Validation of the Six-item Female Sexual Function Index in Middle-Aged Brazilian Women

Dall’Agno, Mona Lúcia; Ferreira, Charles Francisco; Ferreira, Fernanda Vargas; Pérez-López, Faustino R.; Wender, Maria Celeste Osório

doi:10.1055/s-0039-1692694

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 41 (07) • July 2019 • https://doi.org/10.1055/s-0039-1692694 copy

Validation of the Six-item Female Sexual Function Index in Middle-Aged Brazilian Women

Validação do índice de funcionamento sexual feminino-6 em mulheres brasileiras de meia-idade

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To validate the six-item female sexual function index (FSFI-6) in middleaged Brazilian women.

Methods

Cross-sectional observational study, involving 737 (premenopausal n = 117, perimenopausal n = 249, postmenopausal n = 371) Brazilian sexually active women, aged between 40 and 55 years, not using hormonal contraceptive methods. The Brazilian FSFI-6 was developed from the translation and cultural adaptation of the Portuguese FSFI-6 version. The participants completed a general questionnaire, the FSFI-6, and the menopause rating scale (MRS). The validation was performed by AMOS 16.0 software (SPSS, Inc., Chicago, IL, USA) for a confirmatory factor analysis (CFA). The chi-square of degrees of freedom (χ2/df), the comparative fit index (CFI), the Tucker- Lewis index (TLI) and the root-mean-square error of approximation (RMSEA) were used as indices of goodness of fit. Cronbach α coefficient was used for internal consistency.

Results

The process of cultural adaptation has not altered the Brazilian FSFI-6, as compared with the original content. The CFA for the FSFI-6 score showed an acceptable fit (χ2/df = 3.434, CFI = 0.990, TLI = 0.980, RMSEA = 0.058, 90% confidence interval (90%CI) = 0.033-0.083, p ≤ 0.001) and a good reliability was established in FSFI-6 and MRS (Cronbach α = 0.840 and = 0.854, respectively). In addition, 53.5% of the sample had low sexual function.

Conclusion

The FSFI-6 was translated and adapted to the Brazilian culture and is a consistent and reliable tool for female sexual dysfunction screening in Brazilianmiddleaged women.

Keywords:
climacteric; cross cultural comparison; menopause; test reliability; female sexual health

Female data	N= 737
Age (years)
40–44	117 (15.9)
45–49	210 (28.5)
50–54	293 (39.8)
55–59	117 (15.9)
Parity
0	78 (10.6)
1	188 (25.5)
≥ 2	471 (63.9)
Educational level (years)
0–6	109 (14.8)
7–12	316 (42.9)
≥ 13	312 (42.3)
Marital status
Married or living with partner	561 (76.1)
Divorced	98 (13.3)
Single	65 (8.8)
Widowed	13 (1.8)
Currently has partner
Yes	710 (96.3)
No	27 (3.7)
Menopausal status
Premenopausal	117 (15.9)
Perimenopausal	249 (33.8)
Postmenopausal	371 (50.3)
Natural menopause	292 (78.7)
Surgical menopause	79 (21.3)
Time since menopause onset (months)	5.00 [3.00–7.50]
[minimum–maximum]	[0.00–31.00]
Pharmacological treatment for menopause symptoms
No	631 (85.6)
Systemic hormone therapy	44 (6.0)
Alternative therapies (herbal teas, phytoestrogens)	58 (7.9)
Psychotropics	1 (0.1)
Topic estrogen	3 (0.4)
Habits, lifestyle, health aspects and other issues
Current smoking	116 (15.7)
Body mass index	26.29 [23.51–30.39]
[minimum–maximum]	[16.00–54.11]
Sedentary lifestyle	116 (15.7)
Hypertension	130 (17.6)
Diabetes	40 (5.4)
Psychiatric conditions	193 (26.2)

Items	TotalN = 737	PremenopausalN = 117	PerimenopausalN = 249	PostmenopausalN = 371	^* Kruskal-Wallis (Dunn posthoc) and Chi-Square tests with adjusted residual analysis. Bold numbers: association by Chi-Square test with adjusted residual analysis. p-value	Cronbach alpha
Desire[minimum–maximum]	3.00 [2.00–3.00][1.00–5.00]	3.00 [2.00–3.00]^a Different letters indicate statistical significance. Significance set at 5% for all analysis. [1.00–5.00]	3.00 [2.00–3.00]^ab Different letters indicate statistical significance. Significance set at 5% for all analysis. [1.00–5.00]	3.00 [2.00–3.00]^b Different letters indicate statistical significance. Significance set at 5% for all analysis. [1.00–5.00]	0.015	0.840
Arousal[minimum–maximum]	3.00 [3.00–4.00][1.00–5.00]	3.00 [3.00–4.00]^ab Different letters indicate statistical significance. Significance set at 5% for all analysis. [1.00–5.00]	3.00 [3.00–4.00]^a Different letters indicate statistical significance. Significance set at 5% for all analysis. [1.00–5.00]	3.00 [2.00–3.00]^b Different letters indicate statistical significance. Significance set at 5% for all analysis. [1.00–5.00]	≤ 0.0001
Lubrication[minimum–maximum]	4.00 [3.00–4.00][1.00–5.00]	4.00 [3.00–5.00]^a Different letters indicate statistical significance. Significance set at 5% for all analysis. [1.00–5.00]	4.00 [3.00–4.00]^a Different letters indicate statistical significance. Significance set at 5% for all analysis. [1.00–5.00]	3.00 [2.00–4.00]^b Different letters indicate statistical significance. Significance set at 5% for all analysis. [1.00–5.00]	0.002
Orgasm[minimum–maximum]	4.00 [3.00–4.00][1.00–5.00]	4.00 [3.00–4.00]^ab Different letters indicate statistical significance. Significance set at 5% for all analysis. [1.00–5.00]	4.00 [3.00–5.00]^a Different letters indicate statistical significance. Significance set at 5% for all analysis. [1.00–5.00]	3.00 [3.00–4.00]^b Different letters indicate statistical significance. Significance set at 5% for all analysis. [1.00–5.00]	0.010
Satisfaction[minimum–maximum]	4.00 [3.00–4.00][1.00–5.00]	4.00[3.00–4.00][1.00–5.00]	4.00[3.00–4.00][1.00–5.00]	4.00 [3.00–4.00][1.00–5.00]	0.871
Pain[minimum–maximum]	4.00 [3.00–5.00][0.00–5.00]	5.00 [4.00–5.00]^a Different letters indicate statistical significance. Significance set at 5% for all analysis. [0.00–5.00]	4.00 [3.00–5.00]^ab Different letters indicate statistical significance. Significance set at 5% for all analysis. [0.00–5.00]	4.00 [3.00–5.00]^b Different letters indicate statistical significance. Significance set at 5% for all analysis. [0.00–5.00]	0.005
Total[minimum–maximum]	21.00 [17.00–24.00][6.00–30.00]	22.00 [20.11–22.02]^a Different letters indicate statistical significance. Significance set at 5% for all analysis. [7.00–30.00]	22.00 [20.29–21.47]^a Different letters indicate statistical significance. Significance set at 5% for all analysis. [7.00–30.00]	20.00 [19.17–20.18]^b Different letters indicate statistical significance. Significance set at 5% for all analysis. [6.00–30.00]	≤ 0.0001
FSFI total scores ≤ 21	394(53.5)	51(43.6)	116(46.6)	227(61.2)	≤ 0.0001
MRS total score[minimum–maximum]	13.00 [7.00–21.00][0.00–41.00]	12.00 [5.00–17.00]^a Different letters indicate statistical significance. Significance set at 5% for all analysis. [0.00–38.00]	13.00 [7.00–22.00]^b Different letters indicate statistical significance. Significance set at 5% for all analysis. [0.00–41.00]	14.00 [8.00–21.00]^b Different letters indicate statistical significance. Significance set at 5% for all analysis. [0.00–40.00]	0.001	0.854

Items	FSFI-6 total score (N= 737)
Items	Coefficient	^* Spearman correlations. Significance set at 5% for all analysis. p-value
Not having a sexual partner	−0.033	0.375
Single or not living with a partner	0.063	0.087
Female educational level	0.206	≤ 0.0001
Female age	−0.110	0.003
Family income	0.209	≤ 0.0001
BMI	0.038	0.300
Parity	0.097	0.009
Menopause (peri- and postmenopausal status)	−0.154	≤ 0.0001
Time of menopause	−0.107	0.039
Sedentary lifestyle	0.026	0.489
MRS total score	−0.375	≤ 0.0001

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[1] Address for correspondence Mona Lúcia Dall’Agno, MSc, Rua Ramiro Barcelos, 2350, 90035-903, Largo Eduardo Faraco, Serviço de Ginecologia e Obstetrícia, Porto Alegre, RS, Brasil (e-mail: modallagno@hotmail.com).