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Assessing Anorectal Sexual Function: Validity and Clinical Utility of a New Measure.

Thomas W Gaither1, Myles Anderson2, Jonathan A Balcazar3

  • 1Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. tgaither@mednet.ucla.edu.

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This study validated the Anorectal Sexual Function Index (ASFI) to diagnose anodyspareunia and anhedonia during receptive anal intercourse (RAI). The ASFI helps identify individuals with worse sexual function outcomes.

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Area of Science:

  • Sexual Health
  • Anorectal Disorders
  • Psychometrics

Background:

  • Anorectal sexual dysfunction, including anhedonia and anodyspareunia, lacks standardized diagnostic criteria.
  • Existing measurement tools for anorectal sexual dysfunction are insufficient.
  • Disrupted anorectal sexual function can lead to reduced pleasure or increased pain.

Purpose of the Study:

  • To evaluate the Anorectal Sexual Function Index (ASFI) in a clinical sample.
  • To develop diagnostic cut-off scores for anorectal sexual dysfunction.
  • To assess the ASFI's utility in individuals with and without problematic receptive anal intercourse (RAI).

Main Methods:

  • A mixed-method, cross-sectional study was conducted between July 2024 and January 2025.
  • Participants included individuals with concerns during RAI (pain, lack of pleasure) and those with known pelvic pathology.
  • A clinical interview and questionnaires, including the ASFI and quality-of-life measures, were administered.

Main Results:

  • The study included 122 participants (mean age 42, 97% cis-gender men, 85% gay).
  • Participants reporting pain had higher ASFI pain scores (23 vs 13), while those reporting reduced pleasure had lower ASFI pleasure scores (11 vs 17).
  • Anodyspareunia and anhedonia were associated with lower sexual satisfaction, reduced erectile frequency, fewer orgasms during RAI, and worse patient-reported outcomes.

Conclusions:

  • The ASFI was standardized for diagnosing anodyspareunia and RAI anhedonia.
  • The ASFI effectively differentiates individuals with and without anorectal sexual dysfunction.
  • Standardized diagnosis using the ASFI revealed worse patient-reported outcomes in affected individuals.