RE: Bartula I, Sherman KA: Development and validation of the Female Sexual Function Index adaptation for breast cancer patients (FSFI-BC).

Abstract

Bartula and Sherman stated ‘‘This study determined the reliability, validity, and acceptability of a breast cancerspecific adaptation of the Female Sexual Function Index’’ [1]. Female sexual dysfunction (FSD) can be classified as sexual interest/arousal disorder (diminished libido and difficulty to become aroused or maintain arousal during sexual activity), orgasmic disorder (persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation), sexual pain/penetration disorder. If a woman has an orgasm through clitoral stimulation, but not during intercourse, it does not meet the criteria for a clinical diagnosis of female orgasmic disorder, and if the orgasmic difficulties are the result of an inadequate sexual stimulation, these cases should not be diagnosed as a disorder of female orgasm. Questionnaires are used for the prevalence, etiology, diagnosis, and treatment of FSD. The female sexual function index (FSFI) questionnaire is the most widely used measures of FSD (including postmenopausal women) cited in more than 1500 articles. However, FSFI has potential measurement and psychometric flaws that have not been addressed in the literature [2]. FSFI is a 19-item questionnaire with six separate domains of female sexual function, namely desire (items 1 and 2), arousal (3–6), lubrication (7–10), orgasm (11–13), satisfaction (14–16), and pain (17–19). Items 1 and 2 (desire), 6 (arousal: satisfaction), 13 (orgasm: satisfaction), and 14–16 (satisfaction) physiologically do not assess female sexual function. These items are mainly psychological, while items 17–19 measure pain level during or following vaginal penetration. In the questions of the items 3–5 (arousal), 7–10 (lubrication), and 11–13 (orgasm) the word ‘‘intercourse’’ appears. Many questions seem to assess the degree of lubrication and ease of penetration, while little attention is given to clitoral sensation. ‘‘We encourage clinicians and researchers to think critically about whether the FSFI and IIEF are appropriate measures for their practice and research’’ [2]. FSFI questionnaire really to assess the female sexual function? As matter of fact the vagina is mainly a reproductive organ with little sensitivity, the vaginal orgasm is not corroborated by anatomical evidences. The female orgasm is caused by female erectile organs, including the clitoris (glans, body, crura, or roots), vestibular bulbs with the pars intermedia (i.e., female corpus spongiosum), and labia minora. Effective sexual stimulation allows orgasm and multiple orgasms in women. Clitoral stimulation is essential for women to achieve orgasm. The female orgasm is possible to achieve with an effective sexual stimulation by all women if the female erectile organs are effectively stimulated during masturbation, cunnilingus, partner masturbation, or during vaginal intercourse if the clitoris is simply stimulated with a finger. The clitoral sexual response is not affected by aging and for this reason women have the physical capability of being orgasmic at all ages. Gynecologists and sexologists should define having sex the situation in which the orgasm happens in both partners with or without a vaginal intercourse: definition for all human beings [3]. FSFI does not assess female sexual function, but primarily assesses vaginal intercourse. In fact, the decline of desire, decreased interest in sex and reduced ability to & Vincenzo Puppo dottvincenzopuppo@yahoo.it