? Mult Scler J. 2020;26:617. https://doi.org/10.1177/1352458520974937.CrossRef

61.

Reddam S, González-Suárez I, González-Mingot C, Sabin-Muñoz J, Bernad L, Gil-Sánchez A, et al. Sexual dysfunction in premenopausal Spanish women with relapsing multiple sclerosis: a multicenter study. Mult Scler J. 2022;28:944. https://doi.org/10.1177/13524585221123682.CrossRef

62.

Baghbanian SM, Zahedi Z, Cheraghmakani H, Elyasi F, Nadi A. Frequency of sexual dysfunction and associated causes in female patients with multiple sclerosis. J Maz Univ Med Sci. 2020;29:131–7.

63.

Polat Dunya C, Tülek Z, Kürtüncü M, Gündüz T, Panicker JN, Eraksoy M. Evaluating the effects of transcutaneous tibial nerve stimulation or pelvic floor muscle training on sexual dysfunction in female multiple sclerosis patients reporting overactive bladder. Neurourol Urodyn. 2021;40:1661–9. https://doi.org/10.1002/nau.24733.CrossRefPubMed

64.

Altunan B, Aksoy Gündoǧdu A, Kurtoǧlu Özçaǧlayan TI, Unal A, Turgut N. The effect of pelvic floor exercise program on incontinence and sexual dysfunction in multiple sclerosis patients. Eur J Neurol. 2020;27:666.

65.

Zaherian N, Mousavi P, Majdinasab N, Haghighizadeh MH, Afshari P. The effect of pelvic floor muscle exercises on sexual function in women with multiple sclerosis: a pre−/post-intervention clinical trial. Fam Med Prim Care Rev. 2020;22:179–82. https://doi.org/10.5114/fmpcr.2020.95328.CrossRef

Title: Reliability, validity and distribution of the Spanish female sexual function index in women with relapsing multiple sclerosis
Authors: Sara Gil-Perotin
Salma Reddam
Cristina González-Mingot
Anna Gil-Sánchez
Inés González-Suarez
Silvia Peralta
Patricia Escrivá
Lucas Barea-Moya
Beatriz Sánchez-Sánchez
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Multiple Sclerosis
Published in: BMC Women's Health / Issue 1/2023
Electronic ISSN: 1472-6874
DOI: https://doi.org/10.1186/s12905-023-02811-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reliability, validity and distribution of the Spanish female sexual function index in women with relapsing multiple sclerosis

Abstract

Background

Aim

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aim

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

“I think to myself ‘why now?’” – a qualitative study about endometriosis and pain in Austria

Associations with physical activity, sedentary behavior, and premenstrual syndrome among Chinese female college students

Assessment of knowledge and practices of exclusive breastfeeding among rural women during the COVID-19 pandemic in Egypt: a cross sectional study

Does diet and activity lead to difference in resting energy expenditure in obese women?

Awareness and perceptions of Filipino obstetrician-gynecologists on fertility preservation: a cross-sectional survey

The association of dietary approaches to stop hypertension (DASH) with the odds of diabetic nephropathy and metabolic markers in women: a case–control study