Sexual functioning is a sensitive topic, even among patients in Western countries. It has been shown that patients are reluctant to spontaneously report problems with sexual functioning, either as a medication side effect or due to other reasons.
What is a possible solution to the under-reporting of problems with sexual functioning?
It is also known that patients frequently stop taking their medication because they believe it is affecting their sexual functioning, whether that is the case or not.
If sexual functioning is systematically assessed and documented even before a medication is started, this can be extremely helpful in monitoring any change after the medication is started.
The solution is to use a questionnaire that patients can fill out outside of the clinical session on their own time. This has three advantages:
1. It has been shown that people are much more open about difficulties with sexual functioning when asked by a self-report questionnaire than they are when asked by an interviewer.
2. It does not take up any time during the clinical visit where we are already short of time.
3. It may introduce the topic of sexual functioning to the patient.
Which questionnaire should we use?
The questionnaire should not be so brief that it doesn’t get any details of functioning in the different phases of the sexual cycle. But it should also not be so long that patients are reluctant to complete the questionnaire.
The Changes in Sexual Functioning Questionnaire (CSFQ) is a well-established questionnaire that has been extensively validated. It has been used in dozens of clinical trials of psychotropic medications.
The 14-item version is the version recommended for clinical use. It only takes three to five minutes for the patient to complete the questionnaire.
There are a Male and a Female versions of the questionnaire. The questions about desire and pleasure are the same for men and women. But, of course, the questions about arousal and orgasm are different for men and women.
The CSFQ has been validated in the US and in Spain (in Spanish). It has been translated into at least 75 languages!
There is a fee for use of the CSFQ in commercially-sponsored research.
For permission to use the scale in research with other types of funding or no funding, please contact Dr. Clayton.
But for Members of Simple and Practical Mental Health, Dr. Clayton has kindly provided the scale at no cost for use in our clinical work. For details on how to use the scale and to download a copy of the scale for use in your clinical practice, click HERE. Note: This permission is for use in clinical practice only and not for use of the scale for research of any kind (prospective or retrospective).
Sexual dysfunction: Identification, Assessment, and Treatment (Video interview with Anita Clayton, MD)
Bobes J, González MP, Bascarán MT, Clayton A, Garcia M, Rico-Villade Moros F, Banús S. Evaluating changes in sexual functioning in depressed patients: sensitivity to change of the CSFQ. J Sex Marital Ther. 2002 Mar-Apr;28(2):93-103. PubMed PMID: 11894800.
Bobes J, Gonzalez MP, Rico-Villandemoros F, Bascaran MT, Sarasa P, Clayton A. Validation of the Spanish version of the Changes in Sexual Functioning Questionnaire (CSFQ). J Sex Marital Ther. 2000 Apr-Jun;26(2):119-31. PubMed PMID: 10782444.
Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33(4):731-45. PubMed PMID: 9493486.
Keller A, McGarvey EL, Clayton AH. Reliability and construct validity of the Changes in Sexual Functioning Questionnaire short-form (CSFQ-14). J Sex Marital Ther. 2006 Jan-Feb;32(1):43-52. PubMed PMID: 16234225.
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