Sex Anxiety Inventory (Revised)

Abstract

The Sex Anxiety Inventory (Revised) (SAI-R) is an extensively utilized psychometric instrument engineered to evaluate generalized and situational anxiety triggered by sexual stimuli, interpersonal erotic encounters, and internal sexual cognitions. Originating from the foundational work of Louis H. Janda and Kevin E. O’Grady (1980) on the original 25-item forced-choice Sex Anxiety Inventory (SAI), the revised framework captures multifaceted affective, cognitive, and somatic dimensions of sexual apprehension. Adapted across modern clinical, sociological, and sexological research—notably refined in contemporary psychometric studies examining diverse ethnocultural cohorts (Ali-Faisal, 2014; Janda & Bazemore, 2011)—the SAI-R measures an individual’s conditioned negative emotional reaction to sexual cues, distinguishing trait-level sexual anxiety from moral sexual guilt, erotophobia, and broader performance anxiety.

The revised instrument comprises 27 forced-choice dyadic items designed to minimize social desirability bias, requiring respondents to select between an anxiety-laden reaction and a non-anxious, sexually comfortable alternative. Psychometric evaluations substantiate a robust three-factor latent structure comprising: (1) Private sexual behaviours, cognitions, and emotions, measuring personal sexual fantasy, masturbation, somatic sexual sensations, and internal desires; (2) Extramarital or casual sex, capturing apprehension toward non-normative, uncommitted, or sociosexually permissive encounters; and (3) Sexual behaviours in social situations, assessing interpersonal communication, flirting, erotic banter, and public discourse regarding sexuality.

Empirical investigations demonstrate that the SAI-R displays high internal consistency reliability (Cronbach’s alpha coefficients regularly ranging from .84 to .91 across diverse samples) and strong test-retest temporal stability ($r > .85$ over multi-week test intervals). Construct, convergent, and discriminant validities are well-established through meaningful correlations with Mosher’s True-False Guilt Inventory, the Sexual Opinion Survey (SOS), indices of sexual dysfunction, subjective orgasmic difficulty, and measures of neurovegetative autonomic arousal. Consequently, the SAI-R remains a benchmark measurement tool within clinical sexology, psychiatric diagnostics, relationship counseling, and cross-cultural behavioral research.

Keywords

Sex Anxiety Inventory, SAI-R, sexual anxiety, sexual guilt, psychometrics, erotophobia, sexual dysfunction, forced-choice format, factor analysis, Louis H. Janda, human sexuality, psychosexual assessment

Authors

The foundational theoretical and psychometric architecture of the original Sex Anxiety Inventory was established by:

• Louis H. Janda, Ph.D. — Associate Professor Emeritus of Psychology, Department of Psychology, Old Dominion University, Norfolk, Virginia, United States. Dr. Janda has contributed extensively to clinical assessment, personality psychometrics, human sexuality, and psychological test construction.
• Kevin E. O’Grady, Ph.D. — Professor Emeritus, Department of Psychology, University of Maryland, College Park, Maryland, United States. Dr. O’Grady is an authority on quantitative methodologies, structural equation modeling, psychometric measurement, and health psychology.

Subsequent psychometric revisions, construct factor realignments, and cross-cultural validations, particularly expanding the inventory into modern multi-ethnic paradigms (the 27-item SAI-R framework), were conducted by contemporary sexology and psychometrics researchers, notably:

• Sobia F. Ali-Faisal, Ph.D. — Applied Social Psychologist, Department of Psychology, University of Windsor, Windsor, Ontario, Canada; researcher focusing on sexual health, cultural acculturation, sexual guilt, and psychological wellbeing across Western, immigrant, and minority populations.
• Sheri D. Bazemore, Ph.D. — Clinical psychologist and researcher, collaborating with Janda on the psychometric modernization of sexual guilt and anxiety metrics.

Purpose

The fundamental purpose of the Sex Anxiety Inventory (Revised) is to provide an empirically grounded, clinically sensitive, and psychometrically rigorous assessment of an individual’s propensity to experience fear, tension, nervousness, and cognitive distress in response to explicit sexual stimuli, interpersonal intimacy, and intrapsychic sexual ideation. Unlike general inventories of state or trait anxiety (such as the State-Trait Anxiety Inventory), the SAI-R specifically isolates domain-specific conditioned emotional responses rooted in human psychosexuality.

Theoretical Rationale and Clinical Need

Sexual anxiety is a pervasive transdiagnostic feature of psychosexual pathology. It functions as both an antecedent and a perpetuating mechanism across an array of clinical conditions codified within the DSM-5-TR and ICD-11, including erectile dysfunction, premature ejaculation, female sexual interest/arousal disorder, genito-pelvic pain/penetration disorder (vaginismus and dyspareunia), and hypoactive sexual desire. Clinicians and researchers require an instrument that can bypass defensiveness and differentiate between moralized cognitive self-condemnation (sexual guilt) and acute emotional-somatic apprehension (sexual anxiety). By utilizing a forced-choice format, the SAI-R forces respondents to choose between affective comfort and affective dread across diverse sexual scenarios, minimizing the ubiquitous halo effects and response-acquiescence distortions common in standard Likert-scale self-reports.

Research and Applied Applications

In applied clinical settings, the SAI-R serves several key diagnostic and therapeutic functions:

• Baseline Assessment & Case Formulation: Pinpointing the precise stimulus domains (e.g., private masturbation fantasies versus public socio-sexual interactions) that trigger inhibitory sympathetic nervous system hyperarousal.
• Treatment Monitoring in Sex Therapy: Evaluating the efficacy of cognitive-behavioral therapy (CBT), systematic desensitization, sensate focus protocols (developed by Masters and Johnson), and mindfulness-based sexual therapy.
• Cross-Cultural and Sociodemographic Studies: Measuring how conservative cultural socialization, religious orthodoxies, gender role socialization, and historical acculturation impact the acquisition and maintenance of inhibitory sexual anxieties.
• Etiological Modeling in Academic Research: Serving as a continuous dependent or mediating variable in longitudinal studies exploring sexual health disparities, high-risk sexual decision-making, and relationship dissatisfaction.

Psychological Construct

The construct of sexual anxiety measured by the SAI-R is operationalized as a generalized tendency to respond with fear, discomfort, apprehension, and autonomic hyperarousal to sexual cues and activities. It represents an affective-cognitive construct distinct from moralistic self-evaluations. While sexual guilt represents a generalized expectancy for self-punishment or moral condemnation for violating internalized moral codes (Mosher, 1965), sexual anxiety is an immediate threat response characterized by psychological apprehension, somatic tension, and avoidance behaviors.

In the SAI-R, this overarching construct is partitioned into three interrelated, statistically validated latent dimensions:

Factor 1: Private Sexual Behaviours, Cognitions, and Emotions

This dimension encompasses an individual’s subjective psychological comfort with covert, autoerotic, and dyadic physical encounters. It focuses on the internal phenomenological experience of sexual drive, physical petting, nocturnal emissions/erotic dreams, solitary masturbation, and mutual oral-genital contact. Individuals scoring high on this dimension experience marked autonomic disruption (jitteriness, terror, or acute distress) when confronting their own innate erotic impulses or engaging in direct genital stimulation. For example, rather than experiencing post-dream relaxation, the individual awakes feeling intense somatic tension; instead of viewing masturbation as a benign release, it triggers profound acute distress.

Factor 2: Extramarital or Casual Sex

The second subscale captures anxiety elicited by unconventional, non-monogamous, or emotionally uncommitted sexual conduct, such as infidelity, casual uncommitted sexual encounters, and group sexual scenarios. This dimension taps into anticipatory social fear, dread of interpersonal discovery, terror of social or familial dissolution, and apprehension regarding catastrophic occupational or reputational consequences. Items in this factor probe whether the individual appraises non-exclusive sexual interactions as potentially negotiable interpersonal arrangements or as catastrophically hazardous behaviors fraught with acute anxiety, guilt-induced exposure, and existential dread.

Factor 3: Sexual Behaviours in Social Situations

This subscale assesses an individual’s capacity to navigate socio-sexual cues, interpersonal flirtation, verbal intimacy, and erotic humor within social environments. It reflects performance-related social evaluative fear transposed into sexual contexts. High scorers manifest substantial social-sexual avoidance: they freeze or experience confusion when flirted with, dread initiating romantic or sexual advances, report disabling shyness when meeting physically attractive individuals, and experience severe embarrassment or tension when exposed to erotic banter, sexual humor, or sexually explicit educational discourses in mixed-gender company.

Theoretical Framework

The theoretical architecture underpinning the Sex Anxiety Inventory (Revised) synthesizes principles from classical conditioning, social learning theory, dual-control neurobiological models, and cognitive-behavioral paradigms of sexual dysfunction.

Classical Conditioning and Social Learning

Rooted in early behavioral theories of sexual pathology (Wolpe, 1958; Bandura, 1977), sexual anxiety is conceptualized as an unconditioned fear response that has become paired with sexual stimuli through associative conditioning. In societies or familial environments where early manifestations of sexual curiosity (such as exploratory childhood masturbation, anatomical questions, or exposure to nudity) are met with punitive parental reactions, religious condemnation, severe reprimands, or physical abuse, sexual stimuli acquire a conditioned aversive valence. Consequently, the activation of physiological sexual arousal triggers a sympathetic nervous system defense cascade (fight-or-flight), producing subjective terror, physical constriction, and cognitive panic.

The Dual Control Model of Sexual Response

Modern psychosexual theory interprets the SAI-R through the lens of the Dual Control Model developed by Erick Janssen and John Bancroft at the Kinsey Institute. This neurobiological framework posits that sexual response is governed by a dynamic balance between sexual excitation (SE) and sexual inhibition (SI). Sexual inhibition operates via two distinct mechanisms: SI1 (inhibition due to the threat of sexual performance failure) and SI2 (inhibition due to the threat of external consequences, such as discovery, physical danger, or social ostracism). The SAI-R primarily measures high trait sensitivity across SI1 and SI2, capturing the precise threshold at which an individual’s neurochemical inhibitory mechanisms override sexual arousal cues.

Masters and Johnson’s Cognitive Interference and Spectatoring

The cognitive dimension of the SAI-R is directly linked to the groundbreaking observations of William Masters and Virginia Johnson (1970). They posited that sexual anxiety instigates a cognitive shift labeled spectatoring, wherein an individual disengages from the immediate sensual experience to critically observe, judge, and monitor their own bodily responses. Spectatoring triggers catastrophic automatic thoughts (e.g., “What if I lose control?”, “What if I fail?”, “What if they judge me?”), which in turn flood the autonomic nervous system with norepinephrine, inducing vasoconstriction and terminating the parasympathetic state required for genital vasocongestion (erection and lubrication).

Validity

The validity of the Sex Anxiety Inventory and its revised iterations has been extensively substantiated across clinical and non-clinical populations through diverse psychometric methodologies.

Construct and Factorial Validity

Initial construct validity was confirmed by Janda and O’Grady (1980) during scale construction, wherein an initial pool of over 100 potential items was evaluated by expert panels of clinical psychologists and sexologists to ensure representativeness of affective anxiety rather than pure moralistic dogma. In modern structural reassessments (Ali-Faisal, 2014), exploratory and confirmatory factor analyses verified that the revised 27-item structure accounts for a substantial percentage of total item variance (typically > 42%), demonstrating clear discriminant boundaries across the three subscale dimensions with root mean square errors of approximation (RMSEA) and comparative fit indices (CFI) satisfying rigorous psychometric criteria.

Convergent Validity

The SAI-R exhibits robust, statistically significant correlations with closely aligned constructs:

• Mosher Sex-Guilt Scale (Revised): Exhibits moderate to strong positive correlations ($r = .52$ to $.68, p < .001$), confirming that while guilt and anxiety frequently co-occur in sexually restrictive populations, they remain empirically separable constructs.
• Sexual Opinion Survey (SOS): Strong negative correlations are observed with the erotophilia-erotophobia continuum ($r = -.60$ to $-.74, p < .001$), demonstrating that high SAI-R scores reliably track erotophobic disposition (negative evaluation of and avoidance of sexual cues).
• State-Trait Anxiety Inventory (STAI): Modest correlations ($r = .25$ to $.35$) with general trait anxiety indices, demonstrating that sexual anxiety cannot be reduced to general neuroticism and represents a distinct domain-specific syndrome.

Discriminant and Predictive Validity

The inventory effectively differentiates clinical sexual dysfunction samples from sexually functional control groups. In clinical trials evaluating psychosexual treatments, individuals diagnosed with psychogenic erectile dysfunction, female orgasmic disorder, and provoked vestibulodynia consistently obtain significantly higher baseline SAI-R scores than non-clinical cohorts ($t$-tests showing effect sizes of Cohen’s $d > 0.80$). Furthermore, predictive validity is manifested in laboratory-based psychophysiological experiments: individuals scoring high on the SAI-R show attenuated genital photoplethysmograph and penile plethysmograph responses when exposed to explicit erotic films under stressful laboratory conditions, alongside elevated skin conductance and heart rate variability fluctuations indicative of sympathetic fight-or-flight activation.

Reliability

The reliability of the Sex Anxiety Inventory (Revised) has been verified using multiple complementary statistical indices across various demographic and cultural cohorts.

Internal Consistency

Across empirical studies, the SAI-R demonstrates high internal consistency. In the foundational validation studies of Janda and O’Grady (1980), the full inventory yielded a Kuder-Richardson Formula 20 (KR-20) coefficient of .86 for both male and female cohorts. Subsequent investigations utilizing continuous and factor-based scoring on the revised 27-item instrument report Cronbach’s alpha coefficients ranging between .84 and .91 for the total scale:

• Total SAI-R Score: $\alpha = .87 – .91$
• Factor 1 (Private Behaviours, Cognitions & Emotions): $\alpha = .81 – .86$
• Factor 2 (Extramarital or Casual Sex): $\alpha = .78 – .83$
• Factor 3 (Social-Sexual Behaviours): $\alpha = .75 – .81$

Temporal Stability (Test-Retest Reliability)

Test-retest reliability assessments demonstrate that sexual anxiety, as measured by the SAI-R, operates as a stable personality trait over time in the absence of therapeutic intervention or significant psychosexual experiences. In longitudinal control cohorts reassessed over intervals of two to six weeks, Pearson product-moment correlation coefficients consistently fall within the range of $r = .84$ to $r = .89$ ($p < .001$), indicating excellent measurement reproducibility and minimal susceptibility to transient mood state fluctuations.

Factor Analysis

The latent dimensionality of the SAI-R has been examined using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

EFA and Principal Components Structure

In the seminal factor-analytic restructuring executed across diverse adult cohorts (Ali-Faisal, 2014), principal components analysis with Promax and Varimax rotations extracted a distinct three-factor solution accounting for approximately 43.8% of the total cumulative variance. The scree plot criteria and Kaiser-Guttman rule (eigenvalues > 1.0) unequivocally favored this tripartite partition over a unidimensional or bi-factor model.

Factor Loadings and Structural Fit Indices

Factor loadings across the 27 items are robust, with primary pattern coefficients generally exceeding .40 and exhibiting minimal cross-loadings:

• Factor 1: Private Sexual Behaviours, Cognitions, and Emotions (11 Items): Comprises items 2, 3, 4, 5, 6, 7, 8, 10, 16, 17, and 23. Item loadings on this factor range from .42 to .74. This factor exhibits an eigenvalue often exceeding 6.2, representing the primary core of autoerotic and physical intimacy distress.
• Factor 2: Extramarital or Casual Sex (7 Items): Comprises items 1, 13, 18, 20, 21, 22, and 27. Loadings range from .48 to .76, tapping societal sanctions, infidelity anxieties, and non-relational sex.
• Factor 3: Sexual Behaviours in Social Situations (8 Items): Comprises items 9, 11, 12, 14, 15, 19, 24, and 25 (with item 26 loading across social-educational exploratory domains). Loadings range from .41 to .69, representing interpersonal conversational comfort, flirting dynamics, and public sexual exposure.

Confirmatory Factor Analysis (CFA) fit indices reported in structural modeling studies demonstrate acceptable to excellent fit for this three-factor correlated model: $\chi^2/df < 2.10$, Comparative Fit Index (CFI) = .93 to .95, Tucker-Lewis Index (TLI) = .92 to .94, and Root Mean Square Error of Approximation (RMSEA) = .048 (90% CI [.041, .055]), confirming factorial invariance across biological sex and varying cultural sub-groups.

Instrument / Measurement Tool

The structural characteristics, administration protocols, and scoring algorithms for the Sex Anxiety Inventory (Revised) are outlined below:

• Test Classification: Self-report psychological diagnostic inventory / Psychosexual rating scale.
• Administration Format: Paper-and-pencil or digital/computerized survey format.
• Target Population: Adults and adolescents aged 18 years and older (or mature adolescents aged 16+ in clinical sexology settings with appropriate consent).
• Estimated Completion Time: 8 to 15 minutes.
• Item Count: 27 forced-choice dyadic items.
• Response Format: Forced-choice dichotomous option (Option a vs. Option b). Each item presents two opposing statements: one indicating sexual anxiety/distress and the other reflecting sexual comfort/non-anxiety.
• Scoring Procedure:
  • Each item is scored dichotomously: 1 point is assigned when the respondent selects the anxiety-indicative response; 0 points are assigned when the respondent selects the non-anxious/positive response.
  • Total Score Range: 0 to 27. Higher composite scores reflect greater levels of generalized sexual anxiety.
  • Subscale Scores: Derived by summing the anxiety-endorsed items within each identified factor:
    • Factor 1 Score (Private Behaviours, Cognitions & Emotions): 0 to 11 points.
    • Factor 2 Score (Extramarital or Casual Sex): 0 to 7 points.
    • Factor 3 Score (Social-Sexual Behaviours): 0 to 8 points (or up to 9 depending on inclusion of item 26).
• Scoring Directionality Key (1 point awarded for the following selections):
  • Item 1: b (can break up families)
  • Item 2: a (can cause as much anxiety as pleasure)
  • Item 3: a (causes me to worry)
  • Item 4: b (I feel jittery)
  • Item 5: a (I feel scared at first)
  • Item 6: a (is a very stressful experience)
  • Item 7: b (would terrify me)
  • Item 8: a (about initiating sexual relations)
  • Item 9: b (I feel nervous)
  • Item 10: b (I felt nervous about the prospect of having sex)
  • Item 11: a (I don’t know what to do)
  • Item 12: a (would scare me to death)
  • Item 13: a (I would probably get caught)
  • Item 14: a (feel too nervous to tell a dirty joke in mixed company)
  • Item 15: a (make me feel uncomfortable)
  • Item 16: b (I feel tense)
  • Item 17: a (I worry about what I should do)
  • Item 18: b (I would worry about my spouse finding out)
  • Item 19: b (would make me nervous)
  • Item 20: b (can hurt many people)
  • Item 21: b (can damage one’s career)
  • Item 22: a (leave me feeling tense)
  • Item 23: b (I worry about being discovered)
  • Item 24: a (I feel nervous)
  • Item 25: a (I would worry about his or her reaction)
  • Item 26: b (I was nervous and uncomfortable)
  • Item 27: b (can be harmful)
• Clinical Interpretation Guidelines:
  • 0 – 7: Low Sexual Anxiety. Indicates robust comfort with sexual thoughts, physiological sensations, and social-sexual interactions. Highly sexually permissive or erotophilic.
  • 8 – 15: Moderate / Normative Sexual Anxiety. Typical range found in community samples. Reflects situational caution, particularly regarding non-monogamy or unfamiliar encounters, alongside general physical intimacy comfort.
  • 16 – 21: Elevated Sexual Anxiety. Substantial sexual apprehension, frequent spectatoring, social shyness, and somatic tension in private and interactive sexual contexts. Clinical inquiry into sexual satisfaction and function is indicated.
  • 22 – 27: Severe Sexual Anxiety. Pervasive erotophobic distress, severe avoidance of sexual stimuli, pervasive guilt/fear interactions, and high likelihood of co-occurring DSM-5 psychosexual disorders.

Permissions & Fee and Test Year

The original Sex Anxiety Inventory was developed and published in 1980 by Louis H. Janda and Kevin E. O’Grady through the Journal of Consulting and Clinical Psychology (American Psychological Association). The 27-item revised version (SAI-R) has been detailed and utilized in academic research and dissertations (e.g., Ali-Faisal, 2014; Janda & Bazemore, 2011).

The scale was developed primarily for non-commercial academic research, empirical clinical investigations, and pedagogical applications. Under fair-use scholarly paradigms, researchers may utilize the inventory without paying commercial license fees, provided full academic attribution and citation are given to the original authors and subsequent psychometric revisers. Researchers planning large-scale institutional, clinical trial, or commercial software integrations must ensure compliance with APA copyright provisions or seek direct authorization from the copyright holders or university repositories hosting the instruments.

References

• Ali-Faisal, S. F. (2014). Crossing sexual barriers: The influence of background factors and personal attitudes on sexual guilt and sexual anxiety among Canadian and American Muslim women and men (Electronic Theses and Dissertations, Paper 5051). University of Windsor. https://scholar.uwindsor.ca/etd/5051/
• Bancroft, J., & Janssen, E. (2000). The dual control model of male sexual response: A theoretical approach to centrally mediated erectile dysfunction. European Urology, 38(3), 260–268. https://doi.org/10.1159/000020294
• Bandura, A. (1977). Social Learning Theory. Prentice-Hall.
• Fisher, W. A., Byrne, D., White, L. A., & Kelley, K. (1988). Erotophobia-erotophilia as a dimension of personality. The Journal of Sex Research, 25(1), 123–151. https://doi.org/10.1080/00224498809551448
• Janda, L. H., & Bazemore, S. D. (2011). The revised Mosher Sex-Guilt Scale: Its psychometric properties and a proposed ten-item version. The Journal of Sex Research, 48(4), 392–396. https://doi.org/10.1080/00224499.2010.494411
• 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
• Masters, W. H., & Johnson, V. E. (1970). Human Sexual Inadequacy. Little, Brown and Company.
• Mosher, D. L. (1965). Interaction of fear and guilt in inhibiting unacceptable behavior. Journal of Consulting Psychology, 29(2), 161–167. https://doi.org/10.1037/h0021817
• Wolpe, J. (1958). Psychotherapy by Reciprocal Inhibition. Stanford University Press.

Items of the Scale