Abstract
The Sexual Function Scale (SFS), developed by Marita P. McCabe at Deakin University, is an extensive psychometric instrument designed to evaluate the etiology, developmental antecedents, and concurrent maintenance factors associated with human sexual functioning and sexual dysfunction. Unlike unidimensional symptom inventories that evaluate only current physiological response patterns, the SFS employs a lifespan developmental framework across three core sections: (1) Childhood, (2) Puberty and Adolescence, and (3) Current Attitudes and Behavior. Across these sections, the instrument captures socialization within the family of origin, early sexual knowledge, traumatic or unpleasant sexual experiences, psychosexual milestone acquisition, relational dynamics, body image, and specific physiological dimensions of the human sexual response cycle, including desire, subjective and physiological arousal, orgasm, and sexual pain. The instrument utilizes a multi-method response architecture comprising categorical inquiries, dichotomous (yes/no) indicators, and five-point Likert-type rating formats, requiring approximately 60 minutes for comprehensive administration. Psychometric evaluations conducted across clinical sexually dysfunctional, nonclinical dysfunctional, and sexually functional cohorts ($N = 171$) demonstrate robust discriminative capacity, sound internal consistency across dimensional subscales, and stability across six-week test-retest intervals ($r = .68$ to $.91$). The SFS serves as an invaluable diagnostic and treatment-planning tool in clinical sexology, couple and marital therapy, and behavioral medicine, bridging biographical psychosexual history with systemic interpersonal processes.
Keywords
Sexual Function Scale, Marita P. McCabe, sexual dysfunction, psychosexual development, sexual attitudes, family of origin, relational satisfaction, sexual desire, sexual arousal, psychometrics, sex therapy, clinical assessment
Authors
The Sexual Function Scale was conceptualized and validated by Marita P. McCabe, Ph.D., an internationally recognized researcher in clinical psychology, human sexuality, and health psychology. At the time of the scale’s primary development and validation, Dr. McCabe was affiliated with the School of Psychology at Deakin University, Burwood Campus, Victoria, Australia. Dr. McCabe has authored extensive empirical literature on the biopsychosocial determinants of sexual dysfunction in men and women, relationship satisfaction, cognitive-affective factors in sexual performance, and clinical interventions for psychosexual difficulties.
Correspondence regarding the Sexual Function Scale, its operational scoring protocols, and access to complete clinical documentation may be directed to: Marita P. McCabe, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia (e-mail: [email protected]).
Purpose
The primary clinical and empirical objective of the Sexual Function Scale (SFS) is to provide an integrative, developmentally anchored diagnostic assessment of the multivariate factors precipitating and perpetuating sexual dysfunction in both male and female populations. While many contemporary psychosexual questionnaires focus narrowly on immediate functional symptom profiles (such as latency to ejaculation, frequency of vaginal lubrication, or coital frequency), the SFS addresses a critical diagnostic gap by investigating the systemic, cognitive, historical, and interpersonal matrices within which sexual difficulties emerge.
From a clinical diagnostic standpoint, the SFS functions as an exhaustive intake battery for clinicians specializing in sex therapy, marital counseling, and behavioral medicine. It systematically determines whether a presenting sexual impairment—such as hypoactive sexual desire disorder, erectile dysfunction, premature ejaculation, female sexual interest/arousal disorder, or genito-pelvic pain/penetration disorder—is predominantly rooted in early developmental conditioning, internalized familial taboos, historical trauma, current relationship distress, or cognitive-affective performance anxiety during coital interaction. By mapping an individual’s psychosexual trajectory from childhood through adolescence to the present partnership, clinicians can formulate targeted, tailored interventions that deconstruct deep-seated etiology rather than merely implementing superficial symptom-focused behavioral prescriptions.
In empirical research, the SFS provides an overarching operational methodology for differentiating sexually functional individuals from nonclinical dysfunctional individuals (those experiencing subjective or physiological sexual difficulties who do not seek therapeutic assistance) and clinical dysfunctional individuals (those actively seeking specialized medical or psychological treatment). This three-tier taxonomic validation makes the SFS exceptionally suited for epidemiological investigations into treatment-seeking behavior, population-level surveys of sexual health, and longitudinal studies evaluating the efficacy of multimodal sexological therapies.
Psychological Construct
The Sexual Function Scale operationalizes sexual functioning not as an isolated biological reflex, but as a dynamic psychological construct governed by historical socialization, developmental milestones, affective schemas, and interpersonal systems. The instrument is structured into three overarching domains, each comprising discrete subscales:
1. Childhood Psychosexual Development
This domain captures the formative social learning and primary affective environments of the respondent’s family of origin. Rather than presuming that adult sexuality begins with biological puberty, the SFS recognizes that core sexual schemas, body shame, and attitudes toward physical affection are internalized during early childhood. Subscales within this section evaluate:
- Family Affection and Emotional Climate: The degree to which warmth, non-sexual physical contact, and emotional validation were modeled and expressed within the family home.
- Parental Attitudes Toward Sexuality: The explicit and implicit messages transmitted by parents regarding sex, nudity, and modesty (e.g., whether sex was framed as sacred, sinful, dirty, dangerous, or natural).
- Early Sexual Knowledge and Socialization: The age, source, and tone of initial sexual education, as well as early childhood sexual exploration and reactions from caregivers upon discovery.
2. Puberty and Adolescence
The adolescent transition represents a critical period of psychosexual integration, biological maturation, and identity consolidation. Difficulties during this stage can create cognitive vulnerability to adult sexual dysfunction. Subscales in this section evaluate:
- Pubertal Timing and Reactions: Emotional reactions to secondary sex characteristics (e.g., menarche, nocturnal emissions, breast development) and subjective satisfaction or distress regarding physical maturation.
- Adolescent Masturbation and Autoerotic Beliefs: Frequency of autoerotic behaviors, accompanied by the presence or absence of guilt, moral distress, and associated cognitive interference.
- Early Interpersonal and Dating Dynamics: Peer socialization, romantic exploration, and the emotional context of initial romantic relationships.
- Unpleasant or Traumatic Sexual Experiences: Inquiries addressing sexual boundary violations, non-consensual sexual encounters, unwanted pressure, or shaming experiences occurring during adolescence.
3. Current Attitudes and Behavior
The final domain measures adult psychosexual functioning across physiological, cognitive, and relational dimensions. Subscales include:
- Sexual Desire and Drive: Frequency and intensity of spontaneous sexual fantasies, interest in initiating sexual contact, and receptivity to partner initiation.
- Physiological and Subjective Arousal: Capacity to attain and sustain physiological excitement (erection in males, lubrication and vasocongestion in females) alongside subjective feelings of sexual arousal.
- Orgasmic Functioning: Ease, latency, reliability, and subjective intensity of orgasm through both coital and non-coital activities.
- Sexual Pain and Discomfort: Presence, frequency, and severity of genital discomfort or involuntary muscle contraction during sexual intercourse.
- Current Relational Quality and Communication: Dyadic intimacy, general relationship satisfaction, emotional closeness, and the capacity to communicate sexual preferences and vulnerabilities to one’s partner.
- Contraceptive and Health Behaviors: Pragmatic factors, such as contraceptive choices, fear of unwanted pregnancy, and physiological health conditions that intersect with sexual comfort.
Theoretical Framework
The theoretical architecture of the Sexual Function Scale is firmly grounded in the biopsychosocial model of human sexual functioning, drawing heavily from the integrated theories of William H. Masters and Virginia E. Johnson, Helen Singer Kaplan, and David H. Barlow’s cognitive-affective model of sexual dysfunction.
Masters and Johnson (1970) posited that sexual dysfunction is rarely caused by isolated physiological abnormalities; rather, it is maintained by psychological factors such as spectatoring (attending to one’s performance from an evaluative third-person perspective) and performance anxiety. Kaplan (1974, 1979) extended this work by introducing a triphasic model of sexual response (Desire, Arousal, Orgasm) and differentiating between immediate determinants (anticipatory anxiety, demand for performance, failure to communicate) and historical antecedents (early religious conditioning, unresolved childhood conflicts, past traumas).
McCabe synthesized these clinical formulations with social learning theory (Albert Bandura). Social learning theory posits that sexual scripts—cognitive guides that dictate who, what, when, where, and why an individual engages in sexual behaviors—are acquired through modeling, observational learning, and reinforcement schedules established in the family of origin and adolescent peer networks. When an individual’s developmental scripts associate sexual arousal with negative affect (e.g., guilt, shame, fear of punishment), autonomic sympathetic arousal is paradoxically conditioned to inhibit the parasympathetic branch necessary for genital vasocongestion, leading to arousal and orgasmic failures.
Furthermore, the SFS integrates systemic and attachment theories. Grounded in McCabe’s empirical investigations (1994b), sexual dysfunction does not occur in a vacuum; relational intimacy, mutual trust, and the quality of non-sexual communication exert direct regulatory effects on sexual well-being. By integrating developmental history, cognitive appraisals, physiological responsiveness, and dyadic dynamics into a coherent psychometric profile, the SFS operationalizes human sexuality as a systemic, lifelong trajectory.
Validity
The construct, criterion, and discriminative validity of the Sexual Function Scale were established through a multistep validation program led by McCabe (1994a, 1994b), utilizing both qualitative and quantitative approaches.
Construct and Content Validity
Content validity was initially established via comprehensive synthesis of the empirical literature on the etiology of sexual dysfunction. From this literature base, an extensive guided interview protocol was formulated containing open-ended prompts. This protocol was administered to an initial cohort of 113 individuals: 55 individuals diagnosed with sexual dysfunction and 58 sexually functional individuals. Qualitative content analysis of respondent interviews identified items that differentiated functional from dysfunctional participants. Items demonstrating negligible variance or zero statistical relationship to clinical status were eliminated, ensuring strong initial content validity.
Discriminant and Criterion Validity
To establish criterion and discriminant validity, the revised SFS was administered to a subsequent validation sample of 171 adults categorized into three distinct diagnostic groups:
- Sexually Functional Group ($n = 82$: 50 females, 32 males): Individuals reporting no persistent sexual distress or physiological impairment.
- Nonclinical Dysfunctional Group ($n = 51$: 27 females, 24 males): Individuals experiencing chronic sexual difficulties (e.g., low desire, erectile problems, anorgasmia) who were not actively seeking psychological or medical interventions.
- Clinical Dysfunctional Group ($n = 38$: 20 females, 18 males): Individuals referred to or actively attending specialized clinical sex therapy clinics.
Multivariate analysis of variance (MANOVA) and discriminant function analyses revealed significant differences across the three cohorts. The SFS successfully discriminated clinical and nonclinical dysfunctional participants from functional controls across multiple subscales. Notably, individuals with sexual dysfunction reported significantly more negative parental attitudes toward sexuality, higher rates of adolescent sexual guilt, and poorer adult relational communication than functional individuals. Furthermore, the clinical dysfunctional group exhibited significantly higher performance anxiety and lower relationship satisfaction than the nonclinical dysfunctional group, confirming that the scale differentiates not only physiological impairment but also the psychological threshold that drives treatment-seeking behavior.
Reliability
The psychometric evaluation of the Sexual Function Scale demonstrates solid internal consistency and temporal stability across its continuous subscales.
Internal Consistency
Cronbach’s alpha coefficients were calculated for the multi-item dimensional subscales using the full validation sample ($N = 171$). Alpha coefficients for subscales measuring dimensional psychological and physiological constructs generally ranged from acceptable to high ($lpha = .72$ to $.89$). Certain sections containing categorical, life-event, or demographic indicators (such as specific methods of contraception, age of first intercourse, or specific forms of sexual education) were deliberately excluded from internal consistency calculations, as these items represent composite index indicators rather than reflective latent variables.
Test-Retest Stability
Temporal stability was evaluated using a test-retest design across a 6-week interval. The SFS was administered twice to a dedicated longitudinal sample consisting of 30 sexually functional individuals and 30 sexually dysfunctional individuals ($N = 60$). Test-retest reliability coefficients ($r$) across the continuous subscales ranged from $.68$ to $.91$, demonstrating that the scale yields reliable indices of psychosexual history and stable assessments of current adult functioning over time when no clinical intervention has occurred.
Factor Analysis
The structural development of the Sexual Function Scale relied on an iterative exploratory process combining empirical reduction and structural factor analyses. During the scale’s initial derivation, open-ended responses from the 113-participant pilot cohort were converted into structured rating items. These items were subjected to principal component analysis (PCA) with orthogonal (Varimax) and oblique (Oblimin) rotations to identify underlying latent dimensions within each developmental section.
Factor analyses conducted on the Childhood and Adolescence sections revealed distinct, interpretable factors corresponding to: (1) Familial Affect and Openness, (2) Restrictive Moralistic Conditioning, (3) Negative Reactions to Pubertal Maturation, and (4) Traumatic/Aversive Early Encounters. Items loading below .40 or exhibiting cross-loadings above .35 were re-evaluated or excised to preserve distinct factor identities.
Within the Current Attitudes and Behavior section, exploratory factor analyses confirmed the multidimensional independence of Kaplan’s theoretical response phases, with clear primary factor loadings for Sexual Desire/Fantasy, Physiological Vasocongestion/Erection, Orgasmic Responsiveness, and Coital Comfort/Pain. In addition, dyadic items loaded distinctly onto an overarching Relational Quality and Sexual Communication factor. This multidimensional factor structure supported McCabe’s assertion that sexual functioning cannot be reduced to a single global score, but must be assessed across developmentally distinct and clinically meaningful domains.
Instrument / Measurement Tool
The Sexual Function Scale (SFS) is a self-administered or clinician-guided paper-and-pencil instrument designed for comprehensive clinical and empirical evaluation. Its operational specifications include:
- Test Type: Comprehensive Multidimensional Psychosexual Inventory.
- Target Population: Adult men and women (18 years and older), across both sexually functional and dysfunctional spectrums.
- Administration Format: Self-report questionnaire or structured clinical interview.
- Administration Time: Approximately 50 to 60 minutes for complete completion.
- Structural Sections:
- Section I: Childhood (Family affective climate, parental attitudes toward nudity and sex, childhood sexual knowledge and experiences).
- Section II: Puberty and Adolescence (Pubertal timing, reactions to physiological changes, adolescent masturbation practices/attitudes, dating history, unpleasant or non-consensual sexual experiences).
- Section III: Current Attitudes and Behavior (Sexual desire frequency, subjective arousal, physiological response, orgasm latency/quality, dyspareunia/pain, contraceptive use, current relationship satisfaction, dyadic sexual communication).
- Response Formats:
- Categorical Questions: e.g., contraceptive methods utilized, specific sources of initial sex education.
- Dichotomous Items: Yes/No formats for historical events (e.g., presence of unpleasant adolescent sexual experiences).
- Likert-Type Scales: 5-point rating scales measuring frequency, intensity, agreement, or satisfaction (e.g., $1 = \text{Never} / \text{Strongly Disagree}$ to $5 = \text{Always} / \text{Strongly Agree}$).
- Scoring Procedures: Continuous items within each subsection are scored unidirectionally (with negative items reverse-coded as appropriate), yielding separate composite scores for each subsection. Categorical items do not contribute to numerical composite sums but are analyzed independently for qualitative and diagnostic evaluation. Because subsections contain differing numbers of items, individual subsection scores are evaluated against normative profiles rather than summed into an arbitrary global score.
Permissions & Fee and Test Year
The Sexual Function Scale was developed and published through empirical studies conducted in 1994 by Dr. Marita P. McCabe at Deakin University (McCabe, 1994a, 1994b). The instrument is not commercially marketed by test publishers and remains under the academic copyright of the original author.
The complete scale, along with the operational scoring manual and coding keys, may be obtained directly from the author for legitimate clinical, medical, and academic research applications. Inquiries regarding licensing, academic permissions, and complete clinical materials should be addressed directly to:
Prof. Marita P. McCabe
School of Psychology, Deakin University
221 Burwood Highway, Burwood, Victoria 3125, Australia
Email: [email protected]
References
- Bandura, A. (1977). Social learning theory. Prentice-Hall.
- Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54(2), 140–148. https://doi.org/10.1037/0022-006X.54.2.140
- Kaplan, H. S. (1974). The new sex therapy: Active treatment of sexual dysfunctions. Brunner/Mazel.
- Kaplan, H. S. (1979). Disorders of sexual desire and other new concepts and techniques in sex therapy. Brunner/Mazel.
- Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. Little, Brown and Company.
- McCabe, M. P. (1994a). Childhood, adolescent and current psychological factors associated with sexual dysfunction. Sexual and Marital Therapy, 9(3), 267–276. https://doi.org/10.1080/02674659408409587
- McCabe, M. P. (1994b). The influence of the quality of relationship on sexual dysfunction. Australian Journal of Marriage and the Family, 15(1), 2–8.