Sexual Self-Efficacy Scale for Female Functioning

1. Abstract

The Sexual Self-Efficacy Scale for Female Functioning (SSES-F) is a standardized, multidimensional psychometric instrument constructed to evaluate a woman’s perceived behavioral, cognitive, and affective competence across key dimensions of female sexual expression and physiological response. Grounded in Albert Bandura’s social cognitive framework, the instrument operationalizes self-efficacy expectations regarding an individual’s confidence in executing specific sexual behaviors and managing physiological responses under varying interpersonal contexts. Designed as a female counterpart to the Sexual Self-Efficacy Scale—Erectile Functioning (SSES-E), the SSES-F comprises 37 items spanning the human sexual response cycle as well as broad interpersonal dynamics. Factor analytic investigations demonstrate that the 37 items resolve into eight correlated yet distinct clinical subscales: Interpersonal Orgasm, Interpersonal Interest/Desire, Sensuality, Individual Arousal, Affection, Communication, Body Acceptance, and Refusal.

The scale employs a two-tiered response format standard in microanalytic self-efficacy measurement: respondents first indicate whether they believe they are currently capable of performing each behavior (“Can Do” dichotomous check), and for confirmed items, rate their subjective confidence on a continuous numerical scale ranging from 10 (“Quite Uncertain”) to 100 (“Quite Certain”) in 10-point increments; unconfirmed activities are scored as zero confidence. The tool also provides a parallel partner-rating format to assess couple perceptual congruence. Empirical validation with clinical and community samples of adult women demonstrates robust psychometric properties, featuring an internal consistency coefficient of Cronbach’s α = .93 for the full scale and subscale alphas ranging from .70 to .87. Four-week test-retest reliability is firmly established at r = .83 for the global index. Discriminant and convergent validity studies show significant correlations with established inventories of sexual functioning, marital adjustment, and genital pain disorders, confirming the SSES-F as an indispensable tool in cognitive-behavioral sex therapy, clinical screening, and empirical sexuality research.

2. Keywords

Sexual Self-Efficacy Scale for Female Functioning, SSES-F, female sexual dysfunction, sexual self-efficacy, psychometrics, social cognitive theory, sexual satisfaction, sexual communication, female orgasmic disorder, sex therapy

3. Authors

The Sexual Self-Efficacy Scale for Female Functioning was formulated and validated by a distinguished multidisciplinary research team based in Montreal, Quebec, Canada:

• Sally Bailes, Ph.D. — Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital (SMBD-JGH); McGill University, Montreal, Quebec, Canada. (Correspondence: [email protected]).
• Laura Creti, Ph.D. — Department of Psychiatry, SMBD-Jewish General Hospital; McGill University, Montreal, Quebec, Canada.
• Catherine S. Fichten, Ph.D. — Department of Psychiatry, SMBD-Jewish General Hospital; Department of Psychology, Dawson College; McGill University, Montreal, Quebec, Canada.
• Eva Libman, Ph.D. — Department of Psychiatry, SMBD-Jewish General Hospital; Department of Psychology, McGill University, Montreal, Quebec, Canada.
• William Brender, Ph.D. — Department of Psychiatry, SMBD-Jewish General Hospital; Concordia University, Montreal, Quebec, Canada.
• Rhonda Amsel, M.Sc. — Department of Psychology, McGill University, Montreal, Quebec, Canada.

4. Purpose

The primary purpose of the Sexual Self-Efficacy Scale for Female Functioning (SSES-F) is to provide an objective, granular, and multidimensional measurement of a woman’s perceived confidence in her personal sexual capacity. In the domain of cognitive-behavioral therapy (CBT) and clinical sexology, physiological functionality cannot be divorced from cognitive appraisal processes. Subjective judgments regarding whether one can perform a sexual behavior, experience sexual pleasure, or cope with performance disruptions exert a primary causal influence on sexual initiation, persistence, and emotional experience. The SSES-F measures these specific psychological expectations to identify cognitive deficits that perpetuate sexual dysfunctions.

Clinically, the SSES-F serves as a sensitive diagnostic screening tool and an outcome metric for psychological and medical interventions. Traditional psychiatric classification systems, such as the DSM-5-TR, characterize female sexual dysfunctions—such as Female Sexual Interest/Arousal Disorder (FSIAD), Female Orgasmic Disorder (FOD), and Genito-Pelvic Pain/Penetration Disorder (GPPPD)—predominantly by frequency and physiological failure. However, treating clinicians routinely observe that psychological recovery requires restructuring maladaptive cognitive schemas. By administering the SSES-F, therapists can identify specific domains where confidence is deficient (e.g., asserting preferences, tolerating non-orgasmic encounters, or tolerating genital caressing), allowing for targeted behavioral prescriptions such as sensate focus exercises or assertiveness training.

In academic research, the SSES-F facilitates the empirical testing of cognitive models of female sexuality. Researchers utilize the instrument to model the psychological mechanisms connecting distal historical variables (e.g., sexual trauma, conservative religious upbringings) or medical conditions (e.g., provoked vestibulodynia, breast cancer treatments, post-menopausal changes) to distal outcomes such as relationship breakdown or chronic sexual avoidance. Studies have deployed the SSES-F as a critical mediating variable explaining how cognitive constructs like sexual self-schemas translate into overall sexual well-being, subjective distress, and marital adjustment.

Furthermore, because the instrument possesses a parallel partner-rating format, it serves a distinct dyadic diagnostic purpose. Couples in long-term relationships frequently develop discrepancies between the female partner’s actual perceived self-efficacy and the male or female partner’s attribution of her capacity. By comparing self-ratings with partner-ratings, clinicians can illuminate dysfunctional cognitive misattributions, performance pressure dynamics, and interpersonal miscommunications that fuel cyclical distress.

5. Psychological Construct

The psychological construct evaluated by the SSES-F is sexual self-efficacy in women, defined as an individual’s subjective conviction that she can successfully organize, execute, and experience specific behavioral, cognitive, and affective tasks required across diverse sexual encounters. Rather than evaluating generalized self-esteem or trait neuroticism, this construct is strictly task- and context-specific. It operationalizes female sexuality across eight empirical dimensions identified via factor analysis:

Interpersonal Orgasm

This dimension encompasses an individual’s confidence in attaining climax during partnered encounters under varied stimulation conditions, as well as enabling partner climax. Items evaluate orgasmic attainment through concurrent clitoral stimulation, intercourse without clitoral manipulation, manual/oral stimulation, and within a reasonable timeframe. Because female orgasm is heavily influenced by cognitive distraction and spectatoring, high self-efficacy in this subscale reflects freedom from involuntary performance anxiety and the ability to surrender to involuntary physiological reflexes.

Interpersonal Interest/Desire

This subscale captures the motivational and appetitive component of sexual self-efficacy. It assesses perceived capability in feeling desire for a partner, feeling sexually desirable, maintaining broad interest in sexual engagement, initiating activity, and anticipating intercourse without fear or apprehension. Low self-efficacy here is a primary cognitive marker of hypoactive interest disorders.

Sensuality

Sensuality focuses on the receptive and active hedonic enjoyment of tactile physical intimacy. It measures confidence in enjoying broad bodily caresses, genital and breast stimulation by the partner, as well as the active caressing of the partner’s body and genitalia. High self-efficacy in sensuality denotes an absence of tactile aversion and an openness to diverse somatic sensations.

Individual Arousal

Distinct from partnered dynamics, this dimension evaluates an individual’s autonomy over her erotic responsiveness. It measures the capability to become sexually stimulated in response to solitary stimuli (such as erotica), attaining solo arousal and solitary masturbatory orgasm, and early arousal during foreplay. It taps into the internal, private sexual locus of control independent of partner competence.

Affection

This construct isolates the non-demand, non-coital aspects of physical intimacy. It gauges confidence in initiating and enjoying mutual exchanges of affection and sensual encounters without feeling pressured or obligated to culminate in penetrative intercourse. It assesses boundaries protecting non-sexual warmth from involuntary sexualization.

Communication

The communication dimension evaluates verbal and non-verbal assertiveness within an intimate dyad. It measures confidence in asking a partner for specific types and amounts of stimulation, providing requested stimulation, negotiating discrepancies in sexual tastes, and deriving satisfaction from encounters that do not necessarily culminate in personal orgasm.

Body Acceptance

This factor evaluates somatic self-worth and bodily comfort during intimate exposure. It assesses the confidence to be physically nude in the presence of a partner and to maintain positive body appreciation, directly targeting the cognitive interference produced by negative body image and self-consciousness.

Refusal

The refusal subscale captures sexual boundary maintenance and interpersonal resilience. It operationalizes a woman’s perceived competence in declining unwanted sexual advances from a partner and constructively coping with rejection when her own advances are turned down, ensuring sexual agency and autonomy.

6. Theoretical Framework

The conceptual foundation of the SSES-F is derived directly from Albert Bandura’s Social Cognitive Theory (1977, 1986, 1997). Bandura posited that psychological functioning is governed by reciprocal determinism—a continuous, dynamic interaction between cognitive, behavioral, and environmental influences. Central to this theoretical architecture is the construct of perceived self-efficacy: beliefs in one’s capabilities to organize and execute courses of action required to produce given attainments.

Bandura explicitly distinguished self-efficacy expectations from outcome expectations. An outcome expectation refers to the judgment of the likely consequence a given behavior will produce (e.g., “If I ask for clitoral stimulation, my partner may feel inadequate”). In contrast, an efficacy expectation is the conviction that one can successfully execute the behavior itself (e.g., “I am confident I can clearly ask my partner for the stimulation I need”). The SSES-F measures these granular efficacy expectations. According to self-efficacy theory, such beliefs regulate human functioning through four major psychological processes: cognitive, motivational, affective, and selection processes.

In sexual functioning, efficacy expectations determine whether coping behavior will be initiated, the degree of effort expended, and how long persistence will be sustained in the face of obstacles and aversive experiences:

• Cognitive Appraisal: Women with high sexual self-efficacy anticipate positive scenarios and construct cognitive scripts for navigating obstacles (e.g., temporary loss of arousal, communication barriers). Conversely, individuals plagued by low self-efficacy obsess over potential functional failure, engage in catastrophic thinking, and amplify personal deficiencies.
• Affective Regulation and Performance Anxiety: Inadequate self-efficacy triggers autonomic sympathetic hyperarousal, subjective anxiety, and performance apprehension. In Masters and Johnson’s conceptualization of sexual dysfunction, cognitive monitoring or “spectatoring” sabotages the parasympathetic-mediated vasocongestive response required for female arousal and lubrication. Self-efficacy serves as a primary cognitive buffer against this performance anxiety.
• Sources of Efficacy Information: Consistent with Bandura’s model, female sexual self-efficacy is continuously cultivated or degraded through four informational sources: (1) enactive mastery experiences (past successful, pleasurable, or pain-free sexual events); (2) vicarious experiences (social modeling and observational learning); (3) verbal persuasion (affirmations from partners, sex education, therapeutic reframing); and (4) physiological and affective states (interpreting pelvic sensations, lubrication, or pain).

The SSES-F synthesizes Bandura’s microanalytic assessment strategy with modern psychosomatic sexology. Rather than treating female sexuality as an indiscriminate, monolithic drive, the scale recognizes that an individual may demonstrate exceptionally high efficacy in solitary arousal or affectionate display, yet suffer complete efficacy collapse in partnered orgasmic attainment or sexual boundary refusal.

7. Validity

The psychometric validity of the SSES-F has been rigorously examined across multiple community, university, and clinical samples, confirming its construct, convergent, discriminant, and criterion validity.

Construct and Criterion Validity

Initial validation studies conducted by Creti, Bailes, Fichten, Libman, and colleagues (1989) demonstrated marked criterion-related validity by contrasting nonclinical community women with clinical samples seeking sex therapy. Women diagnosed with sexual dysfunctions exhibited significantly lower total SSES-F strength scores compared to sexually functional community controls. Subscale analyses revealed that dysfunctional cohorts exhibited particularly pronounced deficits on the Interpersonal Orgasm, Interpersonal Interest/Desire, Sensuality, and Communication dimensions, confirming that the scale accurately maps onto diagnostic profiles of female sexual impairment.

Convergent Validity

The convergent validity of the SSES-F has been substantiated through significant correlations with several validated, gold-standard sexuality instruments:

• Sexual History Form (SHF; Nowinski & LoPiccolo, 1979): SSES-F overall strength scores demonstrate moderate-to-strong positive correlations with behavioral frequencies and positive sexual history indices on the SHF.
• Golombok Rust Inventory of Sexual Satisfaction (GRISS; Rust & Golombok, 1985): The SSES-F shows strong inverse correlations with GRISS dissatisfaction, avoidance, and non-sensuality scales, indicating that higher perceived efficacy corresponds to lower clinical distress.
• Sexual Interaction Inventory (SII; LoPiccolo & Steger, 1974): High SSES-F scores correlate positively with perceptual congruence and sexual pleasure ratings on the SII.
• Marital and Relational Functioning: SSES-F scores correlate significantly with dyadic harmony as measured by the Locke-Wallace Marital Adjustment Scale (Kimmel & Van der Veen, 1974). Furthermore, Oluwole (2008) demonstrated robust associations between sexual self-efficacy, self-disclosure, and marital satisfaction.

Discriminant and Known-Groups Validity

The scale effectively differentiates between diverse clinical and nonclinical populations:

• Genital Pain Syndromes: Sutton, Pukall, and Chamberlain (2009) evaluated women suffering from provoked vestibulodynia (PVD) against asymptomatic controls. Women with PVD demonstrated significantly depressed scores on the SSES-F total score, as well as the Sensuality, Affection, and Communication subscales, documenting how chronic vulvar pain systematically erodes localized sexual self-efficacy.
• Age-Related Differences: Creti et al. (1989) documented significant discriminant capacity across developmental epochs; women over the age of 50 exhibited lower total strength scores than younger cohorts, mirroring physiological changes and socially mediated efficacy beliefs associated with the menopausal transition.
• Mediational Models: Reissing, Laliberté, and Davis (2005) demonstrated construct validity by confirming that sexual self-efficacy functions as a critical psychological mediator transmitting the effects of core sexual self-schemas, sexual aversion, and negative body attitudes onto young women’s actual behavioral sexual adjustment.

8. Reliability

The SSES-F displays robust reliability across multiple testing methodologies, including internal consistency, temporal stability, and inter-partner agreement.

Internal Consistency

In the primary psychometric validation study by Bailes, Creti, Fichten, Libman, Brender, and Amsel encompassing 131 women (51 married/cohabiting and 80 single; aged 25 to 68 years), item analysis revealed high internal consistency. The total instrument yielded an overall Cronbach’s alpha of:

α = .93

Evaluation of the eight distinct subscales yielded internal consistency coefficients well within accepted standards for clinical assessment instruments:

• Subscale Alphas: Ranged from α = .70 to α = .87, reflecting adequate-to-high homogeneity across the individual behavioral dimensions.
• Subscale-Total Correlations: Correlation coefficients between subscale averages and the global composite score ranged from r = .31 to r = .85, indicating that while all factors contribute meaningfully to a broader self-efficacy construct, they maintain distinct diagnostic variance.
• Inter-Subscale Correlations: Intercorrelations between the eight subscales were moderate to low, spanning r = .08 to r = .63, confirming that the subscales do not display excessive collinearity.

Test-Retest Reliability

Temporal stability was evaluated across a subset of 36 nonclinical women who were re-administered the SSES-F following an interval of four weeks. Pearson product-moment correlations showed excellent test-retest reliability:

• Total Score Stability: r = .83 (p < .001), indicating that overall perceived sexual competence remains stable across time in the absence of clinical intervention.
• Subscale Stability: Test-retest reliability across the eight subscales ranged from r = .50 to r = .93, reflecting stable psychological traits alongside situational behavioral factors.

Dyadic Concordance

Among the 51 married or cohabiting couples where male partners completed the partner-proxy version of the SSES-F, the correlation between the woman’s self-efficacy score and her partner’s estimation was r = .46 (p < .001). This moderate congruence underscores both shared dyadic reality and significant divergent subjective perspectives, reinforcing the utility of the partner assessment form in clinical settings.

9. Factor Analysis

The structural dimensionality of the SSES-F was empirically determined via exploratory factor analysis (EFA) on the confidence ratings gathered from the primary normative validation cohort of 131 women.

Factor Extraction and Rotation

The initial factor analysis utilized a principal axis extraction procedure followed by an orthogonal Varimax rotation to maximize simple structure and conceptual interpretability. Application of the Kaiser-Guttman retention criterion (eigenvalues > 1.0) coupled with scree plot examination identified an eight-factor solution:

• Variance Explained: The eight extracted factors jointly accounted for 68% of the total scale variance, representing substantial structural coverage of the behavioral items.
• Factor Clarity: Items were retained on factors where their primary loading exceeded .40 with minimal cross-loadings, yielding clear, clinically interpretable subscales.

Subscale Factor Distribution and Item Assignments

10. Instrument / Measurement Tool

• Instrument Name: Sexual Self-Efficacy Scale for Female Functioning (SSES-F)
• Target Population: Adult females (single, dating, cohabiting, or married); heterosexual, lesbian, or bisexual orientations across diverse age ranges (validated empirically from age 25 to 68+).
• Format & Administration: Self-administered paper-and-pencil or digital questionnaire; also features an optional parallel partner-report format.
• Administration Time: Approximately 10 to 15 minutes.
• Total Item Count: 37 behavioral statements.
• Response Structure: Two-step microanalytic self-efficacy assessment:
  • Column I (“Can Do”): Dichotomous judgment. The respondent marks a checkmark (✓) if she believes she could perform the activity if requested to do so today. If she believes she cannot, it is left completely blank.
  • Column II (“Confidence Rating”): For items checked in Column I, the respondent indicates her degree of confidence using a 10-point increment scale ranging from 10 to 100:
  • 10 = Quite Uncertain
  • 20 = Moderately Uncertain
  • 30 = Uncertain
  • 40 = Slightly Uncertain
  • 50 = Moderately Certain
  • 60 = Moderately Certain
  • 70 = Fairly Certain
  • 80 = Certain
  • 90 = Very Certain
  • 100 = Quite Certain
• Scoring Protocol:
  • Item Confidence Value: Any item checked in Column I receives its numerical confidence score (10–100). Any item left unchecked in Column I is automatically coded as 0.
  • Total Strength Score: Computed as the mathematical arithmetic mean across all 37 items (sum of all item scores divided by 37). Total scores range continuously from 0 to 100, where higher scores reflect higher overall sexual self-efficacy.
  • Subscale Strength Scores: Calculated by summing the numerical scores for the items constituting each subscale and dividing by the number of items in that subscale (resulting in a mean score from 0 to 100 for each factor):
    • Interpersonal Orgasm: Mean of items 4, 28, 29, 30, 32, 33, 34, 36, 37 (9 items)
    • Interpersonal Interest/Desire: Mean of items 1, 5, 6, 7, 9, 22 (6 items)
    • Sensuality: Mean of items 17, 18, 19, 20, 21, 27 (6 items)
    • Individual Arousal: Mean of items 24, 25, 26, 31 (4 items)
    • Affection: Mean of items 8, 15, 16 (3 items)
    • Communication: Mean of items 12, 13, 14, 23, 35 (5 items)
    • Body Acceptance: Mean of items 2, 3 (2 items)
    • Refusal: Mean of items 10, 11 (2 items)

11. Permissions & Fee and Test Year

The Sexual Self-Efficacy Scale for Female Functioning was developed by Sally Bailes, Laura Creti, Catherine S. Fichten, Eva Libman, William Brender, and Rhonda Amsel. The preliminary validation findings were first presented at the American Psychological Association (APA) Annual Convention in 1989, with extensive comparative psychometric documentation published in sexology literature across subsequent decades (including inclusion in the Handbook of Sexuality-Related Measures).

Licensing and Clinical Access: The SSES-F is placed in the academic and clinical public domain for non-commercial research and therapeutic practice. No licensing fees or commercial royalties are required to administer the instrument. Qualified mental health professionals, sexologists, and academic researchers may reproduce the scale, provided full scholarly citation and intellectual attribution are preserved. Researchers seeking official French translations or guidance on specialized diagnostic scoring protocols should direct correspondence to:

Dr. Sally Bailes
Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital
4333 Cote Ste. Catherine, Montreal, Quebec, H3T 1E4, Canada
E-mail: [email protected]

12. References

• Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191
• Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall.
• Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman and Company.
• Creti, L., Bailes, S., Fichten, C. S., Libman, E., Amsel, R., & Brender, W. (1989, August). Validation of the Sexual Self-Efficacy Scale for Females [Poster presentation]. Annual Convention of the American Psychological Association, New Orleans, LA, United States.
• Fichten, C. S., Budd, J., Spector, I., Amsel, R., Creti, L., Brender, W., & Libman, E. (2010). Sexual Self-Efficacy Scale—Erectile Functioning. In T. D. Fisher, C. M. Davis, W. L. Yarber, & S. L. Davis (Eds.), Handbook of sexuality-related measures (3rd ed., pp. 268–271). Routledge.
• Kimmel, D., & Van der Veen, F. (1974). Factors of marital adjustment in Locke-Wallace test items. Journal of Marriage and the Family, 36(1), 57–63. https://doi.org/10.2307/351111
• Libman, E., Rothenberg, I., Fichten, C. S., & Amsel, R. (1985). The SSES-E: A measure of sexual self-efficacy in erectile functioning. Journal of Sex & Marital Therapy, 11(4), 233–244. https://doi.org/10.1080/00926238508406089
• LoPiccolo, J., & Steger, J. C. (1974). The Sexual Interaction Inventory: A new instrument for assessment of sexual dysfunction. Archives of Sexual Behavior, 3(6), 585–595. https://doi.org/10.1007/BF01541135
• Nowinski, J. K., & LoPiccolo, J. (1979). Assessing sexual behavior in couples. Journal of Sex & Marital Therapy, 5(3), 225–243. https://doi.org/10.1080/00926237908403733
• Oluwole, D. A. (2008). Marital satisfaction: Connections of self-disclosure, sexual self-efficacy and spirituality among Nigerian women. Pakistan Journal of Social Sciences, 5(5), 464–469.
• Reissing, E. D., Laliberté, G. M., & Davis, H. J. (2005). Young women’s sexual adjustment: The role of sexual self-schema, sexual self-efficacy, sexual aversion and body attitudes. The Canadian Journal of Human Sexuality, 14(3–4), 77–85.
• Rust, J., & Golombok, S. (1985). The Golombok Rust Inventory of Sexual Satisfaction (GRISS). British Journal of Clinical Psychology, 24(1), 63–64. https://doi.org/10.1111/j.2044-8260.1985.tb01314.x
• Sutton, K. S., Pukall, C. F., & Chamberlain, S. (2009). Pain ratings, sensory thresholds, and psychosocial functioning in women with provoked vestibulodynia. Journal of Sex & Marital Therapy, 35(4), 262–281. https://doi.org/10.1080/00926230902851272

13. Items of the Scale (Questionnaire)