Female Orgasm Scale: Translation and Psychometric Assessment of an Iranian Version

Document Type : Descriptive & Survey

Authors
F. Rahimi 1
M. Lamyian 1
R. Maasoumi 2
1 Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
2 School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Aims: Female orgasm depends on many factors and is the most enjoyable phase of the sexual response cycle. A valid, reliable, and special scale is required to assess this phase. This study aimed to translate and assess the psychometric properties of the Iranian version of the Female Orgasm Scale.

Instrument & Methods: Initially, using the Forward-Backward method, the questionnaire was translated from English into Persian. After that, a cross-sectional study was carried out, and the psychometric properties of the Iranian version of the questionnaire were tested. Of the 235 married and sexually active women of reproductive age, 200 individuals completed the questionnaire. Reliability was calculated by repeatability and internal consistency methods, and validity was calculated by face, content, and construct validity.

Findings: The mean age of the participants was 31.35±7.13 years. Reliability evaluation revealed high internal consistency and good test-retest reliability. Cronbach's alpha coefficient was 0.7, and the intraclass correlation coefficient was 0.99. The standard error of the mean was 0.7. The mean content validity index and content validity ratio scores were 0.84 and 0.97, respectively. The results of Exploratory Factor Analysis indicated a three-factor solution for the questionnaire accounting for 74.44% of the variance.

Conclusion: The findings suggest that the Iranian version of the Female Orgasm Scale has good psychometric properties and can be used to assess female orgasm in sexual and reproductive healthcare settings.

Keywords

Subjects

Introduction
According to Masters and Johnson's model, the sexual response cycle consists of four stages, excitement, plateau, orgasm, and resolution [1]. The female orgasm is influenced by several factors and plays a crucial role in sexual compatibility and marital satisfaction [2]. In women, orgasm involves the myotonic response of the smooth and striated muscles, along with a sense of sexual stress relief emanating from the stimulation period. Orgasm is described as the most pleasurable sexual sensation [3]. During orgasm, 3 to 5 regular contractions occur in the vagina, perineum, and anal muscles, each of which lasts 0.8 seconds and reaches the uterus [4]. Clitoral tissue is the most sensitive part of anatomical sex for most women that stimulates the most powerful sexual feelings and orgasms [3]. Physiological and mental changes during orgasm are variable and differ among women proportionate to their conditions [5].
Persistent or recurrent delay in or absence of orgasm following a normal excitement phase is defined as Female orgasmic disorder (FOD) by the Diagnostic and Statistical Manual of Mental Disorders 4th Ed. (DSM-IV) [6]. Reduced intensity, delay, infrequency, or absence of orgasm for at least six months, which is not related to other physical, mental, or relational problems, is added by the DSM-V for more explanations of FOD [6].
Results of several studies suggest that the prevalence of orgasmic disorders among women is 18-61% in the general population [7]. Wolpe et al. reported that the prevalence of female sexual dysfunctions in Brazil was between 13.33 and 73.3%, and the orgasmic performance was 18.0-55.4% [8]. According to Zhang et al., the prevalence of sexual dysfunctions in women aged 20-70 in China was 29.7%, and orgasm was 27.9% [9]. According to a survey conducted by Ramezani et al., the prevalence of orgasmic disorders among women in the general population of Iran was 35.3% [10].
FOD is a multidimensional problem influenced by personal, relational, psychological, sociocultural, and religious context factors [11, 12]. Accurate FOD assessment requires applying a gender-based, culturally competent, valid, and reliable instrument [13]. The Female Orgasm Scale (FOS) is a gender-based, short, self-administered tool designed to assess female orgasm. The validity of the FOS questionnaire was assessed by Fisher et al. [14] in Canada for the first time. The study was conducted on three groups of women (n=651) aged 17–49 years. The main feature of the FOS is its assessment of orgasm during sex, including vaginal intercourse and clitoral stimulation. So, it seems that FOS is a culturally safe instrument for assessing orgasm among Iranian women.
Nevertheless, the cross-cultural adaptation of FOS in the Iranian population is necessary. Cross-cultural adaptation is defined as a process that includes language and cultural adaptation of a questionnaire for use in another setting and community [14]. The cultural adaptation process consists of three steps: translation, cross-cultural adaptation, and verification of the instrument's psychometric properties in the target population (i.e., standardization) [15].
There is no valid and reliable Persian version of FOS. Thus, this study aimed to translate and test the psychometric properties of the Iranian version of FOS –namely its cross-cultural adaptation- from English to Persian.
 
Instrument and Methods
This was a cross-sectional study carried out in Tehran, Iran, during September-December 2018. Two hundred thirty-five women attending three maternal health and family planning centers affiliated with Tehran and Beheshti Universities of Medical Sciences for routine care (excluding pregnancy) were chosen through convenience sampling. The inclusion criteria were aged 15 to 49 (reproductive age), married and sexually active, not pregnant, and willing to participate in the study. Thirty-five women did not agree to fill the IV-FOS; So, 200 women completed the questionnaire for construct validity assessment.
The FOS is a short, self-administered questionnaire developed by McIntyre-Smith & Fisher [14]. It assesses the consistency of female orgasm during partnered sexual activities (e.g., intercourse, oral stimulation, self-stimulation in the partner's presence) and overall satisfaction with orgasm frequency and quality. The scale is comprised of seven items. Five items inquire about the frequency of orgasm during different sexual activities: (a) intercourse, (b) intercourse with additional direct clitoral stimulation, (c) manual stimulation of the clitoris and/or genitals by a partner, (d) self-stimulation of the clitoris and/or genitals in the presence of a partner, and (e) oral stimulation. Two other items assess perceived satisfaction with the number and quality of orgasms experienced during sexual activity with a partner. This scale has two subscales: orgasm from clitoral stimulation and orgasmic satisfaction. In this scale, items 1-5 are scored as 0%=0, 10%=1, 20%=2 … 100%=10. Items 6-7 are scored as "Very Unsatisfied" = 1 to "Very Satisfied" = 7. Because items 1-5 are essentially coded on a 10-point scale, and the rest are coded on a 7-point scale, items should be weighted in the following manner: a) multiply items 1-5 by 7; b) Multiply items 6-7 by 10. Scoring the responses marked "Does not apply to me" can be coded as 0, depending on the researcher's rationale and use of the scale [15].
After obtaining a translation permit from the main author, the tool was translated into Persian. The concepts in the translated version were matched with the ones in the original version in the five following steps:
Step 1-Forward translation: The questionnaire was translated separately by two English translators who were native Persian speakers.
Step 2-Expert panel: At this stage, the integration of the two translated versions was done by the panel of experts. The two translators took part in a meeting, reviewed the translations, and reached a consensus after exchanging views, leading to an identical final version. At this stage, the goal was to check the terminology and rectify the deficiencies.
Step 3-Backward translation: The two translators (whose mother tongue was English) and had sufficient fluency in Persian, and had not yet received the English version of the questionnaire, were asked to translate the translated Persian version of the questionnaire into English.
Step 4-Pre-testing and cognitive interviewing: By performing a pre-test, the clarity and transparency of the translated version were measured, and the incomprehensible phrases were identified and reviewed. The translated version of the scale became available to 10 people for inclusion in the study. These people were preferably those who were not in the main study. Then, respondents were asked about the items they had not understood and the ones they found unacceptable or offensive. This information was obtained through detailed personal interviews.
Step 5-Final version: The original versions of the Iranian and translated English versions were compared. The necessary changes were made to the Iranian version of the female orgasm scale (IV-FOS) wording, and it was finalized [16].
After explaining the study's objective, women who agreed to take part in the study filled in the FOS questionnaire.
Psychometric properties of the IV-FOS were assessed through reliability and validity tests. Further details are given below.
- Reliability: The stability or repeatability was examined by the test-retest method. Twenty eligible women completed the questionnaire twice at a two-week interval. The correlation between the scores obtained from the two surveys was determined by the intraclass correlation (ICC) index. ICC is the most acceptable index for testing stability. If this index is between 70- 80%, the stability level is desirable. For internal consistency, an appropriate time tool is suitable for reliability, with a Cronbach's alpha coefficient equal or greater than 0.7. Measurement error (Standard Error of Measurement) calculates the standard deviation of a patient's scores at different test times, which is obtained using the formula
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Health Education and Health Promotion
Volume 9, Issue 3
Summer 2021
Pages 251-256