To our knowledge prior studies have not evaluated a

To our knowledge, prior studies have not evaluated a single-item screening question for sexual function distress. Research has focused on evaluating the FSDS-R single item related to sexual desire bother (item 13) rather than distress about sex life (item 1) among women with DSM-V sexual dysfunction disorders [17]. Using data from 738 women from the United States, Canada, and Europe, FSDS-R total scores and responses to FSDS-R item 13 were found to differentiate between groups with and without hypoactive sexual desire, but not between groups with other different types of sexual dysfunction. Similar analyses for distress about sex life (item 1) were not reported. In our study, item 13 did not perform as well as item 1, probably because we wished to identify an item that assessed global sexual function rather than disorders of desire. While item 13 did differentiate between high and low sexual concerns groups, it thip cost was less highly correlated with FSDS-R total, FSFI total, and FSFI domain scores in comparison with item 1. Further analyses in larger populations would be needed to determine whether FSDS-R item 1 differentiates women with different types of sexual dysfunction and whether the FSDS-R item 1 would be useful in clinical settings, opening up patient–provider discussions that otherwise rarely occur.
Correlations within the FSDS-R and between the FSDS-R and FSFI total and domain scores are somewhat difficult to interpret due to the lack of comparable published data. Several prior psychometric analyses did not report FSDS-R item to total correlations [5-8,17] or FSDS-R to FSFI correlations [5-8,17]. However, correlations were reported for the Farsi version of the FSDS-R among 1,966 Iranian women, most of whom did not report female sexual dysfunction (67%). Farsi FSDS-R item to total correlations ranged from 0.67 to 0.82 (P < .001) [18], which are lower than in our study using the English language version. In addition, correlations between the Farsi FSDS-R total and FSFI dimensions were −0.16 to 0.40 (P < .001) [18], which are comparable with our results. It is possible that the strength of correlations we observed may have varied based on a woman\'s sexual activity. For example, correlations between the Sexual Health Outcomes in Women Questionnaire (SHOW-Q) and health-related quality of life, body image, and symptom scales varied thip cost based on whether or not a woman was sexually active [19].
Limitations include the following. We did not collect data on sexual frequency, partner gender, or history of physical or sexual abuse. The number of study subjects was relatively small and limited to a single geographic area. Only women at a single MsFLASH site completed the FSDS-R due to concerns from principal investigators at all other research sites about subject burden. In addition, the sample was predominantly Caucasian, college educated, and married/living as married. The sample was (i) limited to menopausal women with hot flashes and other symptoms; and (ii) not specifically selected based on sexual dysfunction, so we relied on MENQOL items to differentiate high and low sexual concerns groups based on desire and symptoms, important aspects of DSM-V criteria. The MENQOL is a validated, widely used measure of menopausal symptoms, and the sexual function domain is a validated subscale. The FSFI is a more comprehensive measure of sexual function, but it was not used to determine high and low sexual concerns groups in this study, as then it could not have been used in the assessment of construct validity.

Acknowledgments

Introduction
Despite differences in the etiologies of different pelvic pain medical diagnoses (i.e., endometriosis, vulvodynia, painful bladder syndrome, and pelvic inflammatory disease, for example), the overlap of clinical elements of women with chronic pelvic pain (CPP) makes it appropriate to group these patients under the umbrella diagnosis of “chronic pelvic pain.” These clinical elements include pain with intercourse (dyspareunia) [1-4], pain during menstruation (dysmenorrhea) [5,6], and reports of myofascial pain of the pelvic floor muscles and proximal soft tissue [2,7-9]. CPP is further described as nonmalignant, continuous or recurrent pain of structures related to the pelvis, lasting at least 6 months, and is often associated with negative sexual, cognitive, and emotional consequences [10]. This condition is also associated with dysfunction in one or usually more of the following body systems: gynecological, urological, gastrointestinal, neurological, and musculoskeletal [11]. The community prevalence of CPP is estimated at nearly 15% [12], and primary care prevalence estimates are comparable with that of low back pain and asthma [13]. The annual economic costs associated with only one type of CPP, endometriosis, have been estimated at nearly $22 billion [14]. This prevalent, costly condition is described as a “medical nightmare” for clinicians [11]. Women with CPP report depression, anxiety, and sleep disturbances, in addition to limitations in sexual activity and mobility [15,16].