There are a number of questionnaires that have been developed to collect information about sexual function and pain for research purposes. They may also be used by your doctor to collect important information for diagnosis and treatment.

The Female Sexual Function Index (FSFI)

The FSFI was first published in 2000 and is a commonly used questionnaire for research purposes and for doctors to collect information about their individual patients. The questionnaire collects information about six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. There are 19 questions in total, with 2 to 4 questions per domain. All self-reported information is less reliable than objectively collected information, like test results, but this is the best we have for collecting this type of information.

The validity of results of the FSFI has been assessed by comparing the scores from women diagnosed with sexual dysfunction to a control group, and there is a clear difference in the scores, indicating that the questionnaire does differentiate between women with and without sexual dysfunction. (1-2) For reference, the average score in all categories for control women (no sexual dysfunction) is usually between 4 and 5; desire is slightly lower, at 3 to 4. (1-4) In 2005, a total score of 26.55 or lower was determined to be the best cut-off for distinguishing between women with and without sexual dysfunction. (5) However, do not take this score of 26.55 as definitive, as, with any test, some women fall outside what is statistically likely. In the study, using a cut-off of 26.55, about 71% of women with sexual dysfunction and about 88% of women without sexual dysfunction were correctly diagnosed.

The questionnaire and scoring guide are available here.

The Female Sexual Distress Scale (FSDS)

The FSDS is another commonly used questionnaire that focuses on assessing sexually related personal distress, as this is an essential part of clinical presentation of sexual dysfunction. Meaning, being bothered by and concerned about sexual issues is important for diagnosis. All of the questions ask about feelings concerning sexual function. Results from the FSDS have also been shown to accurately differentiate between women with and without sexual dysfunction. (6) The original FSDS was revised to a 13 question form, referred to as the FSDS-R; the new version was also validated in its ability to distinguish between sexually functional and dysfunctional women. (7)

No official cut-off score is established for the FSDS-R, however in the original validation a cut-off of 11 was used for statistical testing. (7) With a cutoff of 11, the test showed >80% sensitivity and >90% specificity. (7) Note that, with the FSDS-R, a higher score indicates distress, so using a cut-off of 11, women with scores 0-10 would be considered normal and women with scores 11-52 considered distressed. Similar optimal cut-off scores of 11.5 and 13 have been reported when assessing the FSDS-R translated to other languages. (8-9)

The FSDS-R can be downloaded here.

The Vulvar Pain Assessment Questionnaire (VPAQ)

The VPAQ is a comprehensive assessment tool that covers many topics: symptoms, interference with various activities, emotional and cognitive response, coping strategies, and partner factors. The VPAQ was first published in 2016 and used previously established questionnaires, like the FSFI and FSDS, as guides for creation and to assess validity. (10) The full set of questions is much longer than the other questionnaires I’ve discussed, but it covers a lot of information and was created specifically with vulvodynia in mind. The information collected using the VPAQ goes a long way in distinguishing between types of vulvodynia and how symptoms are affecting the patient’s life.

The VPAQfull (55 items) and VPAQscreen (shorter, 30 item version) collect information about the nature of the pain, emotional response, cognitive response, life interference, sexual function interference, and penetration interference. VPAQdsec (short for describe) lists common words used to describe vulvar pain to help patients be descriptive about the pain (e.g. burning, stabbing). VPAQcope addresses the coping strategies used to deal with pain. Finally, VPAQpartner collects information about how romantic partners and spouses are affected.

In a preliminary study, a general cutoff of 2 was suggested to differentiate between symptoms that are not significantly affecting the patient and those of greater significance. (11) In the scale descriptions, this usually differentiates between little to no pain/effect and moderate effect.

The VPAQ is available here.

References

1. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, and R D’Agostino. 2000. The Female Sexual Function Index (FSFI): A Multidimensional Self-Report Instrument for the Assessment of Female Sexual Function. Journal of Sex & Marital Therapy 26: 191-208. https://www.ncbi.nlm.nih.gov/pubmed/10782451 Direct Link to Text: http://www.fsfiquestionnaire.com/Published%20Format.pdf

2. CM Meston. 2003. Validation of the Female Sexual Function Index (FSFI) in Women with Female Orgasmic Disorder and in Women with Hypoactive Sexual Desire Disorder. Journal of Sex & Marital Therapy. 29(1): 39-46. https://www.ncbi.nlm.nih.gov/pubmed/12519665

3. Crisp CC, Fellner AN, and RN Pauls. 2015. Validation of the Female Sexual Function Index (FSFI) for web-based administration. International Urogynecology Journal. 26(2): 219-22. https://www.ncbi.nlm.nih.gov/pubmed/25023778

4. Stephenson KR, Toorabally N, Lyons L, and CM Meston. 2016. Further Validation of the Female Sexual Function Index: Specificity and Associations With Clinical Interview Data. Journal of Sex & Marital Therapy. 42(5): 448-61. https://www.ncbi.nlm.nih.gov/pubmed/26098130

5. Wiegel M, Meston C, and R Rosen. 2005. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. Journal of Sex & Marital Therapy. 31(1): 1-20. https://www.ncbi.nlm.nih.gov/pubmed/15841702

6. Derogatis LR, Rosen R, Leiblum S, Burnett A, and J Heiman. 2002. The Female Sexual Distress Scale (FSDS): initial validation of a standardized scale for assessment of sexual related personal distress in women. Journal of Sex & Marital Therapy. 28(4): 317-30. https://www.ncbi.nlm.nih.gov/pubmed/12082670

7. Derogatis L, Clayton A, Lewis-D’Agostino, Wunderlich G, and Y Fu. 2008. Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder. Journal of Sexual Medicine. 5(2): 357-64. https://www.ncbi.nlm.nih.gov/pubmed/18042215

8. Aydin S, Onaran O, Topalan K, Aydin CA, and R Dansuk. 2016. Development and Validation of Turkish Version of the The Female Sexual Distress Scale-Revised. Sexual Medicine 4(1): e43-50. https://www.ncbi.nlm.nih.gov/pubmed/26796854

9. Nowosielski K, Wrobel B, Sioma-Markowska U, and R Poreba. 2013. Sexual dysfunction and distress--development of a Polish version of the female sexual distress scale-revised. Journal of Sexual Medicine 10(5): 1304-12. https://www.ncbi.nlm.nih.gov/pubmed/23444946

10. Dargie E, Holden RR, and CF Pukall. 2016. The Vulvar Pain Assessment Questionnaire inventory. Pain 157(12): 2672-86. https://www.ncbi.nlm.nih.gov/pubmed/27780177

11. Dargie E, Holden RR, and CF Pukall. 2017. The Vulvar Pain Assessment Questionnaire: Factor Structure, Preliminary Norms, Internal Consistency, and Test-Retest Reliability. Journal of Sexual Medicine 14: 1585-96. https://www.ncbi.nlm.nih.gov/pubmed/29198513