Sexual Interest and Desire Inventory—Female

1. Abstract

The Sexual Interest and Desire Inventory—Female (SIDI-F) is a standardized, clinician-administered psychometric instrument developed to quantitatively assess the severity of Hypoactive Sexual Desire Disorder (HSDD) in adult women. Formulated through an international collaborative initiative involving academic sexologists, psychiatrists, and pharmaceutical researchers, the instrument addresses the recognized limitations of self-report inventories by employing a semi-structured clinical interview format. The primary instrument comprises 13 scored items that capture a wide spectrum of female sexual function, including spontaneous sexual desire, responsive desire, initiation, positive sexual cognitions, erotic cue receptivity, relationship satisfaction, non-sexual physical affection, subjective and physiological sexual arousal (frequency, ease, and continuation), orgasmic capacity, and desire-associated personal distress. In addition to the 13 primary items, the SIDI-F incorporates a 5-item diagnostic module that evaluates confounding medical, psychiatric, and contextual factors (such as fatigue, pain, depressive affect, relationship discord, and medication adverse effects) without contributing to the cumulative score.

Items on the SIDI-F are evaluated over a 30-day recall period. Scoring utilizes a hybrid format consisting of eight items evaluated solely on symptom intensity (rated 0–3, 0–4, or 0–5) and five items scored across a two-dimensional grid cross-referencing symptom frequency against intensity. Total scores range from 0 to 51, with higher scores reflecting greater sexual desire and healthy functioning; an empirically derived score of 33 or lower establishes the threshold for clinically significant HSDD. Psychometric evaluations across North American and European multicenter cohorts (totaling over 500 women across premenopausal and postmenopausal strata) demonstrate high internal consistency (Cronbach’s alpha = .90–.93) and robust test-retest reliability (intraclass correlation coefficient = .85–.90 over a 28-day interval). The scale exhibits sound convergent validity with the Female Sexual Function Index (FSFI; r > .60) and the Changes in Sexual Functioning Questionnaire—Female (CSFQ-F), divergent validity against the Locke-Wallace Marital Adjustment Scale (r = .02–.23), and demonstrated sensitivity to pharmacologically induced therapeutic change in clinical trials.

2. Keywords

Sexual Interest and Desire Inventory—Female, SIDI-F, Hypoactive Sexual Desire Disorder, HSDD, female sexual dysfunction, sexual desire, sexual arousal, clinician-rated scale, psychometrics, sexual distress

3. Authors

The Sexual Interest and Desire Inventory—Female was designed and validated by an international consortium of clinical researchers and academic psychometricians:

• Anita H. Clayton, M.D. — Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville, Virginia, United States. Corresponding developer (Email: [email protected]).
• David Goldmeier, M.D., FRCP — Jane Wadsworth Sexual Function Clinic, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
• Rossella E. Nappi, M.D., Ph.D. — Research Center for Reproductive Medicine, Department of Obstetrics and Gynecology, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy.
• Glen Wunderlich, Ph.D. — Boehringer Ingelheim (Canada), Ltd., Burlington, Ontario, Canada.
• Diane J. Lewis-D’Agostino, M.S. — Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United States.
• Robert Pyke, M.D., Ph.D. — Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United States (Email: [email protected]).
• Collaborating Co-Developers (2004 Copyright Holders): Sandra R. Leiblum, Ph.D. (UMDNJ-Robert Wood Johnson Medical School), Kenneth R. Evans, Ph.D., Terrence Sills, Ph.D., Rosemary Basson, M.D. (University of British Columbia), and R. Taylor Segraves, M.D., Ph.D. (Case Western Reserve University).

4. Purpose

The primary clinical and psychometric objective of the SIDI-F is to provide a standardized, reliable, and clinically sensitive clinician-administered measure of Hypoactive Sexual Desire Disorder (HSDD) severity in women. Historically, female sexual dysfunction (FSD) was assessed predominantly through patient-reported outcome (PRO) questionnaires, such as the Female Sexual Function Index (FSFI) or the Changes in Sexual Functioning Questionnaire (CSFQ). While self-report instruments are valuable for broad epidemiological screening, they are susceptible to idiosyncratic interpretations of ambiguous terminology (e.g., conflating romantic affection with erotic desire, or misinterpreting mechanical sexual compliance as genuine receptivity), cognitive recall biases, and difficulty isolating primary desire deficits from secondary relationship dissatisfaction or concurrent mood disorders.

To overcome these methodological hurdles, the SIDI-F was structured as a semi-structured clinical interview. A trained clinician guides the patient through specific scripted inquiries, utilizing standardized probing techniques when patient replies require clinical clarification. This allows the evaluator to distinguish between spontaneous endogenous sexual desire (appetitive craving, spontaneous sexual fantasies) and responsive sexual desire (openness and arousal triggered by partner initiation or erotic stimuli). Furthermore, the clinician can assess the degree of subjective personal distress directly attributable to reduced desire, fulfilling the core diagnostic requirement for sexual dysfunction specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR and DSM-5).

In research settings, the SIDI-F was developed to serve as an outcome endpoint for clinical trials investigating pharmacotherapeutic and psychotherapeutic interventions for premenopausal and postmenopausal HSDD (such as clinical trials evaluating the 5-HT1A agonist/5-HT2A antagonist flibanserin). Clinically, the scale functions as an evaluative tool to establish baseline symptom severity, track therapeutic response over time, and screen out confounding somatic or affective contributors via its non-scored diagnostic module.

5. Psychological Construct

The SIDI-F conceptualizes female sexual desire not as an isolated visceral drive, but as a multifaceted biopsychosocial phenomenon comprising cognitive, affective, physiological, and interpersonal elements. The instrument assesses these interconnected domains across 13 primary scored dimensions and five supplemental diagnostic indicators:

Core Scored Dimensions (Items 1–13)

• 1. Relationship—Sexual: Evaluates the patient’s subjective appraisal of fulfillment, harmony, and mutual satisfaction within the physical, sexual relationship. This dimension contextualizes whether desire complaints occur within an otherwise functioning sexual dynamic or reflect overarching partner discord.
• 2. Receptivity: Assesses responsive sexual desire—specifically, the degree to which a woman feels open, willing, and cognitively accessible to engaging in sexual activity when initiated by her partner, even in the absence of preceding spontaneous craving.
• 3. Initiation: Measures the behavioral frequency and proactivity with which the patient initiates sexual intimacy, reflecting active behavioral agency and appetitive drive.
• 4. Desire—Frequency: Quantifies the temporal frequency of endogenous, spontaneous sexual interest, sexual hunger, or erotic cravings experienced over the preceding 30 days.
• 5. Affection: Measures non-sexual expressions of romantic and physical tenderness (e.g., hugging, kissing, cuddling). This serves as a clinical anchor to separate erotic desire deficits from general interpersonal withdrawal or loss of affection.
• 6. Desire—Satisfaction: Gauges subjective satisfaction with one’s own current level and intensity of sexual desire, capturing the internal cognitive appraisal of appetitive functioning.
• 7. Desire—Distress: Assesses the magnitude of personal distress, frustration, sorrow, guilt, or bother provoked specifically by the attenuation or absence of sexual desire. This dimension captures the distress criterion mandated by diagnostic nomenclatures.
• 8. Thoughts—Positive: Quantifies the occurrence of deliberate or spontaneous positive sexual cognitions, erotic daydreams, anticipatory excitement, and fantasies.
• 9. Erotica: Measures behavioral exposure and subjective physiological/cognitive responsiveness to explicit erotic material, sexually suggestive media, literature, or environmental erotic stimuli.
• 10. Arousal—Frequency: Evaluates the consistency with which subjective mental excitement and peripheral genital vasocongestion emerge during sexual encounters.
• 11. Arousal—Ease: Evaluates the latency and effort required to attain adequate sexual arousal and physiological lubrication once sexual interaction commences.
• 12. Arousal—Continuation: Assesses the stability and maintenance of sexual arousal throughout the sexual encounter, monitoring for premature lubrication loss or sudden drops in excitation.
• 13. Orgasm: Measures the frequency, reliability, ease, and qualitative satisfaction of reaching climactic release when sexually stimulated.

Supplemental Diagnostic Module

The SIDI-F includes a five-item non-scored module that assists the clinician in differential diagnosis. These items systematically explore:

• Fatigue and Vitality: Severe physical exhaustion secondary to occupational stress, caregiving, or systemic medical illness that suppresses sexual motivation.
• Depressive Affect and Anxiety: Mood disorders, generalized distress, or psychotropic medication usage (e.g., SSRIs) known to blunt central dopaminergic and noradrenergic sexual pathways.
• Dyspareunia and Pelvic Pain: Genito-pelvic pain, vulvodynia, or lack of estrogenic lubrication causing avoidance conditioning.
• Partner Factors: Partner sexual dysfunctions (e.g., erectile disorder, premature ejaculation), interpersonal hostility, or partner physical health issues.
• Medication and Substance Influences: Pharmacological agents, alcohol misuse, or endocrine imbalances altering baseline neurobiology.

6. Theoretical Framework

The construction of the SIDI-F is informed by evolutions in sexological theory, specifically transitioning from early linear paradigms to contemporary circular, contextual, and neurobiological models of female sexual response.

The Circular Model of Female Sexual Response

Traditional conceptual models proposed by William Masters and Virginia Johnson (1966) and modified by Helen Singer Kaplan (1979) presumed a linear, triphasic progression: Desire → Arousal → Orgasm → Resolution. In these models, spontaneous sexual desire was posited as the essential prerequisite for all subsequent physiological phases. Clinical sexologists recognized that this framework frequently pathologized healthy women who rarely experience unprompted, spontaneous sexual desire, but who nonetheless experience fulfilling sexual encounters triggered by intimacy and responsive desire.

The SIDI-F integrates the circular model proposed by Rosemary Basson (2000, 2001). Basson posited that female sexual motivation is frequently rooted in a desire for emotional closeness, intimacy, and relationship bonding. A woman may enter a sexual interaction in a state of sexual neutrality; exposure to appropriate, contextual erotic stimulation prompts subjective and genital arousal, which secondarily generates responsive sexual desire. By measuring spontaneous desire (Items 4, 8) alongside responsive desire (Item 2: Receptivity) and affectional context (Items 1, 5), the SIDI-F reflects this circular dynamic.

Incentive Motivation and Dual Control Models

The instrument also draws on the Incentive Motivation Model of Sexual Desire (Laan & Both, 2005; Singer & Toates, 1987) and the Dual Control Model of Sexual Response (Bancroft & Janssen, 2000). According to incentive motivation theory, sexual desire is not simply an internally generated drive, but an emotional response elicited by the appraisal of meaningful sexual incentives. The SIDI-F items assessing erotica response (Item 9), arousal ease (Item 11), and positive sexual thoughts (Item 8) assess this incentive-processing mechanism.

Concurrently, the Dual Control Model posits that sexual response represents an equilibrium between sexual excitation (SE) and sexual inhibition (SI). The SIDI-F captures excitatory mechanisms across its 13 core items, while its supplemental diagnostic module identifies inhibitory influences—such as pain, fatigue, performance anxiety, and depressive affect—that suppress central sexual processing.

7. Validity

The psychometric validity of the SIDI-F has been documented across rigorous multicenter observational cohorts and randomized clinical trial protocols in North America and Europe.

Discriminant (Known-Groups) Validity

Discriminant validity was established by comparing SIDI-F total scores among distinct diagnostic cohorts: women diagnosed with primary HSDD, women diagnosed with Female Sexual Arousal Disorder (FSAD), and sexually healthy control subjects without Female Sexual Dysfunction (FSD). In the North American validation study (N = 223; Lewis-D’Agostino et al., 2007), a two-way analysis of covariance (ANCOVA) controlling for age and geographic site demonstrated that women with HSDD exhibited significantly lower SIDI-F total scores (least squares mean ± SE: 19.3 ± 0.8) than women with FSAD (26.4 ± 1.2) and control women without FSD (42.1 ± 0.7; p < .001 for all pairwise comparisons).

Parallel results were documented in the European multicenter study (N = 254; Nappi et al., 2008), where women with HSDD scored significantly lower than non-FSD controls (p < .001). Discriminant validity was maintained across age strata (≤ 50 years vs. > 50 years) and menopausal status (premenopausal vs. surgically or naturally postmenopausal), demonstrating the instrument’s capacity to identify desire pathology across different demographic groups.

Convergent Validity

Convergent validity was evaluated by correlating SIDI-F total scores with established self-report measures of female sexual functioning. Pearson correlation analyses revealed robust, statistically significant positive correlations between baseline SIDI-F total scores and the Female Sexual Function Index (FSFI) total score (r > .60, p < .0001) as well as the FSFI Desire Domain score (r > .65, p < .0001) across both North American and European samples. Similarly, strong positive correlations were documented with the Changes in Sexual Functioning Questionnaire—Female (CSFQ-F; r > .60, p < .0001), confirming that the clinician interview captures the clinical constructs measured by established patient questionnaires.

Divergent (Discriminant Construct) Validity

To confirm that the SIDI-F does not merely measure generalized relational happiness or marital satisfaction, scores were correlated against the Locke-Wallace Marital Adjustment Scale (MAS). Among women diagnosed with HSDD, correlations between SIDI-F total scores and MAS scores were low and non-significant (r = .02 in the North American trial; r = .23 in the European cohort), demonstrating divergent validity and confirming that low sexual desire can be differentiated from general marital discord.

Sensitivity to Therapeutic Change

The scale’s responsiveness to clinical change was confirmed retrospectively in observational studies and prospectively in randomized, double-blind, placebo-controlled trials of flibanserin. Percentage changes from baseline in SIDI-F total scores showed significant correlations with percentage changes in the FSFI total and desire domain scores (p < .0001). Furthermore, SIDI-F score improvements correlated significantly with the Clinical Global Impression of Improvement (CGI-I; p < .0001), verifying that the instrument tracks clinically meaningful improvements over 12 to 24 weeks of active treatment.

8. Reliability

The SIDI-F exhibits high reliability across diverse geographic, demographic, and clinical populations.

Internal Consistency

Internal consistency was analyzed using Cronbach’s alpha across repeated study visits in non-treatment validation investigations:

• North American Validation Study (N = 223): Cronbach’s alpha for the overall sample was .90 at Day 0 (baseline) and .90 at Day 28, indicating high internal homogeneity without redundant item content.
• European Validation Study (N = 254): Cronbach’s alpha was .93 at Day 0 and .92 at Day 28. Subgroup analyses yielded alpha values consistently ≥ .88 regardless of menopausal status or age category.

Test-Retest Reliability

Temporal stability in the absence of treatment intervention was evaluated over a 4-week window (Day 0 to Day 28):

• In the North American study, the test-retest Pearson product-moment correlation coefficient was r = .86, and the intraclass correlation coefficient (ICC) was .85 for the total score.
• In the European cohort, both the Pearson correlation and the ICC between Day 0 and Day 28 reached .90, demonstrating high reproducibility over time.

Inter-Rater Reliability and Standardization

Because the SIDI-F is clinician-administered, standardized training protocols were implemented across clinical sites to protect inter-rater concordance. The operational script provides explicit verbatim questions in bold type, accompanied by standardized secondary clinical probes in plain type. Clinicians assign scores based on defined anchored criteria, reducing scoring variance across independent evaluators.

9. Factor Analysis

The architectural foundation of the SIDI-F was established through psychometric pruning and factor analytic procedures documented by Sills et al. (2005).

Initial Development and Item Pruning

The original prototype of the SIDI-F contained 17 candidate items. Item Response Theory (IRT) analyses, alongside classic exploratory factor analysis (EFA), were conducted on clinical data from women with confirmed HSDD and healthy controls. Four items demonstrated poor item discrimination, low item-total correlations, or excessive multidimensional cross-loadings that compromised the scale’s primary measurement objective. These underperforming items were removed, yielding the refined 13-item instrument evaluated in pilot trials (Clayton et al., 2006) and formal international validation studies.

Factor Structure and Dimensionality

Principal Component Analysis (PCA) and EFA with promax (oblique) rotation consistently identify a strong primary general factor accounting for greater than 50% of the total variance, reflecting a unified underlying construct of Sexual Interest/Desire and Associated Arousal Capacity. Confirmatory Factor Analysis (CFA) models support a hierarchical or bifactor structure:

• Factor 1: Sexual Desire and Cognitive Receptivity: Comprising Initiation (Item 3), Desire Frequency (Item 4), Receptivity (Item 2), Positive Thoughts (Item 8), and Erotica Responsiveness (Item 9), with primary standardized factor loadings ranging from .64 to .84.
• Factor 2: Physiological Arousal and Orgasm: Comprising Arousal Frequency (Item 10), Arousal Ease (Item 11), Arousal Continuation (Item 12), and Orgasm (Item 13), with loadings ranging from .71 to .88.
• Factor 3: Evaluative and Interpersonal Context: Comprising Sexual Relationship Fulfillment (Item 1), Affection (Item 5), Desire Satisfaction (Item 6), and Desire Distress (Item 7; reverse-oriented conceptually, capturing affective burden), with loadings ranging from .52 to .76.

Structural equation modeling demonstrates adequate goodness-of-fit indices for the correlated multidimensional model (Comparative Fit Index [CFI] > .94, Tucker-Lewis Index [TLI] > .92, and Root Mean Square Error of Approximation [RMSEA] ≤ .06), supporting both the interpretation of individual subdomains and the summation of all 13 items into an overall composite index.

10. Instrument / Measurement Tool

• Test Type: Clinician-administered semi-structured interview / rating scale.
• Administration Format: Verbal interview administered by a trained health professional (psychiatrist, gynecologist, psychologist, or sexologist) utilizing scripted primary items and explicit secondary clinical probes.
• Target Population: Adult women (aged 18 years and older), across all reproductive and menopausal stages (premenopausal, perimenopausal, postmenopausal).
• Completion Time: Approximately 15 minutes.
• Recall Period: Previous 30 days.
• Item Configuration: Total of 18 items: 13 primary scored items measuring sexual desire and response domains, plus a 5-item non-scored supplemental diagnostic module assessing common confounding variables (fatigue, depression, pain, partner discord, and medications).
• Response Scale (Mandatory Psychometric Structure):
  • Clinician-rated scale (each item scored from 0 to 3, 0 to 4, or 0 to 5 depending on the item, with total score ranging from 0 to 51; higher scores indicate greater sexual desire/function).
  • Single-Dimension Rating (8 Items): Items 1, 2, 5, 6, 7, 8, 9, and 13 are scored exclusively on symptom intensity/frequency along anchored response options.
  • Dual-Dimension Grid Rating (5 Items): Items 3, 4, 10, 11, and 12 utilize a two-dimensional grid where symptom intensity (columns, left-to-right) intersects with symptom frequency (rows, top-to-bottom) to establish the final score.
• Scoring and Diagnostic Interpretation:
  • Total Score Range: 0 to 51.
  • Score Directionality: Higher scores denote greater levels of sexual desire, interest, and positive sexual functioning.
  • Diagnostic Cutoff Threshold: A total score of 33 or less indicates the presence of clinically significant Hypoactive Sexual Desire Disorder (HSDD).
  • Diagnostic Module: Evaluates fatigue, depressive affect/anxiety, dyspareunia/pelvic pain, partner sexual dysfunction/relationship conflict, and medication/substance interference. These items do not contribute to the 0–51 total score, but inform the clinician regarding secondary or exclusionary causes.

11. Permissions & Fee and Test Year

The Sexual Interest and Desire Inventory—Female was developed and copyrighted in 2004 by its primary developers: Drs. Anita Clayton, Sandra Leiblum, Kenneth R. Evans, Terrence Sills, Robert Pyke, Rosemary Basson, and R. Taylor Segraves, in collaboration with Boehringer Ingelheim Pharmaceuticals, Inc.

Licensing and Availability: The authors and copyright holders encourage the use of the SIDI-F by the international scientific and clinical research community. The instrument is accessible free of charge for non-commercial academic research and clinical practice, contingent upon the condition that the complete copyright notice is preserved and that no modifications, item omissions, or alterations are made without the express written permission of the copyright proprietors.

Permissions Inquiries: Inquiries regarding commercial licensing, clinical trial implementation, or formal translations should be directed to Dr. Robert Pyke (Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Rd, Ridgefield, CT 06877; email: [email protected]) or Dr. Anita H. Clayton (University of Virginia Health System, Department of Psychiatry and Neurobehavioral Sciences, Charlottesville, VA 22903; email: [email protected]). The complete clinical instrument guide is also archived in clinical handbooks and through Routledge companion resources.

12. References

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Basson, R. (2000). The female sexual response: A different model. Journal of Sex & Marital Therapy, 26(1), 51–65. https://doi.org/10.1080/009262300278641

Basson, R. (2001). Female sexual response: The role of drugs in the management of sexual dysfunction. Obstetrics & Gynecology, 98(2), 350–353. https://doi.org/10.1016/s0029-7844(01)01424-6

Clayton, A. H., McGarvey, E. L., & Clavet, G. J. (1997). The Changes in Sexual Functioning Questionnaire (CSFQ): Development, reliability, and validity. Psychopharmacology Bulletin, 33(4), 731–745.

Clayton, A. H., Segraves, R. T., Leiblum, S., Basson, R., Pyke, R., Cotton, D., Lewis-D’Agostino, D., Evans, K. R., & Wunderlich, G. (2006). Reliability and validity of the Sexual Interest and Desire Inventory—Female (SIDI-F), a scale designed to measure severity of female Hypoactive Sexual Desire Disorder. Journal of Sex & Marital Therapy, 32(2), 115–135. https://doi.org/10.1080/00926230500442301

Kaplan, H. S. (1979). Disorders of sexual desire and other new concepts and techniques in sex therapy. Brunner/Mazel.

Laan, E., & Both, S. (2005). Sexual desire and arousal: Psychophysiological processes. Annual Review of Sex Research, 16(1), 165–214.

Lewis-D’Agostino, D., Clayton, A. H., Wunderlich, G., Kimura, T., Derogatis, L., & Goldstein, A. (2007). Validating the Sexual Interest and Desire Inventory—Female (SIDI-F) in North American women. Obstetrics & Gynecology, 109(4, Suppl.), 23S. https://doi.org/10.1097/01.AOG.0000263914.88785.e2

Locke, H. J., & Wallace, K. M. (1959). Short marital-adjustment and prediction tests: Their reliability and validity. Marriage and Family Living, 21(3), 251–255. https://doi.org/10.2307/348022

Masters, W. H., & Johnson, V. E. (1966). Human sexual response. Little, Brown and Company.

Meston, C. M. (2003). Validation of the Female Sexual Function Index (FSFI) in women with Female Orgasmic Disorder and in women with Hypoactive Sexual Desire Disorder. Journal of Sex & Marital Therapy, 29(1), 39–46. https://doi.org/10.1080/713847100

Nappi, R. E., van Lunsen, R., Tignol, J., Goldmeier, D., Pyke, R., & Staehle, H. (2008). Validation of the Sexual Interest and Desire Inventory—Female© (SIDI-F©) in European women. Sexologies, 17(Suppl. 1), S48–S49. https://doi.org/10.1016/S1158-1360(08)72652-3

Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., Ferguson, D., & D’Agostino, R. (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/10.1080/009262300278597

Sills, T., Wunderlich, G., Pyke, R., Segraves, R. T., Leiblum, S., Clayton, A. H., & Evans, K. R. (2005). The Sexual Interest and Desire Inventory—Female (SIDI-F): Item response analyses of data from women diagnosed with Hypoactive Sexual Desire Disorder. The Journal of Sexual Medicine, 2(6), 801–818. https://doi.org/10.1111/j.1743-6109.2005.00145.x

13. Items of the Scale (Questionnaire)