1. Abstract
The Attitudes Related to Sexual Concerns Scale (ASCS) is a specialized psychometric assessment instrument developed by Patricia Barthalow Koch and Craig R. Cowden to evaluate evaluative, cognitive, and affective attitudes linked directly to sexual dysfunctions, performance anxieties, and intimate relationship distress. Unlike broader sexual inventory tools that evaluate generalized erotophilia, broad liberal-conservative sexual ideologies, or anatomical sexual knowledge, the ASCS measures highly proximal, personalized attitudes that directly inform and predict clinical sexual concerns in men and women. The instrument consists of 30 self-report items administered on a 5-point Likert scale ranging from 1 (Strongly Agree) to 5 (Strongly Disagree), taking approximately 15 minutes to complete. The scale captures eight distinct psychometric dimensions: Body Image, Sexual Self-Understanding, Gender Roles, Sexual Communication, Sexual Guilt, Commitment, Masturbation Attitudes, and Sexual Performance Anxiety. Psychometric analyses demonstrate robust internal consistency across heterogeneous demographic cohorts, with overall scale Cronbach’s alpha coefficients ranging between .70 and .80, and subscale coefficients reaching up to .91 (e.g., Masturbation subscale). Construct validity is supported through exploratory and confirmatory factor analytic procedures, as well as significant concurrent correlations with established psychosexual measures such as the Mosher Sex Guilt Inventory, the Derogatis Sexual Attitudes Scale, and the Sex Anxiety Inventory. Furthermore, the ASCS exhibits demonstrated discriminant validity, successfully differentiating clinical from non-clinical populations experiencing differing magnitudes of relational dissatisfaction, sexual functioning distress, and religious conflict. The scale represents a vital empirical and diagnostic bridge between psychological attitudes and clinical sexual health.
2. Keywords
Attitudes Related to Sexual Concerns Scale, ASCS, sexual attitudes, sexual dysfunction, sex guilt, body image, sexual communication, psychometrics, sexual performance anxiety, sex therapy
3. Authors
The Attitudes Related to Sexual Concerns Scale was conceptualized, operationalized, and psychometrically validated by:
- Patricia Barthalow Koch, Ph.D.: Professor Emerita of Biobehavioral Health and Women’s Studies, Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, United States. Correspondence regarding the scale was historically directed to Dr. Koch at the Health and Human Development Building East, University Park, PA 16802 (E-mail: [email protected]).
- Craig R. Cowden, Ph.D.: Department of Psychology and Social Sciences, Tacoma Community College, Tacoma, Washington, United States. Dr. Cowden contributed extensively to the cross-validation, demographic invariance testing, and factor-analytic structural refinement of the instrument.
4. Purpose
The primary purpose of the Attitudes Related to Sexual Concerns Scale (ASCS) is to identify, isolate, and quantify the specific evaluative attitudes and maladaptive cognitions that predispose individuals to, or maintain, clinical sexual dysfunctions and interpersonal relational distress. Prior to the development of the ASCS, psychosexual assessment instruments predominantly focused on distal social attitudes (e.g., societal views toward abortion, premarital intercourse, or commercial sex work) or generalized sex knowledge. While these existing metrics provided sociological insights into societal conservatism versus permissiveness, they repeatedly demonstrated weak predictive utility regarding an individual’s idiosyncratic sexual concerns, such as anorgasmia, erectile dysfunction, sexual avoidance, or performance-related distress.
Drawing on contemporary cognitive and social-psychological paradigms, the authors recognized that human sexual behavior is steered most powerfully not by abstract societal beliefs, but by proximal personal attitudes—affective and cognitive orientations directly mapped onto the self, one’s body, intimacy, and the behavioral dynamics of a sexual interaction. Consequently, the ASCS was engineered to bridge this diagnostic and empirical gap.
In clinical sex therapy, marriage and family counseling, and behavioral medicine settings, the ASCS serves as a targeted diagnostic assessment tool. Clinicians utilize the instrument during initial intakes to identify core psychological obstacles—such as somatic shame, communication apprehension, guilt rooted in moral or familial conditioning, or irrational performance demands—that inhibit sexual arousal, pleasure, or orgasm. By profiling client scores across the eight independent dimensions, therapists can formulate tailored, evidence-based intervention plans (such as cognitive restructuring, sensate focus, and assertiveness training) that directly address the specific attitudinal drivers of the dysfunction.
In empirical sexological research, the ASCS provides a standardized, psychometrically validated tool for comparing attitudinal variance across diverse demographic cohorts, including comparisons stratified by biological sex, gender identity, sexual orientation, age, relationship status, racial and ethnic backgrounds, and religious affiliations. The scale enables researchers to track longitudinal shifts in sexual attitudes following educational or clinical interventions and to elucidate the structural pathways linking cognitive schemas to subjective sexual satisfaction.
5. Psychological Construct
The psychological construct underlying the ASCS is multidimensional, conceptualizing sexual concerns as affective-cognitive impediments embedded within self-concept, partner interactions, and sociocultural socialization. The scale comprises eight structurally independent yet clinically interrelated dimensions:
1. Body Image
This subscale evaluates the respondent’s subjective somatic evaluation, physical comfort, and perceived erotic attractiveness in the presence of a partner. Body image within a sexual context involves feelings of physical vulnerability and self-consciousness. Maladaptive attitudes on this dimension manifest as somatic shame, fear of visual exposure during intimacy, and the conviction that one’s nude body is physically unappealing or unacceptable, which frequently leads to spectatoring and sexual avoidance.
2. Sexual Self-Understanding
This dimension operationalizes the degree of internal clarity, cognitive integration, and emotional awareness an individual possesses regarding their personal sexual desires, boundaries, values, and emotional reactions. Individuals with poor sexual self-understanding exhibit high confusion, lack emotional literacy concerning their sexual motives, and experience considerable difficulty articulating their intimate thoughts and needs to a romantic partner.
3. Gender Roles
The Gender Roles dimension measures adherence to rigid, stereotypical sexual scripts and traditional double standards. These items assess beliefs regarding sexual boundary setting (e.g., viewing women as gatekeepers and men as relentless pursuers) and asymmetric acceptance of casual sexual encounters. Rigid adherence to stereotypical gender scripts has been clinically shown to impair relational authenticity, undermine egalitarian negotiation, and generate sexual dissatisfaction.
4. Communication with a Sexual Partner
Effective sexual communication involves the capacity to assertively express desires, articulate boundaries, provide constructive behavioral feedback, and discuss negative affective experiences within an intimate dynamic. High scores on this subscale reflect communicative avoidance, fear of interpersonal conflict, and profound discomfort when discussing sensitive sexual techniques or emotional dissatisfaction with a partner.
5. Sexual Guilt
Sexual guilt represents an internal state of moral self-condemnation, anxiety, and dread elicited by real or anticipated sexual thoughts and behaviors that violate internalized familial or religious standards. This construct captures affective conflict surrounding genital sexual intimacy, religious pronouncements regarding sexual conduct, and solitary erotic fantasies, serving as a primary psychological inhibitor of sexual excitation.
6. Commitment
This subscale measures psychological attitudes toward emotional vulnerability, long-term romantic attachment, and interpersonal trust within sexual partnerships. It examines feelings of entrapment, fear of emotional dependency, and deep-seated apprehension regarding trusting an intimate partner, reflecting attachment-related anxieties that spill over into physical intimacy.
7. Masturbation
The Masturbation subscale assesses subjective comfort, acceptance, shame, and perceived legitimacy regarding solitary autoerotic exploration. Positive attitudes toward masturbation reflect self-efficacy, anatomical self-exploration, and guilt-free sexual release, whereas negative attitudes equate solitary sexual behavior with moral failure, dirtiness, or relational betrayal.
8. Sexual Performance
This dimension taps directly into cognitive anxiety concerning physiological sexual adequacy, fear of partner abandonment linked to sexual performance, and catastrophic evaluations of sexual difficulties (e.g., equating failure to achieve partner orgasm or failure to maintain genital arousal with personal worthlessness). The subscale incorporates gender-tailored items addressing hallmark clinical concerns: orgasmic inadequacy during coitus for females and erectile failure for males.
6. Theoretical Framework
The theoretical architecture of the ASCS is grounded in several converging psychological frameworks, most prominently the Theory of Reasoned Action and its conceptual successor, the Theory of Planned Behavior formulated by Icek Ajzen and Martin Fishbein (1980). A core tenet of this framework is the principle of correspondence: attitudes predict behavioral intentions and specific behavioral outcomes with high precision only when the measured attitude corresponds directly in target, action, context, and time to the behavior in question.
Early sexological assessments measured distal, generalized societal norms, which exhibited negligible statistical covariance with idiosyncratic sexual functioning. Koch and Cowden designed the ASCS to evaluate proximal personal attitudes. By phrasing scale items in the first person (“I feel,” “I would worry,” “It is difficult for me”), the ASCS captures immediate, self-referential cognitive-affective appraisals rather than detached philosophical opinions. These proximal attitudes directly mediate the relationship between distal sociocultural values (such as religious dogma or media portrayals) and immediate sexual behaviors.
Furthermore, the ASCS incorporates principles from Cognitive-Behavioral Sex Therapy, initially conceptualized by Masters and Johnson and later advanced by Helen Singer Kaplan and David Barlow. Barlow’s cognitive-affective model of sexual dysfunction posits that when individuals hold dysfunctional performance expectations or deep-seated guilt, sexual context cues trigger negative affect and attentional diversion. Instead of attending to erotic, pleasure-inducing stimuli, the individual engages in “spectatoring”—monitoring their own physical appearance, erection, or lubrication, which activates the sympathetic nervous system and directly precipitates physiological dysfunction. The ASCS subscales (Performance Anxiety, Body Image, and Communication) directly operationalize the cognitive components that trigger this cascade of sexual dysfunction.
Finally, the scale reflects Sexual Script Theory (Gagnon & Simon, 1973), which articulates that human sexual behavior is guided by cultural, interpersonal, and intrapsychic scripts. When cultural scripts dictate rigid, double-standard gender roles or associate autoeroticism with moral debasement, intrapsychic scripts become laden with conflict, culminating in internal distress and relational discord.
7. Validity
The psychometric validity of the Attitudes Related to Sexual Concerns Scale has been extensively evaluated across multiple empirical investigations using rigorous psychometric methodologies:
Content Validity
To establish comprehensive content validity, the authors conducted an exhaustive systematic content analysis encompassing over 40 prominent human sexuality textbooks, clinical counseling manuals, and sex therapy handbooks, alongside a review of more than 250 peer-reviewed scientific articles addressing sexual concerns, inhibitions, and dysfunctions. Iterative panels of sexuality educators and licensed clinicians evaluated candidate items to ensure clear clinical relevance, conceptual distinctiveness, and comprehensive coverage of the primary cognitive correlates of sexual dysfunction.
Construct and Factorial Validity
Construct validity was initially established through exploratory factor analysis of pilot responses from approximately 400 university students. Principal components analysis utilizing promax (oblique) rotation cleanly isolated an eight-factor solution corresponding directly to the theoretical constructs. The extracted factors demonstrated clear factor structures with high primary item loadings and minimal cross-loadings, demonstrating solid structural construct validity.
Concurrent and Convergent Validity
Concurrent and convergent validity were corroborated by evaluating correlations between the ASCS and established, validated psychosexual self-report instruments:
- Mosher Sex Guilt Inventory (Mosher, 1966): ASCS total and subscale scores (particularly the Guilt and Masturbation subscales) demonstrated statistically significant positive correlations, validating that the ASCS accurately indexes internalized sexual moral conflict.
- Derogatis Sexual Attitudes Scale (DSFI; Derogatis & Melisaratos, 1979): The ASCS showed convergent validity through significant correlations with corresponding subscales measuring liberal versus conservative sexual attitudes and body image satisfaction.
- Sex Anxiety Inventory (Janda & O’Grady, 1980): The ASCS demonstrated robust positive correlations with general sexual anxiety, verifying its sensitivity to affective distress in sexual contexts.
Discriminant and Criterion-Related Validity
The ASCS has demonstrated clinical and demographic discriminant validity across multiple validation studies:
- Relational Distress Discrimination: In clinical and non-clinical trials, the ASCS significantly discriminated individuals experiencing high levels of intimate relationship concerns from those reporting low relational concerns, t(402.87) = 6.58, p < .001 (Koch, 1988; Koch & Cowden, 1990).
- Sexual Functioning Concerns: The instrument successfully differentiated individuals experiencing elevated levels of physiological or psychological sexual functioning concerns/dysfunctions from individuals reporting healthy sexual functioning, t(400.98) = 3.50, p < .001.
- Religious Affiliation Discrimination: Cowden and Bradshaw (2007) verified that the ASCS successfully discriminated individuals with high, active religious affiliation from non-affiliated cohorts, particularly on the Guilt and Masturbation subscales, confirming the tool’s sensitivity to religious socialization.
8. Reliability
The internal consistency reliability of the ASCS and its eight constituent subscales has been evaluated across distinct, demographically varied samples, demonstrating satisfactory to high psychometric stability.
In the primary psychometric validation conducted by Cowden and Koch (1995), internal reliability was evaluated using a sample derived from a large, predominantly White northeastern public research university. Subsequently, Cowden and Bradshaw (2007) cross-validated the instrument in an ethnically and racially diverse collegiate sample recruited from higher education institutions located in Washington, D.C., and North Carolina.
The comparative Cronbach’s alpha internal consistency coefficients across these two independent validation samples are detailed below:
- Overall ASCS Scale: α = .70 (Northeastern Cohort) and α = .80 (Diverse Mid-Atlantic/Southeastern Cohort)
- Body Image Subscale: α = .74 and α = .80
- Sexual Self-Understanding Subscale: α = .84 and α = .67
- Gender Roles Subscale: α = .64 and α = .63
- Communication Subscale: α = .73 and α = .66
- Guilt Subscale: α = .75 and α = .67
- Commitment Subscale: α = .80 and α = .66
- Masturbation Subscale: α = .91 and α = .90
- Sexual Performance Subscale: α = .66 and α = .60
Across both investigations, the Masturbation subscale demonstrated exceptional internal consistency (α ≥ .90). Subscales with fewer items or context-dependent themes (such as Gender Roles and Sexual Performance) demonstrated moderate internal consistency ranging between .60 and .66, which is typical for brief clinical attitude subscales containing between 3 and 4 items. Overall composite reliability remained robust across divergent racial, geographical, and cultural cohorts, indicating good psychometric stability.
9. Factor Analysis
The factor structure of the ASCS was established using exploratory factor analysis during the instrument’s initial development phases with an empirical sample of approximately 400 emerging adults (Cowden & Koch, 1995; Koch, 1983; Koch & Cowden, 1990). The structural properties were isolated via Principal Components Analysis (PCA) accompanied by an oblique (promax) rotation, selected because theoretical subdimensions of human sexual attitudes were hypothesized to share underlying variance rather than operate in complete mathematical orthogonality.
The scree plot inspection, alongside eigenvalues-greater-than-one criteria, confirmed an eight-factor latent architecture that explained the shared variance across the item pool. The variance breakdown across the eight extracted factors was as follows:
- Factor 1: Masturbation Attitudes — accounted for 42% of the explained variance, representing the largest psychometric dimension in the inventory. Items loading onto this factor evaluated personal shame, guilt, and behavioral acceptance regarding autoeroticism.
- Factor 2: Sexual Self-Understanding — accounted for 14% of the explained variance, capturing internal cognitive clarity and communicative confidence regarding personal sexual motives.
- Factor 3: Sexual Guilt — accounted for 11% of the explained variance, grouping items centered on moral distress related to religious, familial, and coital boundaries.
- Factor 4: Communication with a Sexual Partner — accounted for 10% of the explained variance, comprising items measuring discomfort in expressing negative sexual feelings, asserting needs, and providing technical feedback.
- Factor 5: Body Image — accounted for 8% of the explained variance, encompassing items assessing somatic confidence, nude comfort, and perceived physical attractiveness.
- Factor 6: Commitment — accounted for 6% of the explained variance, aggregating items measuring fears of entrapment, vulnerability, and relational trust.
- Factor 7: Sexual Performance — accounted for 5% of the explained variance, representing performance failure anxiety, partner abandonment concerns, and sex-specific physiological inadequacy.
- Factor 8: Gender Roles — accounted for 4% of the explained variance, comprising items assessing traditional double standards and gendered script adherence.
Subsequent psychometric evaluations have demonstrated that while the latent structure holds stable across mixed-gender heterosexual samples, specific subscale adjustments are necessary when administering the tool to gay, lesbian, or bisexual individuals. Specifically, because the Gender Roles subscale contains explicit references to other-gender pairings (e.g., Item 3: “When a male and female are having a sexual relationship…”), this subscale is typically removed for homosexually oriented respondents to prevent construct invalidity and measurement bias.
10. Instrument / Measurement Tool
- Instrument Name: Attitudes Related to Sexual Concerns Scale (ASCS)
- Primary Authors: Patricia Barthalow Koch, Ph.D., and Craig R. Cowden, Ph.D.
- Assessment Type: Self-report psychosexual attitude inventory / clinical rating scale
- Administration Format: Paper-and-pencil or secure computer-based digital questionnaire
- Completion Time: Approximately 12 to 15 minutes
- Target Population: Adults and adolescents aged 18 years and older across clinical and non-clinical environments
- Item Count: 30 total items (each respondent completes 29 items, as Item 29 is administered exclusively to females and Item 30 is administered exclusively to males)
- Response Scale: 5-point Likert format:
- 1 = Strongly Agree
- 2 = Agree
- 3 = Uncertain
- 4 = Disagree
- 5 = Strongly Disagree
- Scoring Range: Total composite scores range from 30 (reflecting the least negative/most positive and functional attitudes) to 150 (reflecting the most negative/dysfunctional attitudes associated with clinical sexual and relational concerns).
- Subscale Item Composition:
- Body Image (3 items): Items 1, 9, *17
- Sexual Self-Understanding (4 items): Items *2, 10, *18, 25
- Gender Roles (3 items): Items *3, *11, 19
- Communication with a Sexual Partner (4 items): Items *4, 12, *20, *26
- Sexual Guilt (4 items): Items *5, *13, 21, 27
- Commitment (4 items): Items 6, *14, *22, *28
- Masturbation (3 items): Items 7, 15, *23
- Sexual Performance (4 items): Items *8, *16, *24, and either *29 (females) or *30 (males)
- Scoring and Directionality Instructions:
- Items marked with an asterisk (*) represent maladaptive, negative, or inhibited sexual attitudes and must be reverse scored prior to computing subscale or total composite sums: 1 becomes 5, 2 becomes 4, 3 remains 3, 4 becomes 2, and 5 becomes 1.
- Non-asterisked items represent healthy, adaptive, or uninhibited sexual attitudes and are scored directly as marked (Strongly Agree = 1 to Strongly Disagree = 5), meaning disagreement reflects a more negative attitude.
- After reversing asterisked items, higher numerical values across all items consistently denote more negative, restrictive, or dysfunctional attitudes related to sexual concerns.
- For homosexually oriented populations, the Gender Roles subscale (Items 3, 11, 19) is excluded from total score computations.
11. Permissions & Fee and Test Year
The Attitudes Related to Sexual Concerns Scale was initially developed and validated between 1983 and 1990 (Koch, 1983; Koch & Cowden, 1990), with its definitive peer-reviewed validation publication appearing in 1995 in the Journal of Sex Education and Therapy (Cowden & Koch, 1995). The instrument is published in scientific literature for academic, non-commercial research, and clinical diagnostic assessment purposes. Researchers and clinicians may utilize the scale provided appropriate scholarly attribution and citation are given. No proprietary software license or commercial usage fee is required for non-funded academic investigations; however, formal institutional permission for commercial deployment, large-scale clinical test battery integration, or digital republishing should be directed to the corresponding developer, Dr. Patricia Barthalow Koch, at The Pennsylvania State University.
12. References
Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Prentice-Hall.
Cowden, C. R., & Bradshaw, S. D. (2007). Religiosity and sexual concerns. International Journal of Sexual Health, 19(1), 15–24. https://doi.org/10.1300/J514v19n01_03
Cowden, C. R., & Koch, P. B. (1995). Attitudes related to sexual concerns: Gender and orientation comparisons. Journal of Sex Education and Therapy, 21(2), 78–87. https://doi.org/10.1080/01614576.1995.11074140
Derogatis, L. R., & Melisaratos, N. (1979). The DSFI: A multidimensional measure of sexual functioning. Journal of Sex & Marital Therapy, 5(3), 244–281. https://doi.org/10.1080/00926237908403732
Gagnon, J. H., & Simon, W. (1973). Sexual conduct: The social sources of human sexuality. Aldine Publishing Company.
Janda, L. H., & O’Grady, K. E. (1980). Development of a Sex Anxiety Inventory. Journal of Consulting and Clinical Psychology, 48(2), 169–175. https://doi.org/10.1037/0022-006X.48.2.169
Koch, P. B. (1983). The relationship between sex-related attitudes and beliefs and the sexual concerns experienced by college students (Publication No. DA83-20895) [Doctoral dissertation, The Pennsylvania State University]. Dissertation Abstracts International.
Koch, P. B. (1988). The relationship of first intercourse to later sexual functioning concerns of adolescents. Journal of Adolescent Research, 3(3-4), 345–362. https://doi.org/10.1177/074355488833008
Koch, P. B., & Cowden, C. R. (1990). Development of a measurement of attitudes related to sexual concerns. Unpublished manuscript, The Pennsylvania State University.
Mosher, D. L. (1966). The development and multitrait-multimethod matrix analysis of three measures of three aspects of guilt. Journal of Consulting Psychology, 30(1), 25–29. https://doi.org/10.1037/h0023086