Validation of a Sexual Function Survey for Transwomen After Vaginoplasty

OBJECTIVE: To describe the final validation processes for the final English-language tool to assess sexual function and satisfaction after gender-affirming vaginoplasty. METHODS: This was a quantitative and qualitative validation study. The 32-question SatisFunction survey was distributed to 50 individuals after vaginoplasty along with the Female Sexual Distress Scale for divergent validity testing. Thirty of these 50 participants then underwent one-on-one cognitive interviews with a member of the research team. The cognitive interviews assessed the construct validity of the survey questions based on the participants' responses. A Community Advisory Board and content expert team reviewed the results of the cognitive interviews to create a final version to be further tested. The revised survey was then distributed to 100 individuals for final validation. RESULTS: Cognitive interviews demonstrated 99.0% concordance between participants' survey responses and verbal confirmations, supporting interpretive reliability. Strong internal consistency was observed, with each domain significantly correlating with the total score (eg, Anatomy r =0.856, Arousal r =0.767, Orgasm r =0.748; all P <.001). Expected interdomain relationships were identified, including Arousal and Orgasm ( r =0.552, P <.001). Female Sexual Distress Scale–Revised scores correlated negatively with Satisfaction ( r =−0.416, P <.001), Desire ( r =−0.302, P =.003), Genital Self-Image ( r =−0.216, P =.034), and Total SatisFunction Score ( r =−0.304, P =.003), supporting divergent validity. Factor analysis supported an eight-factor structure aligning with survey domains. CONCLUSION: This survey has now been developed and validated through a seven-phase process incorporating community input, physician/surgeon and psychologist expertise, and correlation to other surveys and can be reliably used clinically and in research.