Sexual Dysfunctional Beliefs Questionnaire

1. Abstract

The Sexual Dysfunctional Beliefs Questionnaire (SDBQ) is a standardized self-report psychometric instrument developed by Pedro J. Nobre, José Pinto-Gouveia, and F. A. Gomes in 2003. Designed to assess rigid, maladaptive sexual beliefs and cognitive schemas that act as predisposing, precipitating, and maintaining vulnerability factors for sexual dysfunctions, the instrument comprises two gender-specific forms: the Male Version (SDBQ-M) and the Female Version (SDBQ-F). Both versions consist of 40 statements evaluated on a 5-point Likert scale ranging from 1 (“Completely Disagree”) to 5 (“Completely Agree”). Principal component analyses with varimax rotation revealed distinct six-factor structural models for each version. For the male version, the six factors account for 49% of the total variance and encompass: (1) Sexual Conservatism, (2) Female Sexual Power, (3) “Macho” Belief, (4) Beliefs About Women’s Sexual Satisfaction, (5) Restrictive Attitude Toward Sex, and (6) Sex as an Abuse of Men’s Power (with 37 retained items). For the female version, the six factors account for 43% of the total variance, comprising: (1) Sexual Conservatism, (2) Sexual Desire and Pleasure as a Sin, (3) Age-Related Beliefs, (4) Body-Image Beliefs, (5) Denying Affection Primacy, and (6) Motherhood Primacy (with 34 retained items). The SDBQ demonstrates robust internal consistency, with total scale Cronbach’s alpha coefficients reaching .93 for the male version and .81 for the female version, alongside dimensional alphas ranging between .50 and .89. Test-retest reliability across a four-week interval indicates strong temporal stability (male r = .73; female r = .80). Convergent validity has been confirmed through statistically significant associations with the International Index of Erectile Function (IIEF), the Female Sexual Function Index (FSFI), and the Sexual Beliefs and Information Questionnaire (SBIQ). Discriminant analyses demonstrate that clinical cohorts with diagnosed sexual disorders endorse significantly higher levels of dysfunctional beliefs compared to matched sexually healthy controls. The SDBQ serves as an indispensable tool in cognitive-behavioral sex therapy, clinical diagnostics, and sexological research.

2. Keywords

Sexual Dysfunctional Beliefs Questionnaire, SDBQ, sexual dysfunction, cognitive schemas, sexual conservatism, macho beliefs, sex therapy, cognitive-behavioral assessment, psychometrics, sexual health

3. Authors

The Sexual Dysfunctional Beliefs Questionnaire was developed by clinical psychologists and psychosexual researchers based in Portugal:

• Pedro J. Nobre, Ph.D. — Professor of Psychology and Director of the Laboratory of Research in Human Sexuality (SexLab), Faculty of Psychology and Education Sciences, Universidade do Porto (formerly at Universidade de Trás-os-Montes e Alto Douro, Vila Real, Portugal). E-mail: [email protected].
• José Pinto-Gouveia, M.D., Ph.D. — Full Professor of Clinical Psychology and Cognitive-Behavioral Therapy, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Universidade de Coimbra, Coimbra, Portugal.
• F. A. Gomes, Ph.D. — Researcher and Clinical Collaborator in Human Sexuality, Faculty of Medicine / Faculty of Psychology, Universidade de Coimbra, Coimbra, Portugal.

4. Purpose

The primary purpose of the Sexual Dysfunctional Beliefs Questionnaire is to provide an empirical, standardized measure of cognitive vulnerability factors implicated in the onset, exacerbation, and perpetuation of psychogenic sexual dysfunctions in both clinical and nonclinical populations. In modern clinical sexology and psychopathology, sexual functioning is recognized as an integrated neurobiological and cognitive-affective process. While physiological factors provide the substrate for sexual excitation and genital response, cognitive appraisals, attentional focus, and deeply ingrained assumptions critically govern sexual outcomes.

Historically, early sexological frameworks, such as the pioneering behavioral models of Masters and Johnson and Helen Singer Kaplan, identified performance anxiety and “spectatoring” (inwardly monitoring one’s own physiological performance) as central drivers of sexual impairment. However, pure behavioral conditioning fails to explain why certain individuals develop severe performance anxiety while others exposed to identical demands remain resilient. Cognitive-behavioral theory posits that underlying cognitive schemas—termed sexual dysfunctional beliefs—act as cognitive filters that process sexual cues selectively, triggering negative automatic thoughts, catastrophizing, hypervigilance, and physiological inhibition during sexual encounters.

The SDBQ operationalizes these cognitive schemas. It enables clinicians and clinical researchers to:

• Identify idiosyncratic, rigid belief structures that predetermine sexual dissatisfaction, erectile disorder, premature ejaculation, hypoactive sexual desire, female orgasmic disorder, and genito-pelvic pain/penetration disorder.
• Formulate targeted, case-specific cognitive restructuring protocols within cognitive-behavioral sex therapy, challenging deeply held myths regarding masculinity, female passivity, body image, and moral guilt.
• Measure cognitive shifts pre- and post-intervention to verify whether therapeutic gains in physiological functioning are matched by lasting changes in underlying cognitive vulnerabilities, thus mitigating relapse risk.
• Conduct epidemiological and cross-cultural investigations exploring how socio-cultural stereotypes, religious dogma, and traditional gender roles systematically erode sexual well-being across diverse cohorts.

5. Psychological Construct

The overarching construct assessed by the SDBQ is sexual cognitive vulnerability, manifested as rigid, maladaptive, unrealistic, and culturally conditioned beliefs concerning sexual performance, gender roles, physical aesthetics, aging, and sexual morality. Because cultural conditioning differentially shapes male and female sexual socialization, Nobre and colleagues established gender-specific constructs organized into distinct subscales for men and women.

Male Version (SDBQ-M) Dimensions

The male version evaluates six primary cognitive dimensions:

• Sexual Conservatism: Measures adherence to rigid, moralistic, procreation-focused, and restrictive notions of sexuality. Men scoring high on this dimension view sex strictly through conventional, procreative, or missionary-position frameworks, rejecting exploratory practices such as oral sex, sexual fantasies, or premarital sexuality as improper or sinful (e.g., “Vaginal intercourse is the only legitimate type of sex”).
• Female Sexual Power: Captures catastrophic schemas regarding vulnerability, interpersonal control, and the perception of female sexuality as manipulative or punitive. It taps the irrational belief that sexual surrender leaves a man exposed to exploitation or emotional annihilation (e.g., “If a man lets himself go sexually he is under a woman’s control”).
• “Macho” Belief: Reflects hyper-masculine stereotypes equating male worth strictly with constant sexual readiness, hyper-frequent sexual performance, emotional detachment, and effortless orgasmic attainment. Men subscribing to these beliefs perceive any momentary loss of desire or hesitation as an indictment of their manhood (e.g., “A real man is always ready for sex and must be capable of satisfying any woman”).
• Beliefs About Women’s Sexual Satisfaction: Encompasses performance-demanding assumptions asserting that a woman’s sexual pleasure is solely dependent upon the quality, rigidity, and duration of the man’s erection, and that female climax can only be achieved via penetrative intercourse (e.g., “Penile erection is essential for a woman’s sexual satisfaction”).
• Restrictive Attitude Toward Sex: Evaluates avoidance-oriented, phobic, and pathologizing perceptions of varied sexual acts, associating non-coital expressions with physical disease or severe moral degradation (e.g., “Repeated engagement in oral or anal sex can cause serious health problems”).
• Sex as an Abuse of Men’s Power: Assesses latent guilt and conflict regarding male sexual desire, framing sexual intercourse as an inherently aggressive, predatory, or violative act against the female body (e.g., “Sex is a violation of a woman’s body”).

Female Version (SDBQ-F) Dimensions

The female version examines six distinct cognitive schemas:

• Sexual Conservatism: Assesses traditional, restrictive mandates surrounding female modesty, virginity, and anti-masturbatory taboos, dictating that sexual initiative and orgasmic attainment belong exclusively to men (e.g., “The best gift a woman could bring to marriage is her virginity”).
• Sexual Desire and Pleasure as a Sin: Evaluates profound moral guilt, religious scrupulosity, and the perception that experiencing erotic pleasure or engaging in solo sex equates to moral degradation (e.g., “Sex is dirty and sinful”).
• Age-Related Beliefs: Reflects fatalistic, ageist schemas postulating that female sexual desire, responsiveness, and capacity for orgasm naturally extinguish following menopause (e.g., “After menopause women lose their sexual desire”).
• Body-Image Beliefs: Measures cognitive distortions equating sexual entitlement, orgasmic capacity, and partner satisfaction strictly with youth and societal standards of physical attractiveness (e.g., “Women who are not physically attractive can’t be sexually satisfied”).
• Denying Affection Primacy: Evaluates schemas concerning the relational context of sex, specifically whether sexual engagement can be disentangled from romantic love and absolute emotional safety, scored inversely to denote cognitive rigidity.
• Motherhood Primacy: Captures the “Madonna-Whore” dichotomy internalized by women, where the social role of a devoted mother is perceived as fundamentally incompatible with active, autonomous adult sexual desire (e.g., “A good mother can’t be sexually active”).

6. Theoretical Framework

The theoretical framework underpinning the SDBQ is grounded in Aaron T. Beck’s cognitive therapy model and Albert Ellis’s Rational Emotive Behavior Therapy (REBT), adapted specifically to sexual medicine by Pedro J. Nobre and José Pinto-Gouveia in their Cognitive-Affective Model of Sexual Functioning.

According to Beck’s cognitive model of psychopathology, early developmental experiences, socio-cultural socialization, religious strictures, and parental conditioning give rise to deeply embedded cognitive structures known as core beliefs or schemas. These schemas remain dormant until triggered by relevant situational events—in this context, an explicit sexual encounter or a momentary lapse in physiological response (e.g., situational loss of erection or delayed lubrication). Once activated, dysfunctional schemas bias cognitive processing, causing individuals to systematically misinterpret ambiguous physiological or relational signals.

In Nobre’s cognitive-affective formulation, sexual dysfunction operates via a self-perpetuating feedback loop:

1. Activation of Dysfunctional Schemas: When initiating sex, a man endorsing high “Macho” beliefs activates the core rule: “A real man must always maintain a rock-hard erection and satisfy his partner, or he is a complete failure.”
2. Negative Automatic Thoughts: At the earliest sign of normal autonomic fluctuation, the schema generates involuntary, catastrophic automatic thoughts (e.g., “I’m losing my erection; she will think I’m pathetic; this is a total disaster”).
3. Attentional Bias and Spectatoring: Attentional resources are redirected away from erotic, sensory, and affective cues toward internal threat monitoring and physiological inspection (the “spectator” stance).
4. Negative Emotional and Physiological Response: Catastrophic appraisal triggers acute autonomic sympathetic arousal (fight-or-flight response), releasing systemic catecholamines that physiologically oppose parasympathetic genital vasodilation. Erectile detumescence or vaginal dryness immediately ensues.
5. Behavioral Avoidance and Confirmation: The resulting physiological failure serves as apparent “empirical proof” validating the initial dysfunctional schema, consolidating cognitive vulnerability and driving future anticipatory anxiety and behavioral avoidance.

The SDBQ captures the foundational cognitive tier of this model. By systematically measuring the latent schemas that drive this destructive spiral, the instrument bridges the gap between general cognitive theory and the idiosyncratic nuances of sexual clinical psychology.

7. Validity

The psychometric validity of the Sexual Dysfunctional Beliefs Questionnaire has been rigorously examined across numerous clinical and community investigations.

Construct and Factorial Validity

Construct validity was initially established by Nobre, Pinto-Gouveia, and Gomes (2003) via principal component analysis (PCA) with varimax rotation, confirming that the questionnaire captures distinct, conceptually coherent dimensions of psychosexual vulnerability rather than an undifferentiated, unitary construct of general conservatism.

Convergent Validity

Convergent validity was demonstrated through statistically significant correlations with established domain-specific and general psychosexual instruments:

• Sexual Beliefs and Information Questionnaire (SBIQ): Significant positive correlations were observed between SDBQ subscales and the SBIQ (Adams et al., 1996), confirming that the SDBQ accurately tracks sexual misinformation, empirical myths, and rigid cognitive premises.
• International Index of Erectile Function (IIEF): In male samples, elevated scores on the SDBQ total scale and specific subscales—particularly “Macho” Belief (F3) and Beliefs About Women’s Sexual Satisfaction (F4)—correlated negatively with IIEF domain scores (erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction; Rosen et al., 1997).
• Female Sexual Function Index (FSFI): In female cohorts, higher scores on Sexual Conservatism (F1), Sexual Desire and Pleasure as a Sin (F2), and Body-Image Beliefs (F4) exhibited significant inverse correlations with FSFI composite and domain scores, including lubrication, desire, arousal, and orgasm (Rosen et al., 2000).

Discriminant Validity

Discriminant validity was established by comparing clinical cohorts diagnosed with DSM-defined sexual dysfunctions against matched sexually healthy control groups:

• In comparative trials involving 49 men with sexual dysfunction (erectile disorder, premature ejaculation, hypoactive sexual desire) and 49 matched control men without sexual dysfunction, clinical participants systematically scored higher across SDBQ domains. Men with sexual dysfunctions exhibited statistically significantly higher endorsements of “Macho” Beliefs (F3) and Beliefs About Women’s Sexual Satisfaction (F4) compared to healthy controls (Nobre & Pinto-Gouveia, 2006).
• Similarly, in female cohorts (47 women with sexual dysfunction and 46 matched controls), clinical women scored significantly higher on Sexual Conservatism (F1), Sexual Desire and Pleasure as a Sin (F2), and Body-Image Beliefs (F4), confirming the diagnostic utility of the instrument in distinguishing functional from dysfunctional clinical populations.

8. Reliability

The SDBQ exhibits excellent reliability profiles across both internal consistency parameters and temporal stability metrics in published psychometric evaluations.

Internal Consistency

In the seminal psychometric validation study conducted by Nobre, Pinto-Gouveia, and Gomes (2003), Cronbach’s alpha for the total scale was:

• Male Version Total Scale: α = .93, reflecting exceptionally high internal consistency and minimal measurement error across the 37 retained items.
• Female Version Total Scale: α = .81, demonstrating solid, psychometrically sound internal consistency across the 34 retained items.

Subscale-level internal consistency analyses revealed varying ranges reflecting the nuanced, heterogeneous nature of specific cognitive domains:

• Male Version Subscales: Alpha coefficients ranged from α = .54 to α = .89. Highly coherent factors such as Sexual Conservatism (F1) and “Macho” Beliefs (F3) demonstrated high reliability (α ≥ .82), whereas shorter factors such as Restrictive Attitude Toward Sex (F5) and Sex as an Abuse of Men’s Power (F6) exhibited moderate reliability (α = .54 to .65), consistent with their brief item counts.
• Female Version Subscales: Alpha coefficients ranged from α = .50 to α = .89. Sexual Conservatism (F1) and Sexual Desire as a Sin (F2) demonstrated the highest internal consistency (α > .80), while Denying Affection Primacy (F5) and Motherhood Primacy (F6) yielded moderate coefficients (α = .50 to .68).

Test-Retest Reliability (Temporal Stability)

Temporal stability was evaluated by administering the SDBQ twice to nonclinical participant groups over a 4-week interval. Pearson product-moment correlation coefficients indicated substantial temporal stability:

• Male Version: r = .73 (p < .05)
• Female Version: r = .80 (p < .05)

These coefficients confirm that the SDBQ assesses enduring cognitive traits and schemas rather than transient mood states or fleeting situational attitudes.

9. Factor Analysis

The structural dimensionality of the SDBQ was derived via separate exploratory principal component analyses (PCA) with orthogonal (varimax) rotation conducted on large Portuguese community and clinical samples for each gender.

Male Version Factor Structure

The PCA for the male version extracted six meaningful components explaining 49% of the total variance. Of the initial 40 pool items, 37 items met the retention criteria (primary factor loadings ≥ .35, minimal cross-loadings), while items 14, 20, and 23 were excluded from dimensional scoring:

• Factor 1: Sexual Conservatism (10 items: 2, 5, 9, 18, 21, 24, 25, 26, 32, 33; theoretical range: 10–50). Item loadings ranged from .42 to .74, capturing rigid, procreation-restricted sexual definitions.
• Factor 2: Female Sexual Power (8 items: 11, 15, 19, 27, 29, 38, 39, 40; theoretical range: 8–40). Loadings ranged from .38 to .71, clustering items related to vulnerability and female control.
• Factor 3: “Macho” Belief (7 items: 1, 4, 6, 17, 28, 31, 37 [reversed]; theoretical range: 7–35). Loadings ranged from .45 to .78, focusing on performance, hyper-masculinity, and mandatory erection.
• Factor 4: Beliefs About Women’s Sexual Satisfaction (5 items: 3, 7, 16, 35, 36; theoretical range: 5–25). Loadings ranged from .48 to .76, capturing beliefs linking female pleasure exclusively to male erectile capacity.
• Factor 5: Restrictive Attitude Toward Sex (4 items: 8, 12, 13, 30; theoretical range: 4–20). Loadings ranged from .41 to .69, capturing pathologizing attitudes toward oral/anal sex.
• Factor 6: Sex as an Abuse of Men’s Power (3 items: 10, 22, 34; theoretical range: 3–15). Loadings ranged from .51 to .72, linking intercourse to aggression and violation.

Female Version Factor Structure

The PCA for the female version extracted six distinct components accounting for 43% of the total variance. Thirty-four items were retained across six factors, with items 9, 16, 19, 21, 25, and 29 dropped from final factor allocation due to low saturation or cross-loadings:

• Factor 1: Sexual Conservatism (9 items: 2, 4, 7, 13, 14, 17, 27, 28, 32; theoretical range: 9–45). Loadings ranged from .40 to .72.
• Factor 2: Sexual Desire and Pleasure as a Sin (6 items: 15, 34, 35, 36, 37, 39; theoretical range: 6–30). Loadings ranged from .44 to .75, capturing moral culpability and anti-erotic guilt.
• Factor 3: Age-Related Beliefs (5 items: 5, 6, 8, 11, 20; theoretical range: 5–25). Loadings ranged from .46 to .73, reflecting myths surrounding post-menopausal sexuality.
• Factor 4: Body-Image Beliefs (4 items: 10, 12, 38, 40; theoretical range: 4–20). Loadings ranged from .43 to .71, connecting physical aesthetics with sexual legitimacy.
• Factor 5: Denying Affection Primacy (6 items: 1, 3, 18, 22, 23, 24 [items 1, 3, 22, 23, 24 reverse-scored]; theoretical range: 6–30). Loadings ranged from .39 to .68.
• Factor 6: Motherhood Primacy (4 items: 26, 30, 31, 33; theoretical range: 4–20). Loadings ranged from .42 to .70, evaluating the perceived incompatibility of motherhood and eroticism.

10. Instrument / Measurement Tool

• Instrument Name: Sexual Dysfunctional Beliefs Questionnaire (SDBQ)
• Alternative Titles: Questionário de Crenças Sexuais Disfuncionais (QCSD)
• Test Type: Psychometric Self-Report Cognitive Assessment Questionnaire
• Target Population: Adult men and women (clinical cohorts presenting with sexual dysfunctions and nonclinical populations undergoing psychosexual screening)
• Administration Format: Standardized paper-and-pencil or computerized self-administered survey
• Item Count:
  • Male Version (SDBQ-M): 40 total survey items administered (37 items retained in scoring dimensions)
  • Female Version (SDBQ-F): 40 total survey items administered (34 items retained in scoring dimensions)
• Response Scale: 5-point Likert scale:
  • 1 = Completely Disagree
  • 2 = Disagree
  • 3 = Don’t Disagree or Agree
  • 4 = Agree
  • 5 = Completely Agree
• Completion Time: Approximately 10 to 12 minutes
• Scoring Procedures:
  • Reverse-Scored Items:
    • Male Version: Item 37 is reversed (1 = 5, 2 = 4, 3 = 3, 4 = 2, 5 = 1).
    • Female Version: Items 1, 3, 22, 23, and 24 are reversed (1 = 5, 2 = 4, 3 = 3, 4 = 2, 5 = 1).
  • Subscale Scores: Sum the individual item scores assigned to each respective factor.
  • Total Score: An overall index of dysfunctional sexual beliefs is computed by summing the retained items (after reversing specified items). For the male version, the 37 retained items yield a total score range of 37 to 185. For the female version, the 34 retained items yield a total score range of 34 to 170. Higher scores denote greater endorsement of maladaptive, dysfunctional sexual beliefs and heightened cognitive vulnerability.

11. Permissions & Fee and Test Year

The Sexual Dysfunctional Beliefs Questionnaire was first formally published in 2003 by Pedro J. Nobre, José Pinto-Gouveia, and F. A. Gomes in the peer-reviewed journal Sexual and Relationship Therapy.

Licensing and Academic Use: The SDBQ is considered an academic, non-commercial assessment instrument. It is widely accessible for academic research, university teaching, and non-profit clinical practice. However, official permission for clinical adoption, full manual access, translation into other languages, or computerized adaptation should be directed to the corresponding author:

• Corresponding Author: Pedro J. Nobre, Ph.D.
• Institutional Address: Faculty of Psychology and Education Sciences, Universidade do Porto / SexLab (formerly Universidade de Trás-os-Montes e Alto Douro, Apartado 1013, 5001-801 Vila Real, Portugal)
• Direct Inquiries: [email protected]

Commercial deployment, integration into proprietary healthcare software, or corporate clinical trial applications require formal authorization and licensing agreements with the copyright holders and publishing entities.

12. References

Adams, S. G., Dubbert, P. M., Chupurdia, K. M., Jones, A., Lofland, K. R., & Leermakers, E. (1996). Assessment of sexual beliefs and information in aging couples with sexual dysfunction. Archives of Sexual Behavior, 25(3), 249–260. https://doi.org/10.1007/BF02437922

Beck, A. T. (1979). Cognitive therapy of depression. Guilford Press.

Ellis, A. (1962). Reason and emotion in psychotherapy. Lyle Stuart.

Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. Little, Brown and Company.

Nobre, P. J., & Pinto-Gouveia, J. (2006). Dysfunctional sexual beliefs as vulnerability factors to sexual dysfunction. The Journal of Sex Research, 43(1), 68–75. https://doi.org/10.1080/00224490609552299

Nobre, P. J., & Pinto-Gouveia, J. (2008). Cognitions, emotions, and sexual response: Analysis of the relationship among automatic thoughts, emotional responses, and sexual arousal in men and women. The Journal of Sex Research, 45(4), 394–402. https://doi.org/10.1080/00224490802398381

Nobre, P. J., Pinto-Gouveia, J., & Gomes, F. A. (2003). Sexual Dysfunctional Beliefs Questionnaire: An instrument to assess sexual dysfunctional beliefs as vulnerability factors to sexual problems. Sexual and Relationship Therapy, 18(2), 171–204. https://doi.org/10.1080/1468199031000114244

Rosen, R. C., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsig, R., Ferguson, D., & D’Agostino, R., Jr. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26(2), 191–208. https://doi.org/10.1080/009262300278598

Rosen, R. C., Riley, A., Wagner, G., Osterloh, I. H., Kirkpatrick, J., & Mishra, A. (1997). The International Index of Erectile Function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology, 49(6), 822–830. https://doi.org/10.1016/S0090-4295(97)00238-0

13. Items of the Scale (Questionnaire)