Validation of a Women’s Sexual Interest Diagnostic Interview—Short Form (WSID-SF) and a Daily Log of Sexual Activities (DLSA) in Postmenopausal Women with Hypoactive Sexual Desire Disorder

Abstract

Introduction Currently, there is no clear standard assessment tool for the diagnosis and daily monitoring of hypoactive sexual desire disorder (HSDD) in postmenopausal women. Aim The aim of the study was to validate (i) the Women’s Sexual Interest Diagnostic Interview—Short Form (WSID-SF) which is a structured tool to identify HSDD; and (ii) the Daily Log of Sexual Activities (DLSA) which is a diary to monitor daily HSDD status in postmenopausal women. Both assessments were collected as self-reports by an interactive voice response system (IVRS). Methods At the initial study visit, 629 postmenopausal women, age 39–66, were evaluated for HSDD by the WSID-SF. In addition, in a subgroup of 175 subjects at five study sites, HSDD was assessed by physicians who were blinded to the WSID-SF diagnosis. During the 58-day study period, patients completed the DLSA daily through self-reported IVRS. All women also completed the Female Sexual Function Index (FSFI), Menopause Sexual Interest Questionnaire (MSIQ), Female Sexual Distress Scale (FSDS), Dyadic Adjustment Scale (DAS), and Kellner Symptom Questionnaire (KSQ) at both the initial study visit and at the end of the study. The WSID-SF-based identifications were compared with clinical diagnoses made based on physicians’ clinical experience. Construct validity of the WSID-SF and DLSA were assessed based on comparisons with questionnaire results. Internal consistency and test–retest reliability of the DLSA were also evaluated. Main Outcome Measures Main outcome measures include the agreement between WSID-SF diagnosis and clinician diagnosis, convergent and divergent validity of the WSID-SF and DLSA, and reliability of the DLSA. Results Enrolled subjects were classified into HSDD (N = 468) and non-HSDD (N = 161) groups by WSID-SF. When compared with physician’s diagnosis, WSID-SF-based diagnosis had a specificity of 89% and a sensitivity of 70% (kappa = 0.46, P < 0.001). WSID-SF showed significant correlation with each domain of the FSFI, MSIQ, and FSDS (all P < 0.001). As anticipated, WSID-SF had low or nonsignificant correlations with all domains of the DAS and the KSQ. Four different algorithms were piloted to calculate DLSA scores. Data on the detailed analysis conducted to evaluate the four scoring strategies is on file (not presented in this article). Ultimately, the weekly DLSA total score calculated by algorithm #4 was selected to validate the DLSA. In the test–retest reliability evaluation, the intraclass correlation coefficient was 0.80 for women with HSDD and 0.84 for women without HSDD (P < 0.001 for all analysis). In the known-group validity comparison, the weekly DLSA total score was significantly different (P < 0.001) among the HSDD and the no HSDD groups, with an effect size of 0.89–0.92 based on Cohen’s d. The DLSA also showed convergent validity with moderate to high correlations with each domain of the FSFI, MSIQ, and FSDS (P < 0.001 for all correlations). As anticipated, the DLSA had weak correlations with the DAS and KSQ demonstrating divergent validity. Conclusions The WSID-SF had good specificity and sensitivity (i.e., discriminative validity) in identifying HSDD in postmenopausal women. In addition, the DLSA is a reliable and valid patient-reported outcomes tool that can be utilized to assess effectiveness of treatments in postmenopausal women with HSDD. Further, the WSID-SF and DLSA both demonstrated good convergent and divergent validity.

Low Sexual Desire — Is it All in Her Head? Pathophysiology, Diagnosis, and Treatment of Hypoactive Sexual Desire Disorder

“…A number of well-validated self-and clinician-administered questionnaires are available, including the Female Sexual Function Index (FSFI), a 19-item self-report measure of FSD that scores on 6 domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain), as well as a total score, 32 and has been validated in women with HSDD; 33 the PFSF, a 37-item instrument, measures the loss of sexual desire and related aspects of sexual function in menopausal women with HSDD; 28,34 the Sexual Interest and Desire Inventory-Female Version (SIDI-F), a clinicianadministered tool to quantify the severity of symptoms in women with HSDD, 35,36 and the validated Women's Sexual Interest Diagnostic Interview (WSID), an assessment tool designed to help clinicians identify HSDD in postmenopausal women. [36][37][38] Shorter questionnaires have also been developed and validated for use in busy clinical practice, including the brief version of the PFSF, developed using items from the PFSF and the PDS and validated in HSDD, 39 a 4-item HSDD screener, which can be paired with a face-to-face interview by the primary care clinician to reliably screen for HSDD in postmenopausal women, 26 and the Decreased Sexual Desire Screener (DSDS), a 5-item questionnaire developed for practicing clinicians who are neither trained nor specialized in managing FSD. These brief diagnostic screening tools are designed to assist clinicians in making an accurate diagnosis of generalized acquired HSDD.…”

Questionnaires for Assessment of Female Sexual Dysfunction: A Review and Proposal for a Standardized Screener

“…A subgroup of 175 subjects were also interviewed by an experienced clinician. The current study demonstrated good diagnostic sensitivity (70%) and specificity (89%) with a kappa coefficient of 0.46 reflecting agreement on the diagnosis of HSDD between the clinician and the WSID‐SF [70].…”

“…Interestingly, the interrater reliability was assessed and found adequate using trained actresses in video-taped situations. Based on the preliminary investigations, the short from was developed (WSID-SF) in a study on 629 postmenopausal women aged 39-66 years evaluated for HSDD [70]. The WSID-SF is a nine-item questionnaire and includes questions about distress.…”

Comparison of interactive voice response (IVR) with paper administration of instruments to assess functional status, sexual function, and quality of life in elderly men

“…The IVR versions of these measures have been favored by the FDA for use in registration trials in psychiatry and sleep medicine. More recently, IVR versions of other well-known measures have been developed and validated for use in female sexual dysfunction [8], type 2 diabetes [9], HIV-AIDS [10–12], chronic lung disease [13], prostate cancer [14], and various other diseases and indications. Among the advantages by study sponsors and regulatory agencies, use of IVR for data collection has been shown to provide accuracy and reliability of recording, reduce recall errors and improve reliability versus paper measures, and provide firm documentation of time and date of data entry [1–6].…”