Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
J Sex Med. 2021 Dec;18(12):2020-2027. doi: 10.1016/j.jsxm.2021.09.012. Epub 2021 Oct 31.
Patient-reported outcome instruments to assess sexual functioning typically assume that patients are heterosexual and have a single sexual partner, thus they may have limited applicability for sexual and gender minority (SGM) populations as well as for nonpartnered individuals or those with multiple partners.
To explore the perceptions of SGM persons regarding the Female Sexual Function Index (FSFI), a commonly used sexual functioning questionnaire.
We conducted 2 rounds of cognitive interviews with 27 SGM persons with and without a cancer diagnosis. Interviews were audio-recorded and transcribed. Two researchers independently coded the transcripts using inductive thematic analysis to identify major themes.
Themes identified via qualitative analysis.
Cognitive debriefing with the participants provided critical insights about the way we ask questions about sexual functioning in the oncology clinic. Three overarching themes arose from the data: (i) Certain aspects of the questionnaire were felt to unnecessarily medicalize sexuality; (ii) FSFI domains were perceived to represent a narrow and heteronormative experience of sexuality focused on penile-vaginal intercourse; (iii) Questionnaire domains emphasizing sexual "performance" were perceived as male-oriented.
Questionnaires such as the FSFI that were developed in research studies with specific eligibility criteria need to be adapted to the broader population seen in clinical practice.
STRENGTHS & LIMITATIONS: Strengths of the study include purposive sampling of SGM persons through LGBTQ networks. Our sample included individuals of different sexual orientations, gender identities, marital status, and cancer histories. However, a limitation is that the the majority of the sample was white and college-educated. Other limitations of the study include the potential sampling bias of self-selected participants with a particular interest in the study questions.
The findings provide important evidence for the development of a more inclusive sexual function measure, moving away from the traditional heteronormative, cisnormative approach to measuring sexual function. Austria MD, Lynch K, Le T, et al. Sexual and Gender Minority Persons' Perception of the Female Sexual Function Index. J Sex Med 2021;18:2020-2027.
评估性功能的患者报告结局工具通常假设患者是异性恋且只有单一性伴侣，因此它们可能在性少数群体（SGM）人群以及非伴侣或多个伴侣人群中适用性有限。
探讨 SGM 人群对女性性功能指数（FSFI）的认知，FSFI 是一种常用的性功能问卷。
我们对 27 名有或无癌症诊断的 SGM 患者进行了 2 轮认知访谈。访谈进行了录音并转录。两位研究人员使用归纳主题分析对转录本进行独立编码，以确定主要主题。
定性分析确定的主题。
通过与参与者进行认知审查，提供了有关我们在肿瘤诊所中询问性功能方式的重要见解。从数据中出现了三个总体主题：（i）问卷的某些方面被认为不必要地将性行为医学化；（ii）FSFI 领域被认为代表了一种狭隘的、异性恋规范的性行为体验，侧重于阴茎-阴道交；（iii）强调性“表现”的问卷领域被认为是男性导向的。
在具有特定资格标准的研究中开发的 FSFI 等问卷需要适应更广泛的临床实践人群。
本研究的优势包括通过 LGBTQ 网络有目的地对 SGM 人群进行抽样。我们的样本包括不同性取向、性别认同、婚姻状况和癌症病史的个体。但是，该研究的一个局限性是样本的大多数是白人且受过大学教育。该研究的其他局限性包括对具有特定研究问题兴趣的自我选择参与者的潜在抽样偏差。
这些发现为开发更具包容性的性功能测量方法提供了重要证据，这种方法脱离了传统的异性恋、顺性别规范的性功能测量方法。
