Married Women’s Sexual Satisfaction Questionnaire; A Developmental and Psychometric Evaluation


Zahra Shahvari 1 , * , Firoozeh Raisi 2 , Zohre Parsa Yekta 3 , Abbas Ebadi 4 , Anoshirvan Kazemnejad 5

1 Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran

2 Psychiatric and Clinical Psychology Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran

3 Department of Medical Surgical, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran

4 Behavioral Sciences Research Center (BSRC), Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran

5 Department of Biostatistics, Faculty of Medical Sciences, Tarbiyat Modares University, Tehran, IR Iran

How to Cite: Shahvari Z, Raisi F, Parsa Yekta Z, Ebadi A, Kazemnejad A. Married Women’s Sexual Satisfaction Questionnaire; A Developmental and Psychometric Evaluation, Iran Red Crescent Med J. 2015 ; 17(4):e59654. doi: 10.5812/ircmj.17(4)2015.26488.


Iranian Red Crescent Medical Journal: 17 (4); e59654
Published Online: April 25, 2015
Article Type: Research Article
Received: December 28, 2014
Revised: February 11, 2015
Accepted: February 27, 2015




Background: Despite the significant contribution of cultural factors to sexual satisfaction, most of the current sexual satisfaction scales pay little attention, if any, to cultural factors and marital status.

Objectives: The current study aimed to develop and validate the Iranian Married Women’s Sexual Satisfaction Scale.

Patients and Methods: The current methodological study went through three consecutive phases. In the first phase, the concept of sexual satisfaction was defined and analyzed by the hybrid model approach. In the second phase, an item pool was generated by the findings of the first phase. Finally, the psychometric properties of the scale were evaluated in the third phase. All data analyses were performed by the SPSS version 19.0.

Results: A 78-item pool was generated based on the findings of the concept analysis phase. After assessing and confirming its face and content validity, 27 items remained in the final version of the scale. The exploratory factor analysis revealed a four-factor structure for the scale. The results of the known-groups comparison showed that females with lower educational status had significantly lower sexual satisfaction. Moreover, there was a significant correlation between the scores of the finalized scale and those of the ENRICH Marital Satisfaction Scale (r = 0.706, P = 0.01). The interclass correlation between the test and the retest measurements was also statistically significant (ICC = 0.939, P value = 0.001).

Conclusions: The 27-item Iranian Married Women’s Sexual Satisfaction Scale is a simple, valid, and reliable tool to assess married women’s sexual satisfaction.


Personal Satisfaction Couples Therapy Questionnaires Self-Report

Copyright © 2015, Iranian Red Crescent Medical Journal.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

Seeking a healthy, joyful, and satisfactory sexual life is among the fundamental rights of all humans (1). Sexual satisfaction (SS) is an essential prerequisite to a happy and committed relationship. It is significantly correlated with physical and mental health (2), satisfaction with relationship and marriage (3), general well-being, and quality of life (4). SS is considered as a barometer for the quality of a relationship (5). A pleasant and satisfactory sexual relationship has positive effect on subsequent sexual experiences (6) and strengthens the relationship. Perceived SS affects and is affected by all aspects of life (7). According to Parish et al. (8), the five factors of sexual conduct, social and emotional aspects of the relationship, sexual attitudes and values, physical health, and environmental obstacles can affect SS. Moreover, the frequency of sexual activities, the diversity of sexual behaviors, as well as sexual desire are reported to affect SS (9, 10). Sexual relationship is not a mere biological process; rather, it is experienced in a mixed intrapersonal, interpersonal, and cultural context (11). However, despite the significant contribution of cultural factors to SS (12), SS scales mostly assess physiological aspects of sexual relationship and pay little attention, if any, to cultural factors and marital status. Moreover, these scales are widely used in different communities and cultures worldwide without considering and evaluating their cross-cultural appropriateness and adaptation. Several scales have been developed so far in Iran to assess individuals’ sexual functions (13, 14). However, there was no valid and reliable scale to assess SS. Currently, there is no standardized scale to evaluate married women’s SS in the context of the Iranian culture. Most of the scales used in Iran are originally developed in other countries and have not been cross-culturally adapted to be used in the Iranian culture. Accordingly, the items of these scales are either confusing or improper to evaluate Iranian women’s SS.

2. Objectives

The current study aimed to develop and validate the Iranian Married Women’s SS questionnaires (MWSSQ).

3. Materials and Methods

The current methodological study aimed to develop and validate the MWSSQ. A methodological study essentially includes the following steps: defining the concepts, formulating the questionnaire's items, developing questionnaire for users, and testing the questionnaire's reliability and validity (15). The current study was conducted in three subsequent phases as follows.

3.1. First Phase

The concept of married women’s SS was defined by using the three-step hybrid model approach (16). In the first theoretical step, a comprehensive literature review was performed on documents published from 1975 to 2014. This step yielded to a clear and comprehensive definition of the concept based on the existing literature. The second step, i.e. the field work step, was taken concurrently with the theoretical one. The first step aimed to refine the definition of the concept by empirical data. Accordingly, a purposeful sample of twenty 19 - 76 year-old married women was selected. Participants ranged in length of time married from one to 47 years. In this step, in-depth semi-structured personal interviews were conducted to explore the participants’ experiences of SS. Data collection was performed from 2103 to 2014 and was continued until reaching data saturation. Each participant was interviewed for one to three times. The length of the interviews varied from 45 to 90 minutes. Interviews were tape-recorded, transcribed verbatim, and analyzed by the qualitative content analysis approach. In the third step, the findings of the two previous steps were combined to redefine and provide a final definition of the concept of married women’s of SS (16).

3.2. Second Phase

Based on the results of the first phase, two physical and emotional domains were considered for the MWSSQ. Accordingly, an item pool was generated for the scale by the domains and the sub-domains of the SS concept. The items were generated both deductively (i.e. from the existing literature) and inductively (from the empirical data).

3.3.1 Statistical Analysis

The data were tested for normal distribution by Kolmogorov-Smirnov test. Descriptive statistical tests, exploratory factor analysis, one-way analysis of variance (one way ANOVA) test, Interclass Correlation Coefficient (ICC), Cronbach’s alpha and Spearman-Brown test were executed to analyze data. All data analyses were performed by SPSS version 19.0.

3.4. Ethical Considerations

The study was approved by the Ethical Committee of the Research Council of Tehran University of Medical Sciences (Number: 9021151004-1), Tehran, Iran. Study participants were personally informed regarding the aims and the importance of the study. Participants signed informed consent letters. They were assured regarding the anonymity and confidentiality of their information, and that they were free to either participate in or withdraw from the study. No time limit was imposed to complete the questionnaires. It took approximately 15 minutes to complete the questionnaire.

4. Results

4.1. First Phase

In the first phase of the study, the concept of SS was defined by the hybrid model as the pleasure over establishing and maintaining sexual relationship with husband for either fulfilling one’s own and/or husband’s sexual needs or achieving higher aims in/of life. Such pleasure over fulfilling sexual roles as well as mutual interactions is the core concept of SS. According to this definition, SS is a unique, two-dimensional, individual, and subjective concept which is affected by woman’s own expectations of her marital/sexual life as well as the values of marital life. The antecedents of SS include being interested in one’s husband, having emotional intimacy, sexual compatibility, satisfactory performance of marital roles, and feeling sexually potent. The main consequences of SS include continuation of marital/sexual relationship with husband, feeling of emotional serenity, and coping effectively with the difficulties of life.

4.2. Second Phase

In this phase, the findings of the first phase were used to generate an item pool for the MWSSQ. The primary item pool consisted of 78 items in the two physical and emotional domains of SS and several sub-domains. The item pool was assessed and negotiated by the research team in three sessions. Overlapping or repetitive items were either deleted or combined. The research team strived to choose the clearest and most relevant items. The final item pool included 32 items. These 32 items were arranged in a questionnaire format.

5. Discussion

The current study was conducted to develop and validate MWSSQ. The final version of the MWSSQ had 27 items in four domains including antecedents of SS, physical and mental barriers to SS, dominant cultural values, and husband-related factors. The study findings revealed that the MWSSQ had acceptable reliability and validity. The MWSSQ was developed by conducting a hybrid model concept analysis. Accordingly, it can predict whether the antecedents of SS are experienced by a woman or not (32). The first domain of the MWSSQ was related to the antecedents of SS and had eight items. Authors strived to include the most important antecedents of SS in the scale. In the Index of Sexual Satisfaction (ISS), nineteen items deal with the quality of sexual relationship (33). The eight items of the SS antecedent domain of the MWSSQ are comparable with the nineteen items of the quality of sexual relationship domain of the ISS. Accordingly, it seems that these eight items can provide a reasonable estimate of the quality of sexual relationship. The second domain of the IMWSSQ has nine items concerning the barriers to feeling SS. Moreover, this domain indirectly pertains to the quality of sexual relationship. This domain could help healthcare professionals determine and remove the causes to sexual dissatisfaction. The ISS also has six items concerning the negative and positive consequences of sexual relationship (33). The Pinney Sexual Satisfaction Inventory (PSSI) also has two domains including general SS and satisfaction with sex partner which respectively assess SS and factors contributing to sexual dissatisfaction (34). The third domain of the MWSSQ related to “the dominant cultural values” includes five items. It pertains to gaining and maintaining SS, the presence of an intimate relationship between couples, and the cultural values dominating a sexual relationship. The last five items are referred to husband-related factors” and indicate husband’s lack of satisfactory sexual role playing. Previous studies reported that in response to the question “Which characteristics increases your sexual pleasure?”, 91.9% mentioned kindness, affection, good temper, and being cared for; 4.3%, 1.7%, and 1.7% mentioned husband’s hotness, cleanliness, and foreplay as the major points, respectively. In response to “Which characteristics decreases your sexual pleasure?” 66.6% of participants mentioned being upset by husband, 22.1% mentioned bad smell of sweat or smoke, %7 named husband’s low sexual desire, %3.5 named fatigue, and 1.7% named significant age disparity (35). Almost all of these items were considered by researchers in MWSSQ.

Currently, almost all the SS scales contain items on the three domains of antecedents of and barriers to SS as well as husband-related factors (7, 33, 34, 36, 37). However, despite the significant contribution of cultural values to SS (38), none of the previous SS scales contained item(s) on this domain. Probably, cultural values did not contribute to SS in the settings in which previous SS scales were developed. In line with the current study findings, Lee et al. (39) also reported that cultural values affect SS. Given the existence of some degrees of similarities among eastern cultures, it seems necessary to incorporate items about cultural values into SS scales. On the other hand, although previous SS scales were also validated by factor analysis (7, 33, 34, 36, 37), their factors were somewhat different from those of the MWSSQ. This conflict can be attributed to the differences in the theoretical frameworks underpinning the scales. The results of the current study concept analysis revealed that SS had two main physical and emotional domains. However, the factor analysis yielded to a four-factor structure for the MWSSQ. Nonetheless, these four factors were related to both physical and emotional domains of the SS concept. The congruence between the two main domains of the SS concept and the four-factor structure of the MWSSQ confirms the construct validity of the scale. In addition to factor analysis, the study also used the known-groups comparison technique to assess the construct validity of the MWSSQ. The results of this technique revealed that women with lower education had lower SS. Given the real difference in SS among women with different levels of education (31), the known-group comparison confirms an acceptable construct validity for the MWSSQ. Moreover, the significant correlation between the scores of the EMSS and the MWSSQ also confirms the divergent and the construct validity of the MWSSQ (40) .The current study findings also revealed a high Cronbach’s alpha for the MWSSQ, which confirms the great internal consistency and acceptable reliability of the scale. There was also a significant correlation between the total score of the MWSSQ and the score of general SS item. In addition to being a further evidence for the acceptable internal consistency of the MWSSQ, this finding also implies that the items of this scale can accurately reflect women’s feelings towards their sexual relationship. The test-retest technique (with a two-week time interval in between) was also used to assess the stability of the scale. The results of this method also showed a high ICC between the scores of the test and the retest measurements, confirming the stability and reliability of the MWSSQ. Like the PSSI and the ISS, the MWSSQ also exclusively assesses women’s SS. Given the significant differences between men and women’s attitudes towards sexual relationship and SS (9), developing and using gender-specific SS scales seem crucial. The MWSSQ is a short (27 items) and user-friendly questionnaire, which has almost as many items as the PSSI (24 items) and ISS (25 items) do. This scale can be responded to by literate women in about only ten minutes. Given its great simplicity and acceptable validity and reliability, the MWSSQ can be used to evaluate women’s SS in different clinical settings such as sexual disorders clinics, healthcare and rehabilitation centers, and physicians’ private offices as well as in research projects. The inclusion of reversely-scored items in the MWSSQ minimizes some kinds of response biases and increases the probability of acquiring more accurate responses (33, 41). The greatest strength of this study was the development of a context-bound SS scale to assess Iranian married women’s SS. The study did not aim to conduct confirmatory factor analysis and determine the cutoff point(s) of the scale. Consequently, further studies are needed to confirm the study findings.

Conclusion: the current study introduced the MWSSQ as a short self-report scale to assess Iranian married women’s SS as well as the factors contributing to their SS. This scale was developed based on the contextual definition of the SS concept. The MWSSQ is a simple, valid, reliable, and context-based scale, which can be used in different situations and for different purposes. This scale can be used in the Iranian context as well as other cultures in which conventional lifelong marriage and committed marital relationship are greatly valued. Study limitations: authors clearly acknowledge that the development, validation, and evolution of a new scale are lengthy and ongoing processes. Therefore, many other efforts are still needed to evolve and refine the scale. Authors hope to overcome the potential shortcomings of the scale in future researches. Moreover, as a self-report scale, the MWSSQ also suffers from the limitations of self-report scales (42).




  • 1.

    Malarcher S. Social determinants of sexual and reproductive health: informing future research and programme implementation/edited by Shawn Malarcher. 2010;

  • 2.

    Schwartz P, Young L. Sexual satisfaction in committed relationships. Sex Res Social Policy. 2009; 6(1) : 1 -17

  • 3.

    Santtila P, Wager I, Witting K, Harlaar N, Jern P, Johansson A, et al. Discrepancies between sexual desire and sexual activity: Gender differences and associations with relationship satisfaction. J Sex Marital Ther. 2007; 34(1) : 31 -44

  • 4.

    Arrington R, Cofrancesco J, Wu AW. Questionnaires to measure sexual quality of life. Qual Life Res. 2004; 13(10) : 1643 -58 [PubMed]

  • 5.

    Sprecher S. The Handbook of Sexuality in Close Relationships. 2004;

  • 6.

    Whipple B, Brash-McGreer K. Management of female sexual dysfunction Sexual function in people with disability and chronic illness A Health Professional's Guide Gaithersburg. 1997;

  • 7.

    Neto F. The Satisfaction With Sex Life Scale. Meas Eval Couns Dev. 2011; 45(1) : 18 -31

  • 8.

    Parish WL, Luo Y, Stolzenberg R, Laumann EO, Farrer G, Pan S. Sexual practices and sexual satisfaction: a population based study of Chinese urban adults. Arch Sex Behav. 2007; 36(1) : 5 -20 [PubMed]

  • 9.

    Hurlbert DF, Apt C, Rabehl SM. Key variables to understanding female sexual satisfaction: an examination of women in nondistressed marriages. J Sex Marital Ther. 1993; 19(2) : 154 -65 [PubMed]

  • 10.

    Haavio-Mannila E, Kontula O. Correlates of increased sexual satisfaction. Arch Sex Behav. 1997; 26(4) : 399 -419 [PubMed]

  • 11.

    Diagnostic and statistical manual of mental disorders, (DSM-5®). 2013;

  • 12.

    Song JA, Bergen MB, Schumm WR. Sexual satisfaction among Korean-American couples in the Midwestern United States. J Sex Marital Ther. 1995; 21(3) : 147 -58 [PubMed]

  • 13.

    Salehi M, Haghani F. Compiling of curriculum for the Master of Science in genetic counseling. J Educ Health Promot. 2014; 3 : 3 [DOI][PubMed]

  • 14.

    Khademi A, Alleyassin A, Agha-hosseini M, Dadras N, Roodsari AA, Tabatabaeefar L, et al. Psychometric properties of Sexual Function Questionnaire: evaluation of an Iranian sample. Iran J Reprod Med. 2006; 4(1) : 23 -8

  • 15.

    LoBiondo-Wood G, Haber J. Nursing research: Methods and critical appraisal for evidence-based practice. 2014;

  • 16.

    Schwartz Barcott D, Kim HS. An expansion and elaboration of the hybrid model of concept development. Concept Dev Nurs Found Tech Appl. 2000; 2 : 161 -92

  • 17.

    Lacasse Y, Godbout C, Series F. Health-related quality of life in obstructive sleep apnoea. Eur Respir J. 2002; 19(3) : 499 -503 [PubMed]

  • 18.

    Juniper EF, Guyatt GH, Streiner DL, King DR. Clinical impact versus factor analysis for quality of life questionnaire construction. J Clin Epidemiol. 1997; 50(3) : 233 -8 [PubMed]

  • 19.

    Lawshe CH. A Quantitative Approach to Content Validity. Pers Psychol. 1975; 28(4) : 563 -75

  • 20.

    Waltz C, Bausell R. Nursing Research: Design, Statistics and Computer Analysis . 1983;

  • 21.

    Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007; 30(4) : 459 -67 [DOI][PubMed]

  • 22.

    Hyrkas K, Appelqvist-Schmidlechner K, Oksa L. Validating an instrument for clinical supervision using an expert panel. Int J Nurs Stud. 2003; 40(6) : 619 -25 [PubMed]

  • 23.

    Rubio DM, Berg-Weger M, Tebb SS, Lee ES, Rauch S. Objectifying content validity: Conducting a content validity study in social work research. Soc Work Res. 2003; 27(2) : 94 -104

  • 24.

    Patrick DL, Edwards TC, Topolski TD. Adolescent quality of life, part II: initial validation of a new instrument. J Adolesc. 2002; 25(3) : 287 -300 [PubMed]

  • 25.

    Munro BH. Statistical methods for health care research. 2005;

  • 26.

    Kerlinger FN. Foundations of behavioral research: Educational, psychological and sociological inquiry. 1973;

  • 27.

    Bland JM, Altman DG. Statistics notes: Cronbach's alpha. Bmj. 1997; 314(7080) : 572

  • 28.

    Fox DJ. Fundamentals of research in nursing. 1982;

  • 29.

    Burns N, Grove S. Understanding Nursing Research. 2003;

  • 30.

    de Boer MR, Moll AC, de Vet HC, Terwee CB, Volker-Dieben HJ, van Rens GH. Psychometric properties of vision-related quality of life questionnaires: a systematic review. Ophthalmic Physiol Opt. 2004; 24(4) : 257 -73 [PubMed]

  • 31.

    Fahs B, Swank E. Social identities as predictors of women's sexual satisfaction and sexual activity. Arch Sex Behav. 2011; 40(5) : 903 -14 [PubMed]

  • 32.

    Walker L, Avant K. Strategies for Theory Construction in Nursing. 1995;

  • 33.

    Hudson WW, Harrison DF, Crosscup PC. A short‐form scale to measure sexual discord in dyadic relationships. J Sex Res. 1981; 17(2) : 157 -74

  • 34.

    Pinney EM, Gerrard M, Denney NW. The pinney sexual satisfaction inventory. J Sex Res. 1987; 23(2) : 233 -51

  • 35.

    Shadman Z, Akhoundan M, Poorsoltan N, Larijani B, Arzaghi SM, Khoshniat M. Factors associated with sexual function in Iranian women with type 2 diabetes mellitus: partner relationship as the most important predictor. Iran Red Crescent Med J. 2014; 16(3)[PubMed]

  • 36.

    Meston C, Trapnell P. Development and validation of a five-factor sexual satisfaction and distress scale for women: the Sexual Satisfaction Scale for Women (SSS-W). J Sex Med. 2005; 2(1) : 66 -81 [PubMed]

  • 37.

    Stulhofer A, Busko V, Brouillard P. Development and bicultural validation of the new sexual satisfaction scale. J Sex Res. 2010; 47(4) : 257 -68 [DOI][PubMed]

  • 38.

    Acitelli LK, Kenny DA, Weiner D. The importance of similarity and understanding of partners' marital ideals to relationship satisfaction. Pers Relatsh. 2001; 8(2) : 167 -85

  • 39.

    Lee JT. The meaning of sexual satisfaction in pregnant Taiwanese women. J Midwifery Womens Health. 2002; 47(4) : 278 -86 [PubMed]

  • 40.

    Hattie J, Cooksey RW. Procedures for Assessing the Validities of Tests Using the "Known-Groups" Method. Applied Psychological Measurement. 1984; 8(3) : 295 -305

  • 41.

    Sauro J. Are both positive and negative items necessary in questionnaires? 2011;

  • 42.

    Barlow DH, Hersen M. Single case experimental designs. Food Agric Organ United Nation. 1984;