Sexual Distress Scale: Translation, Psychometric Validation, and Reference Values for Cisgender Women and Men in a Representative Population-based Sample in Germany

Abstract Sexual dysfunction is common but often remains undetected in gynecological care. Validated instruments can support accurate and efficient diagnosis, especially under time constraints and limited patient contact. The Female Sexual Distress Scale–Desire/Arousal/Orgasm (FSDS-DAO) is an internationally validated instrument to assess sexual distress, the core diagnostic criterion for sexual dysfunction according to ICD-11. This study aimed to i) validate the factor structure of the German FSDS-DAO questionnaire, ii) examine its applicability in cisgender women and men, and iii) determine a clinically relevant cutoff score. The German version was developed using a standardized translation process and extended by a 16th item assessing distress due to pain during sexual activity. Validation was based on a representative German sample from a population survey on persons seeking help for sexual dysfunction (N = 4023). Cisgender women and men were matched using propensity scores based on sociodemographic characteristics. Confirmatory factor analysis and measurement invariance testing were conducted in the matched sample (N = 2829). A ROC analysis using an ICD-11 screening tool was performed in the full sample (N = 4023) to determine a clinically relevant cutoff. The proposed factor structure was confirmed. Partial strict measurement invariance between women and men was observed, with one item showing group-specific properties. Overall, men reported slightly higher sexual distress (d = 0.13). A clinically relevant cutoff of 16 (AUC = 0.89) was identified with high diagnostic accuracy. With 16 items and a validated cutoff score of 16, the German version of the FSDS-DAO represents a practical screening instrument for use in the care of both women and men.