B-PFSF

Applications of the B-PFSF

The Brief PFSF is widely used in academic research. It was derived from a longer scale developed for Procter and Gamble Pharmaceuticals for use in the clinical trial of a new product prior to submission to the US Federal Drugs Administration (FDA). The team constructed the Profile of Female Sexual Functioning (PFSF), a diagnostic instrument for the DSM-IV(R) diagnostic category of Female Hypoactive Sexual Desire Disorder (HSDD), a combination of low sexual desire and associated distress, often a side-effect of ovariectomy or hysterectomy.

The development of the PFSF went through several stages including:

• focus groups of patients to generate appropriate laymans’ terminology for the condition
• item writing based on the interviews and feedback from physicians, counselors and other professionals
• pilot studies of a longer form of the questionnaire
• item analysis of the results
• administration to appropriate patient and non-patient groups
• translation, back translation and cognitive interviews in the various languages of the project (French, English, Italian and Dutch)

The final form of the instrument involved 37 items, grouped in seven domains: sexual desire, arousal, orgasm, sexual pleasure, sexual concerns, sexual responsiveness and sexual self-image. A trial of the PFSF in eight countries (France, Germany, Holland, Italy, the UK, Canada, the USA and Australia) showed a decrease in satisfying sexual activity and desire in patients with HSDD.

Subsequent double-blind clinical trials of a testosterone patch in comparison with a placebo showed that the use of the patch led to a significant improvement in sexual desire in

• Naturally menopausal women with low libido
• Surgically menopausal women with low libido

The product was initially marketed throughout Europe as Intrinsa™, a female testosterone patch, but in the USA failed FDA approval (very likely for political reasons). However, a shorter version, the Brief-PFSF, did survive and continues to be used in academic studies.

Navigating the Controversy: Understanding Low Sexual Desire

The Profile of Female Sexual Functioning, originally designed to assess low sexual desire in postmenopausal women, ignited a debate that highlights a critical intersection of medical science and societal norms. At the heart of this controversy was the proposed DSM-V disorder of ‘low female sexual desire,’ which many critics, particularly from the women’s movement, argued risks pathologizing the natural spectrum of sexual desire. It was contended that such medicalization not only imposes an unrealistic standard on women’s sexual experiences but also potentially stigmatizes those whose desire does not conform to these narrow criteria. This debate underscores a broader dialogue on the medicalization of female sexuality, the autonomy of women’s bodies, and the societal expectations that shape our understanding of sexual health. It calls for a more nuanced and empowering approach to women’s sexual well-being, one that acknowledges the diversity of sexual desire without resorting to medical labels.

Publications 

• Rust, J., Derogatis, L., Rodenberg, C, Koochaki, P., Schmitt, S. and Golombok, S. (2007) Development and validation of a new screening tool for hypoactive sexual desire disorder: The Brief Profile of Female Sexual Dysfunction (B-PFSF). Gynecological Endocrinology, 23(11), 638-644.
• McHorney, C. A., Rust, J., Golombok, S., Davis, S., Bouchard, C., Brown, C., Basson, R., Sarti, C. D., Kuznicki, J., Rodenberg, C. & Derogatis, L. (2004) The Profile of Female Sexual Dysfunction (PFSF): A patient-based international psychometric instrument for the assessment of hypoactive sexual desire in oophorectomized women. Menopause, 11(4), 474-483.
• Derogatis, L, Rust, J., Golombok, S., Bouchard, C., Nachtigal, L. Rodenberg, C., Kuzniki, J. & McHorney, C. (2004) Validation of the Profile of Female Sexual Function (PFSF) in surgically and naturally menopausal women. Journal of Sex and Marital Therapy. 20(1), 25-36.