4. CAPITULO IV - DESARROLLO
4.6 ANÁLISIS DE INGRESOS POR LAS LINEAS DE COCINAS A GAS Y LAS
4.2.5.3.1 The Female Sexual Function Index (FSFI) (Rosen et al., 2000) -
the Satisfaction Subscale
In the current study a Satisfaction subscale, consisting of 3 items (14, 15, and 16) drawn from the 19 items were drawn from the Female Sexual Function Index (FSFI) was used. This subscale is only comprised of items that measure and load statistically the global satisfaction of sexual and relationship aspects and therefore, according to its authors, this subscale can be regarded as the “quality of life” domain of the FSFI (Rosen et al., 2000, p. 198). Respondents rate their overall satisfaction with respect to the extent of emotional closeness during sexual activity, extent of satisfaction due to their sexual relationship with their partner, and their overall satisfaction in sexual life on a 5-point Likert scale over the past 4-weeks.
Only the satisfaction subscale was used in the current study to avoid repetition/duplication and to shorten the questionnaire for women as the topics of other subscales were covered by the other sexual function/satisfaction scales employed, namely, the SAQ and the SFAGIS (both described below).
The individual domain scores are used for estimating the subscale scores of FSFI. The scores of the individual items comprising the domain are added and the sum is multiplied by the factor of the domain concerned. A domain score of zero indicates that there was no sexual activity during the past month. Scores range from 0-5 or 1-5 since the ranges items are: 14=0-5, 15 and 16=1-5. Less than 5.04 on the satisfaction subscale were found to be the cut-off score determining difficulty/low satisfaction in that domain (Weigel et al., 2005).
The FSFI has norms based on a sample of women who are diagnosed with Female Sexual Arousal Disorder. It discriminates well between clinical and non-clinical populations (Rosen et al., 2000). The Satisfaction subscale demonstrates high internal consistency denoted by Cronbach’s alpha value of 0.82 (Dargis et al., 2012) and test-retest reliability (r value of 0.83) (Rosen et al., 2000).
function in colorectal cancer survivors (e.g. da Silva et al., 2008 who examined the effect of colorectal surgery on sexual function for female cancer patients; and Jayne et al., 2005 and Hendren et al., 2005, where the scale was used to assess sexual function in rectal cancer post-surgery women. Baser et al. (2012) found that the FSFI showed strong psychometric properties supporting its ongoing use in assessing women’s cancer-related sexual function. The current study included rectal and anal patients since this is an understudied and under included patient population with regards to the sexual side effects of PRT though the PRT sexual side effects mimic those of the gynaecological setting (Wolf, 2006). Hence this appeared to be a well validated and reliable scale for the current study where gynaecological and female anorectal cancer women’s post PRT cancer-related post PRT sexual function was being assessed.
4.2.5.3.2 The Sexual Activity Questionnaire (SAQ) (Thirlaway et al., 1996)
The 14-item scale Sexual Activity Questionnaire (SAQ) was used in the assessment of various facets related to sexual function. The SAQ consists of three sections: hormonal status and status of women as sexually active, sexual inactivity reasons and sexual functioning. The first part of hormonal status, whether women are active sexually or not and reasons for sexual inactivity including issues related to partner, fatigue, lack of interest in sexual activity and difficult or uncomfortable sexual relations due to physical problems. The format gives space for participants to add reasons not listed. Sexually active women then complete the second section of the scale, assessing aspects of sexual functioning. The time frame for SAQ sexual function section is the previous one month. It has 10 items with three subscales related to pleasure, discomfort and habit. A four-point Likert scale is used for rating of items 1–7 of the SAQ sexual function section ranging from ‘not at all’ (0) to ‘very much’ (3). The SAQ—Discomfort items are expressed in three ways related to ‘dryness of the vagina’ and ‘pain and discomfort at penetration’. There are five items related to SAQ—Pleasure component. These are: ‘sex is important’, ‘do enjoy sexual activity’, ‘do desire to have sex’, ‘feel satisfied with sex’ and ‘satisfied or not with frequency of sexual activity’. Accordingly, high scores of SAQ pleasure and discomfort together means simultaneous high pleasure and high discomfort. There are seven items in pleasure subscale with its scores ranging from 0-18. In thediscomfort subscale, there are two items with scores ranging from 0-6. The habit subscale has only one item with the range of scores from 0-3 (Metcalfe et al., 2004).
Normative data of the SAQ based on studies on Norwegian women registered high internal consistency and high test-retest reliability for the scale according to Vistad et al. (2007). Liavaag et al. (2008) obtained the internal consistency values of α = 0.93, 0.81 and 0.93 for SAQ—Pleasure, for SAQ—Discomfort and among NORM corresponding values respectively. The test-retest reliability estimates of Pearson’s r for the individual items ranged from 0.68 to 1.00 (Carmack Taylor et al., 2004). The SAQ distinguishes between groups expected to differ on sexuality as in the case of pre- and postmenopausal women and has been used in breast (Ganz et al., 2002)in gynaecological cancer (Carmack Taylor et al., 2004)and in rectal cancer populations (Movsas et al., 1998). The SAQ has been found to be non-offensive and feasible. Findings demonstrate that the SAQ can be used for sexual function evaluation in women with different gynaecological diseases and other conditions affecting their sexuality (Vistad et al., 2007). The SAQ has been shown to be acceptable to both younger and older women and is recommended for use in clinical trials (Stead et al., 1999).
4.2.5.3.3 The Sexual Functioning After Gynaecological Illness Scale
(SFAGIS) (Bransfield, Horiot, & Nabid, 1984)
This scale was included in order to assess clinically important elements of post- treatment rehabilitation such as sexual health, side effects of radiation treatment and use of vaginal dilators. The SFAGIS (original form) is self-report measure containing 30 items. Each item is assessed on a 4-point Likert-type scale. An extensive review of the literature on sexual functioning and gynaecological cancer led to the conception of the SFAGIS and its main themes (Bruner & Boyd, 1999). The themes were identified and integrated into 15 item pools of sexual desire, availability of a partner, patient's fear of sexual activity, sexual satisfaction, initiation of sexual activity, affectionate behaviour, frequency of sexual intercourse, frequency of orgasm, vaginal dimensions and mucousal conditions, potential for vaginal lubrication, desire for information on sexual matters, changes in sexual activity after therapy, compliance with a recommendation for a dilator use and intervention of a
2003), a value of 0.80 for split-half reliability coefficient and internal consistency reliability alpha (based on Kuder-Richardson formula) of 0.756 and a reliability alpha of 0.70, Bruner and Boyd (1999) found it focuses more on narrow aspects of sexual function and not the broader issue of sexuality. However, despite the SFAGIS’s limitations particular items were relevant with regards to narrower aspects of sexual function since at the time of the pilot study it was the only scale we are aware of that included a combination of items such as the use of vaginal dilators and post- treatment mucosal changes. We used additional scales and subscales (i.e. the FSFI and SAQ) to make up for and include broader function and satisfaction dimensions of sexuality. In order to reduce the burden for participants, items of the SFAGIS that overlap with the SAQ and FSFI items were excluded from the scale, leaving an adapted 22-item version of the scale (see Appendix 3.1).