Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Female Sexual Distress Scale-Revised questionnaire for women with vaginal laxity

International Urogynecology Journal https://doi.org/10.1007/s00192-022-05227-0 ORIGINAL ARTICLE Cross‑cultural adaptation and validation of the Brazilian Portuguese version of the Female Sexual Distress Scale‑Revised questionnaire for women with vaginal laxity Glaucia Miranda Varella Pereira1 · Cassia Raquel Teatin Juliato1 · Daniela Angerame Yela Gomes1 · Tais de Souza Beltramini1 · Marilene Vale de Castro Monteiro2 · Luiz Gustavo Oliveira Brito1 Received: 5 March 2022 / Accepted: 29 April 2022 © The International Urogynecological Association 2022 Abstract Introduction and hypothesis Vaginal laxity (VL) can impair women´s quality of life and there are not many tools aimed at quantitatively addressing this complaint. Sexual distress can be present within this group of patients. The aim of our study is to carry out the cross-cultural adaptation/translation and validation of the Female Sexual Distress Scale-Revised (FSDS-R) for Brazilian Portuguese women with VL. Methods Women age ≥ 18 years, with VL (n=82), and without VL (n=53) were included. Continuous variables were described in the form of mean/standard deviation or median/range, and Student’s t test was used. The Chi-squared test was used for dichotomous variables. Cronbach's alpha coefficient was used for internal consistency and Spearman's correlation was used to assess construct validity (FSDS-R, Female Sexual Function Index [FSFI], and Incontinence Questionnaire Vaginal Symptoms [ICIQ-VS]). A significance level of 5% was established using a two-tailed test. Results Women with VL presented more anal/vaginal sexual intercourse than women without VL (p=0.030). All three instruments (FSDS-R, FSFI, and ICIQ-VS) presented discriminant validity between women with and without VL (p<0.001). A high internal consistency (Cronbach´s alpha =0.887) was found in women with VL and without VL (0.917). Regarding construct validity (n=82), there was a strong positive correlation between FSDS-R score and ICIQ-VS scales, except for a weaker correlation between the ICIQ-VS vaginal symptoms subscale (r: +0.2788; p=0.013). A moderate negative correlation was found between FSDS-R and all FSFI domains (p<0.001), except for pain (p<0.062). Conclusions The Brazilian version of the FSDS-R showed adequate internal consistency and discriminant validity, and a correlation was found with other instruments such as FSFI and ICIQ-VS. Keywords Vaginal laxity · Sexual dysfunction · Surveys and questionnaires · Validation study Introduction Vaginal laxity (VL) is defined as a complaint of excess vaginal flaccidity and is described as a vaginal symptom of sexual function specific to pelvic floor dysfunction by the * Luiz Gustavo Oliveira Brito 1 Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas – UNICAMP, 101 – Cidade Universitária – Campinas, São Paulo 13083‑881, Brazil 2 Department of Obstetrics and Gynecology, School of Medicine, Federal University of Minas Gerais – UFMG, Belo Horizonte, Brazil latest International Urogynecological Association (IUGA)/ International Continence Society (ICS) terminology [1, 2]. Women with VL may be representative of an early stage of development of pelvic organ prolapse [3]; however, a consensus on this matter has not yet been reached. According to another study, VL differs from pelvic organ prolapse, the former being related to symptoms concentrated in the vagina and the latter involving the descent of one or more pelvic organs [4]. The decreased vaginal sensation during intercourse may be related to anatomical damage to the perineal body, vaginal canal or introitus, underlying nerve and connective tissue damage during pregnancy and childbirth, or potentially a combination of these factors [5]. The diagnosis of VL is based on the patients' self-report [6]. A comprehensive medical history, physical examination, 13 Vol.:(0123456789) International Urogynecology Journal and psychosexual evaluation are the initial steps for the proper identification of patients with VL. The Vaginal Laxity Questionnaire is an instrument used in clinical research to assist in the identification and severity of VL [7]. However, this instrument does not fully understand the extent of the impact on the quality of life of women with VL. The Female Sexual Distress Scale-Revised – FSDS-R assesses sexual distress with a composite score ≥ 11 [8]. Sexual distress is characterized by a set of feelings and emotions that individuals have about their sexuality. It differs from sexual dysfunction related to symptoms of sexual function, such as arousal, orgasm, and pain, separate from emotions [8]. Assessing sexual distress in women complaining of VL can help to understand its pathophysiology. Sexual distress in women with VL has already been investigated in previous studies in the English language [7, 9]; however, this questionnaire has not yet been translated into or validated in Brazilian Portuguese, making it difficult to investigate the Brazilian population. Therefore, the aim of this study is to carry out the cross-cultural adaptation, translation, and validation of the Female Sexual Distress Scale-Revised (FSDSR) in Brazilian Portuguese for women with VL. Materials and methods This is a cross-sectional study conducted from November 2021 to January 2022 at Women’s Hospital - Prof. Dr. José Aristodemo Pinotti, CAISM, at the University of Campinas – Brazil. The study was approved by the Institutional Review Board under the number CAAE: 53164221.3.0000.5404 and followed the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures [10]. Study population Women aged ≥ 18 years, with VL and women without VL assessed by a single, dichotomous question (do you consider yourself to have vaginal laxity) and by the Vaginal Laxity Questionnaire (VLQ) [7] were included in the present study. We considered the answers (very loose, moderately loose, slightly loose) for VL and (neither loose nor tight) for women without VL. Women with VL were recruited through advertisements on the Hospital's official website and referred to the study through the urogynecology outpatient clinic. Participants without VL were recruited in their first appointment at the Family Planning outpatient clinic. These participants were referred for counseling for or to receive contraceptive methods, without any complaints of prior genital or sexual dysfunction. We excluded women with reading and language comprehension difficulties, who had undergone surgeries for pelvic floor disorders, who had undergone previous treatment for VL, and who had used vaginal estrogen 13 in the past 6 months. The women who agreed to participate in the study signed the consent form. Regarding the sample size, as we know from the literature that there is heterogeneity for calculating the minimum sample size from instrument validation studies, these data show a variation ranging from 100 to 300 cases [11]. As the complaint of VL is ra (...truncated)