Bringing the body of the iceberg to the surface: the Female Sexual Dysfunction Index-6 (FSDI-6) in the screening of female sexual dysfunction.
OBJECTIVE
Female Sexual Dysfunction (FSD) is a still poorly studied and underdiagnosed condition. The aim of the study was to produce an improved version of FSFI-6 (6-Item Version of the Female Sexual Function Index), entitled Female Sexual Dysfunction Index-6 (FSDI-6), and to estimate its accuracy as a screening instrument for FSD.


METHODS
In the new version, an item related to the personal interest in having a satisfying sex life was added, while the item rating the entity of sexual arousal was removed. We administered FSDI-6 in a consecutive series of female adult patients not consulting for sexual problems (n = 120, Cohort 1), and in another series of patients specifically consulting for sexual problems, which were considered as the control group (n = 160, Cohort 2).


RESULTS
FSDI-6 score was significantly higher in patients in Cohort 2 (p < 0.0001). Cronbach's alpha for FSDI-6 was 0.784, indicating a high level of reliability. The estimated area under the ROC curve for FSDI-6 was 0.657 (p < 0.0001, 95 % CI 0.584-0.730). The proportion of subjects with a pathological FSDI-6 score (≥16.5) was 29.9 (n = 32) and 59.4 % (n = 95) in Cohort 1 and 2, respectively (p < 0.0001). Among subjects with a pathological FSDI-6 (score ≥16.5), those consulting for FSD had been postmenopausal for fewer years, had a higher level of education, a lower BMI and a lower prevalence of chronic diseases than those not consulting for FSD (p < 0.05).


CONCLUSIONS
Although a lower educational level, overweight/obesity, menopause and chronic diseases are risk factors for FSD, they are often associated with the failure in medical consultation for FSD. We propose that FSDI-6 should be performed by health care providers in non-specialist settings to detect potential FSD, which otherwise could remain under-diagnosed.
Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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Maseroli
Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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Fanni
Gynecology and Obstetrics Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
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Fambrini
Diabetes Agency, Careggi Hospital, Florence, Italy.
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Ragghianti
School of Sexology, Department of Clinical, Applied and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy.
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Limoncin
Diabetes Agency, Careggi Hospital, Florence, Italy.
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Mannucci
Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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Maggi
Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50139, Florence, Italy. l.vignozzi@dfc.unifi.it.
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Vignozzi
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008403:Mass Screening; D008593:Menopause; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011594:Psychometrics; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D012735:Sexual Dysfunction, Physiological / Q000175:diagnosis* / Q000453:epidemiology*; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires
Female sexual dysfunction; Questionnaire; Referral; Screening