A Validation Study of the Female Sexual Function Index for Use in Pregnant and Postpartum Samples

Sexual function problems are common during the perinatal period, with prevalence estimates ranging from 36 to 88%. Low desire, arousal and lubrication difficulties, dyspareunia, and orgasm problems are frequently reported, yet few measures have been developed for pregnancy and postpartum populations. Most research has relied on the Female Sexual Function Index (FSFI), although its psychometric properties in perinatal samples remain largely untested. Guided by contemporary validity theory, this study examined the validity of the FSFI scores in samples of sexually active pregnant and postpartum individuals. Factor analyses supported a six-domain structure (desire, arousal, lubrication, orgasm, satisfaction, pain), whereas models including a total score were not supported. Items discriminated well at low-to-average levels of sexual function but less effectively at higher levels, suggesting the FSFI is more informative for pregnant and postpartum individuals with poorer sexual function or with sexual difficulties. With a few exceptions, evidence from associations with external variables indicated that FSFI domain scores are sensitive to individual differences in sexual function and distinguish individuals with and without distressing sexual difficulties. Overall, findings suggest that FSFI domain scores provide a meaningful assessment of perinatal sexual function and are good indicators of the underlying constructs. However, the use of a total score is not supported. Further research is warranted to address identified limitations. In the meantime, researchers and clinicians should interpret FSFI total score results cautiously, as well as results from domain scores that showed weaker performance (sexual arousal and sexual satisfaction).