Ethnic Representation in Female Sexual Dysfunction Questionnaire Validation

Ethnic Representation in Female Sexual Dysfunction Questionnaire Validation
Sexual Health Topics: Women’s Sexual Health


Female sexual dysfunction (FSD) is fairly common and affects between 10-40% of women. It encompasses multiple conditions that cause marked interpersonal distress or difficulty in at least one area of sexuality: desire, interest, arousal, orgasm, or pain.

Given the broad and sensitive nature of FSD, it can be difficult to identify and diagnose. As such, it is thought to be underreported and underdiagnosed in most communities. Tools such as validated questionnaires can provide useful information to health care professionals when they are screening patients for FSD.

However, the validation process for such questionnaires (i.e., the process for determining if the questionnaires truly measure what they intend to measure) requires testing the questionnaire on sample populations that are representative of the general population, and this may not always be the case. Historically, minority populations have been underrepresented in such studies, which can have an impact on the outcome.

Therefore, a recent study was designed to evaluate the ethnic representation of sample populations used in the validation process of FSD questionnaires.


The authors of this study completed a thorough scoping review using electronic databases to identify all FSD questionnaires that had been validated between 1976 and 2021. After removing duplicate publications and those that were determined not to fit the inclusion criteria, the researchers were left with 48 validation studies for FSD questionnaires.

They then used 2019 U.S. Census data to determine the ethnicity breakdown of adult women in the U.S. general population and 2018 healthcare workforce reports to determine the ethnicity breakdown of the U.S. female health care workforce. This made it possible for the researchers to compare the representation of minority ethnic groups in the validation studies to the overall U.S. population and the U.S. female health care workforce.


In the end, the authors found that white individuals were overrepresented in study populations used to validate FSD questionnaires, and minority ethnic groups were underrepresented. Specifically, the average ethnic representation of the 48 study populations compared to the U.S. general population and the U.S. female health care workforce was as follows:


% Average Study Population

% U.S. General Population

% U.S. Female Health Care Workforce













Native American












Discussion & Conclusion

These findings demonstrate a trend toward the underrepresentation of ethnic minority groups in validation studies for FSD questionnaires. Representation is important because questionnaires are designed to measure aspects of the communities in which they are used. Moving forward, strides can be made to improve representation in questionnaire validation efforts.

The authors of this study concluded, “The current study is intended neither to critique nor to undermine the contributions that have been made in this important field of study. The recent Covid-19 pandemic has shed light on healthcare disparities and offered a chance for us to reflect on how to address these challenges. We believe that the trends in ethnic underrepresentation may reflect limited healthcare professional awareness and barriers in access to healthcare. FSD is an important area of research that we must continue to prioritize and advance for all women, including ethnic minorities, to narrow the gaps in under recognition and undertreatment. Furthermore, as future tools for assessing sexual function are considered, strategies to include ethnic minorities in the target populations during development and validation should be prioritized.”


  • Battle, C.R., Rubin, R.S., Kingsberg, S.A., & Alzweri, L. (2022). Ethnic Minority Representation in Female Sexual Dysfunction Questionnaire Validation: A Scoping Review. The Journal of Sexual Medicine, 19(12), 1824-1838. DOI:

Members Only


ISSM Update