R O A M Q e L M a b c R A 5 h 0 B evista Latinoamericana de Psicología (2016) 48, 88--97 Revista Latinoamericana de Psicología www.elsevier.es/rlp RIGINAL ARTICLE daptation, validation and reliability of the assachusetts General Hospital-Sexual Functioning uestionnaire in a Colombian sample and factorial quivalence with the Spanish version aurent Marchal-Bertranda, José Pedro Espadab, Alexandra Moralesb, ayra Gómez-Lugoa, c Franklin Soler , Pablo Vallejo-Medinaa,∗ SexLab KL, School of Psychology, Fundación Universitaria Konrad Lorenz, Bogotá, Colombia Department of Health Psychology, Miguel Hernández University, Alicante, Spain School of Psychology, Universidad del Rosario, Bogotá, Colombia eceived 16 October 2015; accepted 30 January 2016 vailable online 14 March 2016 KEYWORDS Abstract Sexual dysfunctions are a highly prevalent problem. It is necessary to have instru- MGH-SFQ; ments adapted to the Colombian population in order to evaluate their sexual functioning Massachusetts because to date none of them have been validated. The aim of this study was to adapt and General validate the Massachusetts General Hospital-Sexual Functioning Questionnaire in Colombian Hospital-Sexual population, and compare it with a similar sample from Spain. Two different samples were used Functioning in this study. On one hand, a sample of expert judges who performed the cultural adaptation and Questionnaire; the evaluation of the scale, and on the other hand, a second end sample of 1117 participants Factorial -men and women of both nationalities- who answered the questionnaire -together with others- equivalence; through a virtual platform. Some of the items were adjusted based on the initial results of the Sexual functioning; evaluation by the expert judges. Cronbach’s alpha between .81 and .92 were obtained after Validation; the application of the test. The psychometric properties of the scale are adequate and this Sexual health instrument properly correlates with other criterion variables. Construct validity was evaluated using factorial invariance. The unidimensional configural model for men (RMSEA = .000; CFI = 1) and for women (RMSEA = .048, CFI = .997) had an adequate fit, and a level of strict invariance was also reached. Screening can be performed with this first validated scale in order to eval- uate the sexual difficulties of the Colombian population and compare them with the Spanish population. © 2016 Fundación Universitaria Konrad Lorenz. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/). This work has been possible, thanks to ‘‘Fundación Universitaria Konrad Lorenz’’ funding associated to the research project (number: 5270151) granted to last author. ∗ Corresponding author. E-mail address: pablo.vallejom@konradlorenz.edu.co (P. Vallejo-Medina). ttp://dx.doi.org/10.1016/j.rlp.2016.01.001 120-0534/© 2016 Fundación Universitaria Konrad Lorenz. Published by Elsevier España, S.L.U. This is an open access article under the CC Y-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Massachusetts General Hospital-Sexual Functioning Questionnaire 89 PALABRAS CLAVE Adaptación, validación y fiabilidad del Cuestionario de funcionamiento sexual MGH-SFQ; del Hospital General de Massachusetts en una muestra colombiana y equivalencia Cuestionario de factorial con la versión en español funcionamiento sexual del Hospital Resumen Las disfunciones sexuales son un problema muy frecuente. Es necesario contar con General de instrumentos adaptados a la población colombiana con el fin de evaluar su funcionamiento sex- Massachusetts; ual porque hasta la fecha ninguno de ellos se ha validado. El objetivo de este estudio fue adaptar Equivalencia y validar el Cuestionario de funcionamiento sexual del Hospital General de Massachusetts en la factorial; población colombiana y compararla con una muestra similar de España. Se utilizaron dos mues- Funcionamiento tras diferentes en este estudio. Por una parte, una muestra de jueces expertos que realizaron sexual; la adaptación cultural y la evaluación de la escala, y por la otra, una segunda muestra final Validación; de 1.117 participantes - hombres y mujeres de ambas nacionalidades - que respondieron el Salud sexual cuestionario, junto con otros, a través de una plataforma virtual. Algunos de los elementos se ajustaron según los resultados iniciales de la evaluación realizada por jueces expertos. Se obtu- vieron coeficientes alfa de Cronbach entre 0.81 y 0.92 después de la aplicación de la prueba. Las propiedades psicométricas de la escala son adecuadas y este instrumento se correlaciona debidamente con otras variables para el criterio. La validez del constructo se evaluó mediante invariancia factorial. El modelo configural unidimensional para los hombres (RMSEA = 0.000; CFI = 1) y para las mujeres (RMSEA = 0.048; CFI = 0.997) tenía un ajuste adecuado, y también se alcanzó un nivel de estricta invariancia. Puede realizarse un cribado con esta primera escala validada para evaluar las dificultades sexuales de la población colombiana y compararlas con las de la población española. © 2016 Fundación Universitaria Konrad Lorenz. Publicado por Elsevier España, S.L.U. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/ by-nc-nd/4.0/). e l D t b t r s S O S L I S 1 w o m t 1 r s t s . S u Sexual dysfunctions are a problem of great impact on the world’s population (World Health Organization, 2000). Sex- ual functioning disorders may arise during different stages of the sexual response cycle. Thus, desire, arousal, orgasm and general sexual satisfaction can be affected. Pain in the genital area at some point during sexual intercourse is also considered as a sexual functioning disorder (American Psychiatric Association, 2000; Laumann, Paik, & Rosen, 1999). Patients who have sexual dysfunctions may be also have anxiety and depression disorders (Michael & O’Keane, 2000; Ozkan, Orhan, Aktas, & Coskuner, 2015; Rajkumar & Kumaran, 2015). The prevalence of sexual dysfunction in men is estimated between 20% and 30%, while in women it ranges between 40% and 45% (Lewis et al., 2004, 2010; Lewis, 2011; Nicolosi et al., 2004). The Diagnostic and Statistical Manual of Mental Dis- orders -- 5th edition (DSM 5) presents the following prevalences: delayed ejaculation is less than 1%; erectile disorder between 13% and 50%; hypoactive sexual desire dis- order between 6% and 41% and premature ejaculation between 20% and 30%. For women, female orgasmic disorder varies between 10% and 42%; data regarding the sexual inter- est/arousal disorder are not shown since it has recently been defined. Finally, 15% of women may have genito/pelvic pain disorder (American Psychiatric Association, 2013). Similar data have been found in other studies (DeRogatis & Burnett, 2008; Lewis et al., 2010). As for prevalence in Colombia, only a few studies report the prevalence and incidence of sexual dysfunctions. A study by Acuña and Ceballos (2005) showed that 54.5% of the male t population has sexual dysfunctions, and the most frequent s ones are erectile dysfunction with 43.27% and premature pjaculation with 14.93%; another study reported a preva- ence of 55.8% in women (García, Aponte, & Moreno, 2005). esire and arousal-related problems are most prevalent in his sample. However, these are approximate data estimated ased on small samples and unvalidated scales. It is important to have validated instruments in order o evaluate sexual functioning thereby allowing to obtain eliable data. There are many instruments to evaluate exual functioning (Fisher, Davis, Yarber, & Davis, 2013; ierra, Santos-Iglesias, Vallejo-Medina, & Moyano, 2014). ne of these tests is the Massachusetts General Hospital- exual Functioning Questionnaire (MGH-SFQ; Labbate & are, 2001), which was developed based on the Guided nterview Questionnaire and the Arizona Sexual Experience cale (Fava, Rankin, Alpert, Nierenberg, & Worthington, 998). This questionnaire consists of five different items hich evaluate sexual interest, arousal, the ability to reach rgasms, the ability to reach and maintain an erection (for en only) and general satisfaction. Values were assigned o the Likert response scale as follows: 0 = totally reduced, = strongly reduced, 2 = moderately reduced, 3 = slightly educed and 4 = normal. The original study showed that the cale correlated significantly in each of its dimensions with he CSFQ scale (Labbate & Lare, 2001). In the validation tudy for Spain, this scale showed an internal consistency of 90 and .93 in men and in women (Sierra, Vallejo-Medina, antos-Iglesias, & Fernandez, 2012). The MGH-SFQ has proven to be reliable in identifying sex- al dysfunctions in the target population; it has been applied o detect sexual dysfunction in patients under antidepres- ant treatment (Taylor et al., 2013), with psychological roblems (Hoyer, Uhmann, Rambow, & Jacobi, 2009) or 9 i S s a P a i S T c i v u o M l t P S b T v w w a h o s a a a m o o p s T u 1 a w s t e t . l c M f 1 p S s a u c 1 i c a 6 t u i 8 f 7 I P M T t o c e i f f K s o f b e S o g s w w ( 2 A w ( a a n s T 2 t a 0 n order to evaluate the effect other substances have on exual functioning (Dording, Mischoulon, Shyu, Alpert, & apakostas, 2012). The aim of this study was to adapt and validate the MGH- FQ in a sample of Colombian men and women as well as to alculate its factorial equivalence as compared to its Spanish ersion. ethod articipants he sample initially included a total of 1797 participants, ho were selected incidentally, seeking to achieve a bal- nce regarding sex and age. Inclusion criteria were: being f age, having a Colombian or a Spanish nationality -as ppropriate- accepting voluntarily to partake in the study nd having answered the questionnaire thoroughly. Based n these criteria, the final sample consisted of 1117 partici- ants, 621 Colombian nationals and 496 Spanish nationals. he age range for the Colombian population ranged between 8 and 72 years (M = 32.04, SD = 10.87). Age ranges in Spain ere 18 and 70 years (M = 33.94, SD = 12.61), and statis- ically significant differences were observed between the wo countries t(1115) = 2.69; p < .01; d = 0.16. The schooling evel in Colombia was M = 16.69 years (SD = 2.84) and in Spain = 15.88 years (SD = 3.97), with statistically significant dif- erences t(1104) = 3.95; p < .01; d = 0.23. Fifty-five point nine ercent of respondents who were tested in Colombia were ingle, versus 60.5% in Spain. According to Kinsey’s Sex- al Orientation Scale (Kinsey, Pomeroy, Martin, & Gebhard, 953, and Kinsey, Pomeroy, & Martin, 1948), 84% of parti- ipants in Colombia stated being exclusively heterosexual, .9% mainly heterosexual, and 3.1% exclusively homosex- al, among other smaller percentages, whereas in Spain, 2% of participants stated to be exclusively heterosexual, .5% mainly heterosexual and 3.8% exclusively homosexual. nstruments assachusetts General Hospital-Sexual Functioning Ques- ionnaire (MGH-SFQ; Labbate & Lare, 2001). Description and haracteristics of this questionnaire can be found in the ntroduction (see Appendix 1). Sexual Opinion Survey (SOS; Fisher, White, Byrne, & elley, 1988). It originally consisted of 21 items answered n a 7-alternative Likert scale ranging from 0 = totally alse to 6 = totally true. The SOS evaluates the erotophilia- rotophobia personality trait, which identifies the positive r negative evaluation that people have toward stimuli of exual content. A brief 6-item version of the SOS scale which as validated in Spain and Colombia (Vallejo-Medina et al., 015a, 2015b; Vallejo-Medina, Granados, & Sierra, 2014) as used in this study; this version has shown adequate reli- bility (˛ = .74). Reliability in this study was .85 for Colombia nd .66 for Spain. Sexual Assertiveness Scale (SAS; Morokoff et al., 1997).he brief 9-item version of the scale (Vallejo-Medina et al., t 015a, 2015b) was used. This scale was based on the adap- s ation by Sierra, Vallejo-Medina, Santos and Iglesias (2011), t nd Sierra, Santos-Iglesias and Vallejo-Medina (2012). The aL. Marchal-Bertrand et al. AS consists of three dimensions: Initiation, which is the bility to initiate sexual relations whenever desired, as well s carrying them out as desired; refusal, which is the abil- ty to reject sexual unwanted practices or contact; Sexually ransmitted Diseases -- unwanted Pregnancy (STD-P), which s the ability to negotiate the use of a condom during sex- al relations (Morokoff et al., 1997). Each subscale consists f three items scored from 0 = never to 4 = always. The fol- owing reliability data were found in the three subscales in his study (initiation = .72 and 0.75; refusal = .60 and .82; and TD-P = .90 and .91 for Colombia and Spain respectively). Sexuality Scale (SS; Snell & Papini, 1989). The 15-item rief version of Wiederman and Allgeier (1993) as well as the ersion validated in Colombia and Spain (Soler et al., 2015) ere used in this study. The aforementioned questionnaire as three subscales: Sexual Self-Esteem (SS), Sexual Depres- ion (SD) and Sexual Preoccupation (SP). SS is defined as the bility to experience sexuality in a positive and confident anner. SD is the feeling of experiencing depression about ne’s own sexuality. The SP is the tendency to think exces- ively about sex (Snell & Papini, 1989). This scale is answered sing a 5-category Likert scale ranging from strongly dis- gree to strongly agree. The Cronbach’s alphas for each ubscale in this questionnaire were as follows: sexual self- steem .82 in Colombia and .87 in Spain; sexual depression 86 for both countries; and sexual preoccupation .85 for both ountries. The Rosenberg Self-Esteem Scale (RSES; Rosenberg, 965). This study was based on the validated version for pain by Martin-Albo, Nuñez, Navarro and Grijalvo (2007) nd for Colombia (Gomez-Lugo et al., in press). The scale onsists of 10 items which evaluate general self-esteem; t is answered on a Likert scale wherein 1 = strongly dis- gree, 2 = disagree, 3 = agree, 4 = strongly agree. Therefore, he overall score ranges from 10 to 40 points. Higher scores ndicate better self-esteem. The Cronbach’s alphas were .83 or Colombia and .87 for Spain. rocedure he scales were reviewed by four Colombian expert psychol- gists who had lived for at least two years in Spain. These xperts contributed in the cultural adaptation of the scales rom Spanish of Spain into Spanish of Colombia. In addition, our experts in psychometrics and/or sexuality evaluated ome of the properties of the items. Initially, the cultural adaptation of the MGH-SFQ was ased on the version that had already been validated in pain (Sierra, Vallejo-Medina, et al., 2012), following the uidelines by Vallejo-Medina et al. (2015a, 2015b), which as based on the proposal by Muñiz, Elosua and Hambleton 2013), as well as the recommendations of Elosua, Mujika, lmeida, and Hermosilla (2014) and APA, AERA and NCME 2014). Once this first adaptation was performed, the question- aire was submitted to 4 experts in psychometrics and/or exuality who evaluated the adequacy of the items. All he experts evaluated the item’s representativeness of the exual functioning construct, the item’s comprehension in he Colombian version, the single item’s interpretation (no mbiguity), and the item’s clarity (how concise the item is). nair v t A i T a v ( C t r i f S a F P f c b w fi m w s f a m . l fi i A l w fi i t E M S e o s a t S s k Massachusetts General Hospital-Sexual Functioning Question The experts rated the items in different categories ranging from 1 (nothing . . .) to 4 (very . . .) using the table of specifi- cation of the items (Osterlind, 1989). The ICaiken program (Merino & Livia, 2009) was used in order to calculate the confidence interval of the Aiken’s V (Aiken, 1980, 1985). Scores below .50 at the lower limit (CI = 95%) were estab- lished as the cutoff point for Aiken’s V and a criterion of inadequacy of the item (Merino & Livia, 2009). The final sampling was performed through virtual plat- forms. The questionnaire was entered in Typeform© and it was applied in an homologous way in both countries. Sam- pling was conducted between October 23, 2014 and February 24, 2015. Data analysis SPSS 20.0 was used to analyze some of the psychomet- ric properties of the items. EQS 6.1 was used to calculate the factorial invariance (FI) as in other studies of sexual- ity (Monge, Sierra, & Salinas, 2013). The FI was evaluated progressively under a Mean and Covariances Structures pro- cedure (MACS), as recommended by Byrne et al. (2009). Multivariate data distribution was calculated using Mardia’s test, wherein values above 5 are indicative of non-normality. This test indicated results of 38.0 in Colombia and 74.6 in Spain for men, and 17.04 in Colombia and 14.36 in Spain for women. Thus, the Maximum Likelihood method, Robust (ML, R) was used as the estimation method since the parameter of normal distribution was not met. Regarding progressive fac- torial invariance, the configural invariance was evaluated during the first stage: no restrictions in the model. Metric or weak invariance was evaluated during the second stage: the factorial loads are restricted evaluating the equivalence of the loads of each item regarding the factor. Strong invari- ance was measured during the third stage -- intercepts were restricted- and strict invariance measurements showed that the variances of the errors were restricted. The indices taken into account in order to evaluate the fit of the models were as follows: the Root Mean Square Error Approximation (RMSEA; Hu & Bentler, 1999), the confidence interval -- at 90% -- and the Comparative Fit Index (CFI; Bentler, 1990). Values below .08 for the RMSEA (Browne & Cudeck, 1992) and greater than .95 for the CFI were considered indicative of good fit. A decrease no greater than .01 with regard to the least restrictive model was taken as evidence of invariance (Cheung & Rensvold, 2002). The Akaike Information Crite- rion (AIC; Akaike, 1974) was also taken into account, which indicates absence of FI should the increase with regard to the least restrictive model be considerable. Results Properties of items and content validity Table 1 shows the qualitative evaluation that four experts in psychometrics and/or sexuality performed on the five items from the scale of the Colombian version. The lower l limit of Aiken’s V was not always above 50%; for this reason, s it was necessary h to make some adjustments to the items such as modifying their wording as recommended. C Contente 91 alidity was optimal for all items with a 100% agreement by he judges regarding the relevance of all items. nalysis of some psychometric properties of the tems and reliability able 2 shows that the indicators analyzed were generally dequate. Both versions were reliable and had very similar alues in both countries. Corrected item-total correlations Ccit) are always greater than .30. No significant increase in ronbach’s alpha was observed if an item was removed, and he mean values of the items were slightly above the theo- etical average of response (2.5). Furthermore, SD’s above 1 ndicated adequate response variability. Cronbach’s alphas or this scale were .89 and .81 for men in Colombia and pain respectively; and .89 and .92 for women in Colombia nd Spain respectively. actorial invariance rogressive factorial invariance was performed separately or men and women (Table 3) in order to evaluate the scale’s onstruct validity and establish the factorial equivalence etween versions of Spain and Colombia. Analysis began ith the model’s most basic level of restriction: the con- gural variance -- without constrictions. Good fit of the data atrix was observed in the proposed theoretical model, hich allows to accept the equivalence of the basic mea- urement models between the two versions of the test. As or weak invariance, proper fit of the model is observed, s well as compliance with factorial invariance for both en and women, with a decrease in CFI no greater than 01, thereby indicating that the factor loads are equiva- ent in both scales. In regards to strong invariance, a good t is observed in both men and women. However, the CFI ncrease for men is slightly higher than expected, though IC increase is not very high, so it was considered that this evel of invariance is also met. Finally, for strict invariance, hich was the last level tested, results also showed a good t in RMSEA values in both men and women; the CFI and AIC ncrease indicate equal estimation error in evaluating both he Colombian and the Spanish versions. xternal validity and clinical approach GH-SFQ scores were correlated with the SOS, the SAS, the S and the RSES scores (Table 4) in order to evaluate its xternal validity. These scales evaluate some variables the- retically related to the MGH-SFQ. The majority of the scales how a significant correlation as compared to the MGH-SFQ nd they aim at the expected direction. The only subscale hat does not correlate with the test is the assertiveness TD-P. Furthermore, the intra-items correlations are very imilar for Spain and Colombia, as shown in Tables 5 and 6. Likewise, the percentage of participants who had some ind of dysfunction was estimated establishing a score of 2 or ess as a cutoff point. Thus, 33.5% of men in Colombia had a exual dysfunction of some kind, while in Spain 31.6% of men ad a dysfunction. Forty-four point six percent of women in olombia and 50.5% in Spain had a sexual dysfunction. 92 L. Marchal-Bertrand et al. Table 1 Evaluation of the characteristics of the items of the Massachusetts General Hospital-Sexual Functioning Questionnaire by experts. EXP.1 EXP.2 EXP.3 EXP.4 M Aiken’s V % agreement LI-UL 95% Rep. 3 4 4 4 3.75 .91 .64 .98 Rel. 1 1 1 1 100 Item 1 Com. 3 4 3 3 3.25 .75 .46 .91 Int. 4 4 4 4 4 1 .75 1 Cla. 4 4 4 3 3.75 .91 Rep. 3 4 4 4 3.75 .91 .64 .98 Rel. 2 2 2 2 100 Item 2 Com. 3 4 3 3 3.25 .75 .46 .91 Int. 4 4 4 4 4 1 .75 1 Cla 4 4 4 3 3.75 .91 .64 .98 Rep 3 4 4 4 3.75 .91 .64 .98 Rel. 3 3 3 3 100 Item 3 Com 3 4 4 4 3.75 .91 .64 .98 Int. 4 4 4 4 4 1 .75 1 Cla. 4 4 4 3 3.75 .91 .64 .98 Rep. 3 4 4 4 3.75 .91 .64 .98 Rel. 4 4 4 4 100 Item 4 Com. 4 4 3 4 3.75 .91 .64 .98 Int. 4 4 4 4 4 1 .75 1 Cla. 3 4 4 3 3.5 .83 .55 .95 Rep. 3 4 4 3 3.5 .83 .55 .95 Rel. 5 5 5 5 100 Item 5 Com. 4 4 4 2 3.5 .83 .55 .95 Int. 4 4 4 2 3.5 .83 .55 .95 Cla. 4 4 4 2 3.5 .83 .55 .95 Note. Rep: representativeness; Rel: relevance; C: comprehension; I: interpretation; CL: clarity; Exp: expert; M: mean; LI: lower limit; UL: upper limit. Table 2 Reliability and some properties of the items for both men and women from Colombia and Spain. Country Item M DE c Cit ˛ − i ˛ M total SD total MGHSFQ1 3.11 1.24 .68 .88 MGHSFQ2 3.15 1.25 .85 .82 Women MGHSFQ3 3.04 1.36 .75 .85 .88 12.39 4.53 MGHSFQ5 3.08 1.37 .74 .86 Colombia MGHSFQ1 3.41 1.03 .75 .87 MGHSFQ2 3.46 0.97 .80 .86 Men MGHSFQ3 3.46 1.06 .74 .87 .89 17.13 4.43 MGHSFQ4 3.53 1.01 .75 .87 MGHSFQ5 3.28 1.17 .69 .88 MGHSFQ1 2.97 1.31 .71 .88 MGHSFQ2 3.07 1.3 .85 .83 Women MGHSFQ3 3.08 1.37 .75 .86 .92 11.97 4.73 MGHSFQ5 2.85 1.42 .75 .86 Spain MGHSFQ1 3.38 1.09 .64 .76 MGHSFQ2 3.59 0.86 .69 .74 Men MGHSFQ3 3.64 0.84 .63 .76 .81 17.75 3.50 MGHSFQ4 3.80 0.65 .55 .79 MGHSFQ5 3.34 1.10 .55 .79 cNote. M: mean; SD: standard deviation; Cit: corrected total-item corre alpha.lations; ˛ − i: Cronbach’s alpha if item is removed; ˛: Cronbach’s Massachusetts General Hospital-Sexual Functioning Questionnaire 93 Table 3 Invariance fit indices for men and women model. Invariance level 2 S-B  gl p AIC CFI CFI RMSEA 90% for RMSEA LI LS Men Configural invariance 4.12 6 .66 237.67 1.00 -- .000 .000 .046 Weak invariance 16.13 11 .13 237.67 .988 −.012 .034 .000 .08 Strong invariance 26.69 16 .04 285.84 .972 −.016 .057 .000 .097 Strict invariance 21.10 21 .45 314.60 .999 .027 .008 .000 .062 Women Configural invariance 71.84 2 .02 98.81 .997 -- .04 .00 .10 Weak invariance 12.76 5 .02 98.81 .994 −.003 .04 .00 .09 Strong invariance 28.80 9 .00 1104.32 .988 −.006 .07 .03 .11 Strict invariance 26.98 13 .01 1194.39 .993 .005 .04 .00 .08 Note. CFI: Comparative Fit Index; S-B 2  : Santorra-Bentler Scaled Chi-Square; RMSEA: Root Mean Square Error of Approximation; LL: lower limit; UL: upper limit. Table 4 Correlations with the different tests evaluated. Country SS SD SP IA RA STD-P GS SOS Colombia MGH-SFQ .31** −.43** .21** .20** −.24** −.01 .25** .08* Spain MGH-SFQ .27** −.39** .19** .13** −.23** −.04 .28** .17** Note. MGH-SFQ: Massachusetts General Hospital-Sexual Functioning Questionnaire; SS: sexual self-esteem; SD: sexual depression; SP: sexual preoccupation; IA: initiation assertiveness; RA: refusal assertiveness; STD-P: Sexual Transmitted Diseases-Pregnancy Sexual Assertiveness; GS: general self-esteem; SOS: Sexual Opinion Survey. * p < .05. ** p < .01. Table 5 Correlations between items of MSG-SFQ for women. Colombia Spain Desire Arousal Orgasm Satisfaction Desire 1 .77** .55** .53** Arousal .76** 1 .72** .71** Orgasm .54** .74** 1 .71** Satisfaction .61** .70** .70** 1 Correlations for Colombia are above the diagonal, and correlations for Spain are below the diagonal. ** p < .01. Table 6 Correlations between items of MSG-SFQ for men. Colombia Spain Desire Arousal Orgasm Erection Satisfaction Desire 1 .77** .57** .63** .59** Arousal .61** 1 .68** .69** .58** Orgasm .47** .55** 1 .65** .62** Erection .43** .44** .54** 1 .60** Satisfaction .47** .49** .42** .35** 1 Correlations for Colombia are above the diagonal, and correlations for Spain are below the diagonal. ** p < .01. 9 D s f T D C I F & i I s & b 2 a 2 C r m a s ( t b e t t I i o a e I i b g ( c e c s B a c i a f w a p s t b i i w o t S a 2 i m i i e e ( a d a t c v l A i t i s F t i i b u 4 iscussion he first scale to evaluate sexual functioning in both olombian men and women was validated in this study. urthermore, it was proven that the scores are strictly nvariant, thus allowing to compare sexual functioning cores for both men and women from Spain and Colom- ia. Consequently, the MGH-SFQ becomes the only valid nd reliable instrument for evaluating sexual functioning in olombia. The samples obtained in this study were homologous in ost socio-demographics, and those in which statistically ignificant differences were found are not expected to affect he results due to the low size of the effect of the differ- nces. The qualitative evaluation of the items was appropriate. tems which showed any problems during the initial stage f adaptation were modified following the comments of the xperts (from ‘‘How would you rate your overall sexual sat- sfaction in the last month?, to ‘‘How would you rate your eneral sexual satisfaction in the last month?’’) In addition, ontent validity was optimal, which could indicate adequate onstruct validity. The quantitative evaluation of the items is also optimal. oth the Colombian and Spanish versions showed adequate orrected item-total correlations indices and Cronbach’s lphas if the item is removed. The distribution of scores, ith a mean of the scale slightly above its theoretical aver- ge (as would be expected in non-clinical population), and tandard deviations close to 1 indicate an adequate distri- ution of scores. Furthermore, a scale with good reliability s shown (Nunnally & Bernstein, 1995), similar to the one btained in previous studies (Labbate & Lare, 2001; Sierra, antos-Iglesias, et al., 2012; Sierra, Vallejo-Medina, et al., 012). One of the limitations of the MGH-SFQ is the fact that ts dimensionality has not been replicated; in fact, to the xtent of our knowledge, only Sierra, Santos-Iglesias, et al. 2012) and Sierra, Vallejo-Medina, et al. (2012) have con- ucted an exploratory factor analysis. Not only was the heoretical basis of dimensionality verified through content alidity, but a confirmation of the dimensionality and equiva- ence with the version validated in Spain was also performed n this study through factorial invariance. A level of strict nvariance was obtained for both men and women with a ingle limit value in strong invariance. This allows not only he comparison between groups (Elosua, 2005), but to carry t out with the same level of error (Dimitrov, 2010).External validity shows positive significant correlations t etween low and moderate with sexual self-esteem, sex- r al preoccupation, initial sexual assertiveness, general c Totalmente M disminuido. d 1. ¿Cómo ha estado su interés sexual durante 0 1 el último mes? 2. ¿Cómo ha estado su capacidad para 0 1 conseguir excitación sexual en el último mes?L. Marchal-Bertrand et al. elf-esteem and erotophilia. Other authors had already ound some of these relations: sexual self-esteem (Brassard, upuy, Bergeron, & Shaver, 2015; Sanchez-Fuentes, Santos- glesias, & Sierra, 2014; Wentland, Herold, Desmarais, Milhausen, 2009), initial sexual assertiveness (Santos- glesias & Sierra, 2010), general self-esteem (Tan, Waldman, Bostick, 2002) and erotophilia (Nobre & Pinto-Gouveia, 006; Ponseti & Bosinski, 2010; Sanchez-Fuentes et al., 014; Santos-Iglesias, Sierra, & Vallejo-Medina, 2013). Negative correlations with sexual depression and sexual efusal assertiveness were also found; the latter relation -- lbeit weak- was also observed in Vallejo-Medina and Sierra 2015). This result is coherent since it could be an avoidance ehavior of people who have some type of sexual dysfunc- ion, because they tend to avoid sexual contact in order not o face the difficulty they are dealing with. Sexual function- ng and assertiveness STD-P do not correlate and this fact grees with other studies’ findings as highlighted by Santos- glesias and Sierra (2010). Besides, correlations observed etween items in this study indicate, as in other studies Sierra, Santos-Iglesias, et al., 2012; Sierra, Vallejo-Medina, t al., 2012), the relations between the sexual functioning tages, even though they are independent. This instrument could be used for screening because it llows to identify difficulties regarding sexual response, but t does not allow to specify particular characteristics of dif- erent dysfunctions. This study has some limitations related to a linear inter- retation of sexuality, an aspect that may not correspond o women sexual functioning which is more complex. It s also important to establish the correlation of this scale ith other sexual functioning scales, as well as extending he study population including clinical sample, which would llow a better extrapolation of data. Finally, the use of an ncidental sampling, conducted through a virtual evaluation, akes generalization of results impossible. Nevertheless, it s worth considering that this is a first validation of a scale to valuate sexual functioning in Colombia. The result is a valid nd reliable adaptation for evaluating Colombian women nd men’s sexual functioning, which also allows a cultural omparison with Spain. ppendix A. Colombian validated version of he Massachusetts General Hospital-Sexual unctioning Questionnaire (MGH-SFQ; Labbate & Lare, 2001) n Colombia En la presente escala se le preguntará por algunos aspec- os relacionados con el funcionamiento sexual. Por favor esponda con sinceridad cada una de las preguntas, selec- ionando una de las opciones disponibles arcadamente Moderadamente Mínimamente Normal isminuido disminuido. disminuido. 2 3 42 3 4 nair M di 1 1 1 A A A B B B B C D D D E E F Massachusetts General Hospital-Sexual Functioning Question Totalmente disminuido. 3. ¿Cómo ha estado su capacidad para 0 alcanzar el orgasmo en el último mes? 4. ¿Cómo ha estado su capacidad para 0 conseguir y mantener una erección en el último mes? (solo para hombres) 5. ¿Cómo calificaría su satisfacción sexual 0 general en el último mes? Dimensiones de la escala: - Deseo Sexual: se conceptualiza como un impulso apeti- tivo que es necesario para provocar los cambios físicos anteriores a la excitación sexual. - Excitación Sexual: es la preparación fisiológica para el contacto sexual. - Orgasmo: es una sensación de intenso placer acompañada por una alteración de la conciencia y contracción de la musculatura genitourinaria. - Erección (Sólo para hombres): hace alusión a la capacidad para alcanzar y mantener una erección. - Satisfacción general: es el valor subjetivo otorgado a lo placentero de la actividad sexual. Inversión de ítems: No hay ítems invertidos para el MGH- SFQ. Correspondencia de ítems en dimensiones: 1. Deseo. 2. Excitación. 3. Orgasmo. 4. Erección (Para hombres únicamente). 5. Satisfacción general. - Mujeres: Se deben sumar los ítems 1, 2, 3 y 5, y el resultado de dicha suma debe ser divida en 4. - Hombres: Se deben sumar los ítems 1, 2, 3, 4 y 5, y el resultado de dicha suma debe ser divida en 5. 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