Female sexual dysfunction.

331 FEMALE SEXUAL DYSFUNCTION (FSD) affects a significant number of women of all ages, but the prevalence tends to increase with age. Almost 10 million American women aged 50–74 years selfreport diminished vaginal lubrication, pain and discomfort with intercourse, decreased arousal, and difficulty in achieving orgasm.1,2 Their discomfort and distress have received all too little attention in the scientific literature. This issue of the Journal of Women’s Health & Gender Based-Medicine reports results of two studies that address different aspects of research on female sexual functioning—methodological, physiological, and treatment.3,4 A third study was reported in the previous issue of the Journal.5 The authors of these papers do us an enormous service. The papers help to focus our attention and advance our understanding of critical issues with which the field of female sexuality is grappling as it struggles to establish a sound scientific foundation. This work was presaged by a recent international consensus conference establishing criteria for previously identified distinct FSD entities, including hypoactive sexual desire disorder (HSDD), female sexual arousal disorder (FSAD), orgasmic disorder (FOD), and sexual pain disorder.6 There was agreement at this conference that FSD should be approached from both psychogenic and organic perspectives to provide clinical end points and outcomes. For example, FSAD was redefined as the persistent or recurring inability to attain or maintain sufficient sexual excitement so as to cause personal distress, which may be associated with a lack of subjective excitement, lack of genital lubrication/swelling, or other somatic changes. In addition, conference participants identified useful and clinically relevant subtypes for several of the other disorders, for example, sexual pain disorder, which may include vaginismus and dyspareunia. In the first of these studies, Quirk et al.5 describe the development of a female sexual function questionnaire (SFQ) designed to provide a valid and sensitive measure of the nature and severity of most types of FSD and a sensitive measure of the effect of treatment intervention. Although earlier validated scales exist that measure FSD, including the Derogatis Sexual Functioning Inventory (DSFI)7 and the Brief Index of Sexual Function for Women (BSIF-W),8 these instruments were developed before the more recent classification of sexual dysfunction.6 As a result, they may lack current construct validity and thus fail to provide systematic assessment of the key clinical features of specific sexual dysfunction disorders. In contrast, the SFQ was designed to evaluate seven domains of female sexual function, five of which map directly onto the clinically relevant subtypes of FSD identified in the current classification scheme: desire, arousal-sensations, arousallubrication, orgasm, and pain. The results presented suggest that the SFQ has very good internal consistency, moderate to good reliability, and very good discriminant validity and sensitivity. It is an important measure designed to further our understanding of FSD. The validation of the SFQ, however, could have been enhanced had the authors shown the extent to which these domains differ based on current FSD diagnostic subtypes. It is hoped that in a subsequent publication Quirk et al. will provide investigators in the Guest Editorial