Sexual Dysfunctional Beliefs

Sexual and Relationship Therapy, Vol 18, No.
2, 2003
Sexual Dysfunctional Beliefs

Questionnaire: an instrument to
assess sexual dysfunctional beliefs
as vulnerability factors to sexual
problems
PEDRO J. NOBRE1*, JOSE PINTO GOUVEIA2 &
FRANCISCO ALLEN GOMES3
1
Universidade de Tras-os-Montes e Alto Douro, Miranda do Douro, Portugal, 2Faculdade

de Psicologia e Ciencias da Educacao da Universidade de Coimbra, Coimbra, Portugal &
3
Hospitais da Universidade de Coimbra, Coimbra, Portugal
The aim of the present article is to present a new instrument, specially developed to assess
beliefs about sexuality that are supposed to be closely related with the development of sexual disorders.
Using a cognitive theory perspective we hypothesized that sexual behaviour and its problems are in
someway related to the way we think about sexuality, our beliefs and our expectations. Although
some questionnaires of sexual attitude, information and beliefs already exist, there is, until now, no
specic measure oriented to assess both male and female sexual dysfunctional beliefs related to
aetiology. The Sexual Dysfunctional Beliefs Questionnaire is a 40-item self-reported measure
constituted by two versions (female and male) rated on a ve point likert scale. Both male and
female versions present satisfactory test retest reliability (r = 0.73 and r = 0.80 respectively), and
internal consistency (Cronbachs alpha = 0.93 for male and 0.81 for the female version). Studies of
convergent validity show a relationship with other measures of sexual and more general beliefs, as
well as with measures of sexual functioning. Discriminant validity studies support its capacity to
discriminate functional from sexual dysfunctional subjects. It is expected that these measures could be
useful in both clinical practice and educational programmes serving as an indicator of vulnerability
to sexual dysfunction.
ABSTRACT
Introduction
Beliefs are ideas that we have about ourselves, others, or the world, that guide the
way we interpret events, inuencing our behaviour and emotions. According to
cognitive theory, there are two different levels of beliefs, a more nuclear and
unconditional one, called core belief, and a more intermediate and conditional one
* Now at the Center for Anxiety and Related Disorders, Department of Psychology, Boston University.
Correspondence to: Pedro Nobre, Rua Amorim de Carvalho, 97, 4460 Senhora da Hora, Portugal.
Tel: +351 22938 6958; Email: pedro.j.nobre@clix.pt
ISSN 14681994 print/ISSN 1468-1479 online/03/020171-34
# British Association for Sexual and Relationship Therapy
DOI: 10.1080/1468199031000061281
172
Pedro J. Nobre et al.
(usually known as attitude or conditional belief). Core beliefs are usually self-beliefs
(also called self-schemas) that function in a more automatic and tacit way, not being
easily accessible to the conscience. On the other hand, conditional beliefs are less
central, more accessible to conscience and usually presented in a if ... then basis
(Beck, 1996). These conditional beliefs (also called conditional rules) stipulate the
conditions for the activation of the core beliefs or schemas. Beck (1996) gives some
examples of conditional rules associated with different psychopathological states: If I
mingle others, I will be rejected (social anxiety), If I attempt to do anything, I will
certainly fail at it (depression), If I have an inexplicable sensation, it is a sign of a
catastrophic internal danger (panic). Whenever any internal or external stimulus
fulls these conditions core cognitive schemas or core beliefs would be activated or
enhanced: Im friendless, rejected (social anxiety), Im a failure, worthless
(depression) or Im physically vulnerable (panic).
Several instruments were developed to assess general beliefs presumably related to
psychopathology: Schema Questionnaire (Young & Brown, 1989), Sociotropy
Autonomy Scale (Beck et al., 1983) and Dysfunctional Attitudes Scale (Weissman &
Beck, 1978). Studies based on these measures had been the basis of the creation of
several well accepted theoretical cognitive models of psychological problems: depression
(Beck et al., 1979); anxiety (Beck & Emery, 1985); relationship disorders (Beck, 1988);
personality disorders (Beck & Freeman, 1990); substance abuse disorders (Beck et al.,
1993) and hostility (Beck, 1999). It is our intention to apply this framework to the sexual
health eld. Cognitive conceptualizations of sexual problems are far lacking, and we
hypothesized that a systematic study of these variables could help in shedding some light
over the comprehension and treatment of sexual disorders.
In fact, several clinical reports and theoretical works point to some recurrent beliefs
as etiologic factors of sexual dysfunction. Religious beliefs and conservatism (Lo Piccolo
& Friedman, 1988; Kaplan, 1979; Masters & Johnson, 1970), fear of intimacy and
losing control (Hawton, 1985; Kaplan, 1979; Lo Piccolo & Friedman, 1988; Rosen &
Leiblum, 1995, Lazarus, 1988), body-image beliefs (Lo Piccolo & Friedman, 1988;
Rosen & Leiblum, 1995) and beliefs about the role of affection in sex (Tevlin &
Leiblum, 1983) are among the most common cited etiologic causes of female sexual
dysfunction; while high performance beliefs, beliefs about womens sexual satisfaction,
and sexual conservatism appear as the top listed causes of male sexual disorders
(Zilbergeld, 1992; Hawton, 1985; Wincze & Barlow, 1997).
However, despite the strong convergence of these theoretical formulations based on
clinical observations, its empirical validity remains to be tested in a systematic basis, and
assessment instruments designed to do so are lacking.
Some studies have previously assessed similar concepts in the eld. Baker & De Silva,
(1988), using Zilbergelds (1983) myths about male sexuality, conclude that dysfunctional males present higher beliefs in myths than functional subjects. Andersen &
Cyranowski (1994) and Andersen et al. (1999) developed the Sexual Self-Schema (male
and female versions), a questionnaire to assess cognitive generalizations about ourselves
as sexual subjects. They postulate that these sexual schemas were developed through life
experiences and would guide sexual behaviour. In their studies, they show that this
construct is somehow related to sexual dysfunction patterns. Adams et al. (1996) had
Sexual Dysfunctional Beliefs Questionnaire
173
developed a questionnaire for assessing sexual beliefs and information (SBIQ) especially
in ageing couples. They hypothesized in the same direction as Baker & De Silva (1988)
that the higher the belief in sexual myths and erroneous beliefs, the more the tendency to
develop a sexual disorder. Unfortunately they did not present any supporting results.
These studies, although contributing to understanding sexual dysfunction using a
cognitive framework, do not develop a consistent model of cognitive theory of sexual
problems. Our goal is to ll that gap by developing a measure to assess both male and female
beliefs about sexuality. Moreover, this study is also part of a more systemic research project
developed to assess the role of cognitive emotional variables in sexual functioning
(Nobre, 1999). For this purpose, two other measures were also created to study different
levels of cognitive interference: cognitive schemas (Nobre & Pinto-Gouveia, 2002b) in
sexual context (in order to assess the relevance of schema activation in sexual functioning),
and sexual modal questionnaire (Nobre & Pinto-Gouveia, 2002c) (assessing the
interaction between sexual thoughts, emotions and sexual response). It was hypothesized
that sexual beliefs would stipulate the conditions for the activation of the cognitive schemas
in specic sexual unsuccessful experiences. Once activated, these cognitive schemas would
elicit a systemic structure composed by thoughts, emotions and sexual response. For
example, the sexual belief (a man who fails to obtain an erection is a failure) would facilitate
the activation of negative self-schemas (Im incompetent) whenever an erection difculty
occurs. This negative self-schema, once activated would elicit negative automatic thoughts
(Im not able to satisfy my partner, I will never be the same again) and negative emotions
(sadness, disillusion, etc.), impairing the sexual response. Past research with erectile
disorders seems to support this model (Nobre, 1997; Nobre & Pinto-Gouveia, 2000a).
Method
Participants and procedures
A total of 360 participants (154 females and 206 males) were recruited from the general
population with the help of community volunteers (demographic characteristics
presented in Table I). The subjects answered the questionnaires anonymously and
returned them by mail. This sample was used in most of the reliability and validity studies.
A second sample was also collected in order to perform a discriminant analysis. A
clinical group of 96 subjects (49 males and 47 females) from the sexology clinic of
Coimbras University Hospital answered the questionnaire. Subjects diagnosed with
sexual dysfunction, using DSM-IV criteria constitute this clinical group. Erectile
disorder (70%) and premature ejaculation (25%) were the most common diagnostics in
the male sample, while hypoactive sexual desire (38%), vaginismus (24%) and orgasmic
disorders (20%) were the main female complaints. A control group was also collected
from the community sample above presented. Subjects were selected in order to match
the clinical group in age, marital status and education level. Also a screen on the sexual
functioning was performed using the International Index of Erectile Function (Rosen et
al., 1997) and the Female Sexual Function Index (Rosen et al., 2000) to eliminate those
subjects presenting signs of sexual dysfunction. Detailed demographic data from both
male and female clinical and control groups are presented in Table II.
174

TABLE I. Demographic characteristics of the community sample
Age
M
Min Max
SD
Marital status
Single
Married
Divorced
Living together
Education level
0 4 years
5 6 years
7 9 years
10 12 years
13 15 years
16 or more years
Female (n = 154)
Male (n = 206)
24.4
18 55
7.2
%
82.2
15.8
0.0
2.0
30.6
18 56
9.4
%
55.2
39.8
2.5
2.5
3.0
3.0
2.0
23.4
8.1
60.5
8.5
3.5
5.1
17.1
7.0
58.8
Materials
In order to validate our instrument, we used several other reliable and valid
questionnaires that measure sexual beliefs and information, or more general beliefs
usually related to psychopathology. Thus, besides our Sexual Dysfunctional Beliefs
Questionnaire, we also used: the Sexual Beliefs and Information Questionnaire (SBIQ;
Adams et al., 1996), the Sexual Self-schema Questionnaire (SSS; Andersen &
Cyranowski, 1994; Andersen et al., 1999), the Sociotropy-Autonomy Scale (SAS; Beck
et al., 1983) and the Dysfunctional Attitudes Scale (DAS; Weissman & Beck, 1978). In
order to assess the relationship between our measures and sexual functioning we also
used the International Index of Erectile Function (IIEF; Rosen et al., 1997) and the
Female Sexual Function Index (FSFI; Rosen et al., 2000).
Sexual Dysfunctional Beliefs Questionnaire (SDBQ)
The SDBQ is a 40-item questionnaire assessing a sort of specic stereotypes and beliefs
presented in the clinical literature as predisposing factors to the development of the different
male and female sexual dysfunctions. The questionnaire presents a male and a female
version assessing specic gender related beliefs. The subjects are asked to identify the degree
of concordance with 40 statements regarding diverse sexual issues (from 1-completely
disagree to 5-completely agree). The psychometric characteristics as well as the factor
structure and the total index and domain scores of the questionnaires will be presented later.
Sexual Beliefs and Information Questionnaire (SBIQ)
The Sexual Beliefs and Information Questionnaire is a measure developed by Adams et
al. (1996) to assess sexual myths and lack of information about normal sexual
175
functioning. The questionnaire consists of 25 items rated in a true false or dont know
bases. Correct answers are scored as 1 and incorrect as 0, with the total score
demonstrating knowledge about sex related issues. Psychometric studies conducted by
the authors (Adams et al., 1996), indicated adequate test retest reliability and internal
consistency. Internal structure assessed by factor analysis showed ve components:
TABLE II. Demographic characteristics of the clinical and control groups

Female
Age
M
Min Max
SD
Marital status
Single
Married
Divorced
Living together
Education level
0 4 years5 6 years
7 9 years
10 12 years
13 15 years
16 or more years
Clinical sample (n = 47)
Control sample (n = 46)
28.7
19 50
6.7
%
63.8
25.5
4.3
6.4
29.2
18 48
8.6
%
60.9
28.2
0.0
6.5
10.6
10.6
6.4
31.9
10.6
29.8
10.9
10.9
6.5
34.8
4.3
32.6
Male
Age
M
Min Max
SD
Marital status
Single
Married
Divorced
Living together
Education level
0 4 years5 6 years
7 9 years
10 12 years
13 15 years
16 or more years
Clinical sample (n = 49)
Control sample (n = 49)
43.0
18 67
14.4
%
26.5
61.2
2.1
10.2
42.7
18 56
15.7
%
22.4
71.4
2.0
4.1
38.8
24.5
12.2
22.4
0.0
2.0
36.0
8.0
22.0
30.0
0.0
4.0
176
Time/Patience, Stress/Pressure, Ageing, Sexual Satisfaction, Miscellaneous/Basic

Knowledge. A Portuguese version of the measure was developed by Nobre (2000a).
Sexual Self-Schema (SSS)
The Sexual Self-Schema questionnaire is a measure developed by Andersen &
Cyranowski (1994, female version) and Andersen et al. (1999, male version). These
measures intend to assess cognitive generalizations about sexual aspects of oneself, that
are responsible for guiding sexual behaviour. Both versions present acceptable test
retest reliability, internal consistency and validity characteristics (Andersen &
Cyranowski, 1994; Andersen et al., 1999). The male version is composed of 45
adjectives rated on a seven point likert scale (from 0 to 6 according to the degree of
identication with each adjective). A factor analysis of the scale shows a three factor
structure: Passionate Loving, Powerful Aggressive and Open-Minded Liberal. The
female version consists in of a 50-item scale also rated on a seven point likert scale (from
0 to 6). Factor analysis also showed a three factor structure: Passionate Romantic,
Open Direct and Embarrassed Conservative. A translation from the original measure
to Portuguese was developed, and applied to a sample of 65 students. Cronbachs alpha
of 0.78 for the total scale support the internal consistency of the Portuguese version
(Nobre, 2000b).
Dysfunctional Attitude Scale (DAS)
The Dysfunctional Attitudes Scale is an instrument developed by Weissman & Beck (1978)
to assess negative attitudes conceptualized as predisposing factors for psychopathology
(mainly depression). The measure presents acceptable reliability and validity characteristics (Weissman & Beck, 1978). A Portuguese version of the scale was developed by PintoGouveia et al. (1987). Psychometric studies of the Portuguese version conducted with 404
subjects showed acceptable test retest reliability (r = 0.69) and internal consistency
(Cronbachs alpha of 0.84). A factorial analysis of the Portuguese version resulted in a seven
factor structure: perfectionism, absolutist imperatives, dependence/independence,
adaptive cognitions, high performance demands, adaptive coping and autonomy.
The Sociotropy Autonomy Scale (SAS)
The Sociotropy Autonomy scale (Beck et al., 1983) is a self-reported measure that
assesses two overall dimensions conceptualized as related to psychopathology:
sociotropy, a dimension characterized by a dependence on social supportive feedback,
and autonomy, dened as the investment in achieving independent status and
individual goals. The scale contains 60 statements rated in a ve point likert scale (0
4), 30 of which are related with sociotropy and 30 with autonomy. The scale presents
high internal reliability with Cronbachs alpha coefcients between 0.83 and 0.90.
Validity studies point to moderate to high correlations between the sociotropy scale
and measures of interpersonal dependence (Barnett & Gotlib, 1988) and to some
inconsistent results regarding correlations between the autonomy scale and measures
177
of achievement and independence (Clark & Beck, 1991). A recent factor analysis
(Bieling et al., 2000) suggests a by-dimensional structure for each scale: fear of
criticism and rejection and preference for afliation in the Sociotropy Scale;
independent goal attainment and sensitivity to others control in the Autonomy
Scale. A Portuguese version of the scale was developed by Cardoso (1998).
Psychometric studies conducted with a sample of 225 subjects supported the internal
consistency of this version (Cronbachs alpha of 0.87 for the Sociotropy scale and 0.74
for the autonomy scale).
The International Index of Erectile Function (IIEF)
The IIEF (Rosen et al., 1997) is a 15-item, brief, self-administered measure of
erectile function, evaluating ve domains: erectile function, orgasmic function, sexual
desire, intercourse satisfaction and overall satisfaction. Psychometric studies
supported the validity (signicant mean difference scores between a clinical and a
control group) and reliability (Cronbachs alpha values of 0.73 and higher and test
retest from r = 0.64 to r = 0.84) of the measure. Studies with clinical samples also
demonstrated its sensitivity and specicity for detecting treatment related changes
(Rosen et al., 1997).
The Female Sexual Function Index (FSFI)
The FSFI (Rosen et al., 2000) is a 19 item instrument, easily administered and
scored, providing detailed information on the major dimensions of sexual function:
sexual interest/desire, sexual arousal, lubrication, orgasm, sexual satisfaction and
sexual pain. The measure presents acceptable test retest reliability (r = 0.79 to
r = 0.86), internal consistency (Cronbachs alpha values of 0.82 and higher) and
validity (demonstrated by signicant mean difference scores between a clinical and a
control group).
Results
Item analysis
To develop the instruments outlined above, we proceeded with an item analysis of the
initial Sexual Dysfunctional Beliefs Questionnaire. The items were selected from an
initial version of 95 item (female version) and 94 item (male version). From those, 49
items (male and female versions) were selected based on item-total correlation
(r 4 0.40), and clinical relevance (correlations with FSFI and IIEF total scores
p 5 0.05).
The remainder of the 49 items (both male and female versions) were submitted to a
exploratory factor analysis where we rejected nine items from each version that
presented factor loadings higher than 0.4 in more than one factor or which didnt load
signicantly (higher than 0.4) in none of the factors. The remaining 40 items constitute
the nal version of the male and female SDBQ.
178
Factor analysis and domain scores

In order to analyse the internal structure of our instrument, we submitted our results to
a factor analysis of both male and female versions as recommended by Campbell &
Fiske (1959) and Cronbach & Meehl (1955).
Female version
A principal component analysis with varimax rotation was performed to investigate the
internal structure of the 40 beliefs presented in the female version (Table III). Six
factors were identied using Catells scree test. The factors identied showed theoretical
consistency and account for 42.5% of the total variance (F1 = 17.0%, F2 = 6.1%,
F3 = 5.3%, F4 = 5.2%, F5 = 4.6%, F6 = 4.3%). Kaiser Meyer Olkin of 0.77 supported the adequacy of the sample, and Bartletts test of sphericity was signicant (Chisquare = 2426, p 5 0.001).
The item selection for each factor was based on statistical and interpretability
criteria. Inclusion decision was based on loadings higher than 0.4 on the respective
factor. Items which didnt load high on any of the factors were excluded. Based on these
criteria six items were excluded: 9there is a variety of ways of getting pleasure and
reaching orgasm, 16simultaneous orgasm for two partners is essential for a satisfying
sexual encounter, 19A successful professional career implies control of sexual
behaviour, 21men only pay attention to young, attractive women, 25any woman
who initiates sexual activity is immoral, 29if women let themselves go sexually they
are totally under mens control. Items 6, 7, 26 and 37 although presenting some high
loadings in more than one factor were retained (included in the factors where the
loadings were higher). The six domains identied were as follows:
(1) Sexual conservatism: factor characterized by the idea that coitus is the central
aspect of human sexuality, considering masturbation, oral and anal sex as
deviant and sinful activities. Females sexual role as passive and receptive, with
virginity being an important value for non-married women.
(2) Sexual desire and pleasure as a sin: dimension dominated by the idea that sex is a
male activity, where women must control their sexual urges and pleasure since
these are sinful experiences.
(3) Age related beliefs: domain where the central theme is the decrease of sexual
desire, pleasure or orgasm with age, especially after menopause.
(4) Body-image beliefs: factor characterized by the idea of body-image as a central
aspect on females sexuality.
(5) Affection primacy: dimension where affection, love and agreement between
partners constitute the central aspect of human sexuality. Since the items were
scored in reverse order, the higher the factor score the lower the affection
importance.
(6) Motherhood primacy: factor characterized by the idea that motherhood activities
are the most important female pleasure and that procreation is the goal of any
sexual experience.
179
Analysing the inter-correlation between the diverse dimensions of the female version we
may highlight the overall high relationship showed by all the dimensions except one
(denying affection primacy). In fact, all correlations showed statistical signicance
(p 5 0.01), with sexual conservatism presenting the higher correlations with the other
factors. Affection primacy on the contrary does not correlate with any of the remaining
domains, indicating that this factor is not clearly associated with the other concepts
analysed by the questionnaire (Table IV).
The range of possible domain and total scores for the Sexual Dysfunctional Beliefs
Questionnaire is presented in Table V. The higher the scores on the total scale the
greater the dysfunctional beliefs.
Male version
To assess the internal structure of the male sexual dysfunctional beliefs questionnaire,
we performed a factor analysis of the 40 item scale using a varimax rotation (Table VI).
Six factors were identied using Catells sree test accounting for 49.4% of the total
variance (F1 = 25.1%, F2 = 7.7%, F3 = 4.7%, F4 = 4.5%, F5 = 3.9%, F6 = 3.6%). The
factors identied were theoretically sound, Kaiser Meyer Olkin of 0.85 supported the
adequacy of the sample, and Bartletts test of sphericity was signicant (Chisquare = 2778.72, p 5 0.001).
The item selection for each factor was based on statistical and interpretability
criteria. Inclusion decision was based on loadings higher than 0.4 on the respective
factor. Items which didnt load highly on any of them were excluded. Based on these
criteria three items were excluded: 14, there are certain universal rules about what is
normal during sexual activity; 20, a woman may stop loving a man if he is not capable
of satisfying her sexually; 23, A successful career implies the control of sexual urges.
Items 6, 18, 21 and 39 although presenting some high loadings in more than one factor
were retained (included in the factors where the loadings were higher). The six domains
identied were the following:
(1) Sexual conservatism coitus/procreation primacy: dimension characterized by
conservative ideas about sexual behavior. Sex before marriage is unacceptable,
has to be quick, directed to coitus, without foreplay, with man on top and serving
procreative goals.
(2) Female sexual power need for sexual control: domain closely related with the
idea that female sexual power can be dangerous and if men dont control their
sexual urges, they will fall under womens power.
(3) Macho belief: factor dominated by the concept of mans capacity for being
always ready for sex, satisfy all women, and keep an erected penis until the end of
any sexual activity.
(4) Beliefs about womens sexual satisfaction: dimension characterized by the
importance of satisfying female partners, and by the idea that penis erection and
vaginal coitus are necessary in order to sexually satisfy any woman.
(5) Restricted attitude toward sexual activity: factor where sexual fantasies, oral and
anal sex are seen as unhealthy or incorrect experiences.
180

TABLE III. Female SDBQ principal component analysis with varimax rotation (n = 154)
Factors
SDBQ items
Sexual conservatism
2.
Masturbation is wrong and sinful
4.
The best gift woman could bring
to marriage is her virginity
7.
Masturbation is not a proper
activity for respectable women
13. Reaching climax/orgasm is acceptable for men but not for
women
14. Sexual activity must be initiated
by man
17. Orgasm is possible only by vaginal intercourse
27. Sexual intercourse during menstruation can cause health problems
28. Oral sex is one of the biggest
perversions
32. Anal sex is a perverted activity
0.66
0.63
7 0.08
7 0.05
0.14
0.25
0.14
0.20
7 0.02
7 0.08
0.15
7 0.10
0.53
0.20
0.23
0.41
7 0.04
7 0.09
0.43
7 0.11
0.27
0.14
0.27
0.02
0.45
0.19
0.22
0.01
0.01
0.32
0.46
0.15
7 0.03
0.27
0.11
0.28
0.40
0.33
7 0.03
7 0.03
0.17
0.12
0.64
0.35
0.05
7 0.02
0.12
0.29
0.65
0.06
0.07
7 0.04
7 0.08
0.08
7 0.07
0.08
0.50
0.79
0.09
0.09
0.29
0.13
0.20
7 0.00
0.21
0.02
0.13
0.72
7 0.02
0.03
7 0.01
0.28
0.05
0.63
0.14
0.22
0.04
7 0.37
0.06
0.52
0.27
0.46
0.02
0.26
0.23
0.45
0.13
0.28
7 0.01
0.10
0.17
0.11
0.67
0.09
7 0.07
0.02
0.11
0.47
0.52
7 0.04
0.13
7 0.09
Sexual desire and pleasure as a sin

15.
34.
35.
36.
37.
39.
Sex is dirty and sinful

Sex should happen only if a man
initiates
There is just one acceptable way
of having sex (missionary position)
Exper. pleasure during sexual
act. is not acceptable in a virtuous woman
A good mother must control her
sexual urges
A woman who only derives sex
pleasure through clitoris stimulation is sick
Age related beliefs

5.
6.
After menopause women lose

their sexual desire
Women who have sexual fantasies are perverted
(continued )
181
TABLE III. (continued )

Factors
SDBQ items
8.
0.15
0.19
0.70
0.11
7 0.01
0.07
0.01
7 0.18
0.54
0.22
7 0.05
0.23
0.17
0.18
0.62
0.17
7 0.12
0.26
0.14
0.03
0.34
0.64
7 0.08
7 0.05
0.01
0.12
0.25
0.71
0.02
0.27
0.12
0.24
0.04
0.53
7 0.06
0.05
0.24
0.21
0.10
0.48
7 0.04
7 0.12
0.06
7 0.06
0.24
7 0.38
0.52
7 0.21
0.09
0.06
0.11
0.04
0.56
7 0.03
0.28
0.11
0.16
0.21
0.47
0.00
0.01
0.14
0.05
0.07
0.67
0.08
0.25
0.08
7 0.00
0.14
0.56
0.04
0.23
7 0.01
0.05
7 0.07
0.60
7 0.05
0.15
0.16
7 0.19
0.40
0.12
0.54
0.14
0.12
0.23
0.14
0.02
0.60
0.19
0.00
0.23
0.02
7 0.16
0.53
After menopause women cant

reach orgasm
11. In the bedroom the man is the
boss
20. As women age the pleasure they
get from sex decreases
Body-image beliefs
10.
12.
38.
40.
Women who are not physically

attractive cant be sexually satised
A good mother cant be sexually
active
An ugly woman is not capable of
sexually satisfying her partner
Pure girls dont engage in sexual
activity
Affection primacy
1.
3.
18.
22.
23.
24.
Love and affection from a partner are necessary for good sexa
The most important component
of sex is mutual affectiona
The goal of sex is for men to be
satised
Sex is a beautiful and pure
activitya
Sex without love is like food
without avoura
As long as both consent agree
anything goesa
Motherhood primacy
26.
30.
31.
Sex is meant only for

procreation
Being nice and smiling at men
can be dangerous
The most wonderful emotions
that a woman can experience are
maternal
(continued )
182

TABLE III. (continued )
Factors
SDBQ items
33.
0.10
0.05
0.24
In the bedroom the woman is the

boss
4
7 0.22
0.12
0.43
F5
F6
0.01
Items scored in reverse order
TABLE IV. Female SDBQ domain intercorrelations (n = 154)

Domains
F1 Sexual conservatism
F2 Sexual desire and pleasure as a
sin
F3 Age related beliefs
F4 Body-image beliefs
F5 Denying affection primacy
F6 Motherhood primacy
F1
F2
0.42**
0.42**
0.43**
0.06
0.41**
0.43**
0.52**
0.09
0.27**
F3
0.42**
7 0.08
0.38**
F4
7 0.01
0.21**
*p 5 0.05. **p 5 0.01.
TABLE V. Domain and total scores of the SDBQ (female version)

Domains
Item numbers
F2 Sexual desire and pleasure as a sin
Total
2, 4, 7, 13, 14, 17, 27, 28, 32

15, 34, 35, 36, 37, 39
5, 6, 8, 11, 20
10, 12, 38, 40
1, 3, 18, 22, 23, 24
26, 30, 31, 33
Minimum
Maximum
9
6
5
4
6
4
34
45
30
25
20
30
20
170
*Items 1, 3, 22, 23, 24 are scored in reverse order.
(6) Sex as an abuse of mens power: dimension dominated by the idea of sex as an
act of violation or abuse of womans body by male.
The inter-correlations between the diverse factors of the male sexual beliefs
questionnaire, present a consistent relationship (Table VII). All inter-correlations
are greater than 0.34 and statistically signicant (p 5 0.01). These results show that
the scale assesses different dimensions of the same general concept. Looking more
specically to the individual relationship, we may highlight the higher correlations of
183
the sexual conservatism dimension with all the other factors, specially, sex as an abuse
of mens power (r = 0.61, p 5 0.01) and restrictive attitude toward sex (r = 0.59,
p 5 0.01).
The range of possible domain and total scores for the Sexual Dysfunctional Beliefs
Questionnaire (male version) is presented in Table VIII. The higher the scores on the
total scale the greater the dysfunctional beliefs.
Reliability studies
In order to assess the reliability of our measure, we performed two types of tests: test
retest reliability to assess the temporal stability of the questionnaires and internal
consistency to analyse the degree of consistency (relatedness) among the several
dimensions represented in our instrument.
Test retest reliability
Test Retest reliability for both male and female versions was assessed by
computing Pearson product moment correlations between two consecutive administrations of the questionnaires with a four week interval. Both male and female
versions presented statistically signicant results (p 5 0.05) for the total scale
(r = 0.73 and r = 0.80 respectively), showing that the instrument present good
stability across time. However, when analysing specically the results for each
dimension of both male and female measures we found some non-signicant
correlations (Table IX).
Internal consistency
Internal consistency of the instrument was assessed by calculating Cronbachs alpha
statistic for the total scale and also for each dimension of both male and female
versions (Table X). Results for the total scale (Cronbachs alpha = 0.93 for the male
and 0.81 for the female version) supported the high internal consistency of the
questionnaires. When we analysed each dimension, a relative discrepancy was
observed in its consistency, with Cronbachs alpha statistic ranging between 0.50
and 0.89. The smallest results are presented from the motherhood primacy and
denying affection primacy of the female version and from the restrictive attitude
toward sex and sex as an abuse of mens power of the male version. These ndings
may be interpreted as possible lack of consistency between the items within the
mentioned dimensions.
Validity studies
Convergent validity. In order to assess the convergent validity of our measure we used
self-reported questionnaires partially associated with the dimensions we assess. We
performed Pearson product moment correlations between our questionnaire and the
SBIQ, DAS, SSS, IIEF and FSFI.
184

TABLE VI. Male SDBQ principal component analysis with varimax rotation (n = 206)
Factors
SDBQ items
Sexual conservatism
2.
Orgasm is possible only by
vaginal intercourse
5.
Women have no other choice
but to be sex. Subjugated by
mans power
9.
A shorter duration of intercourse is a sign of mans power
18. In sex anything but vaginal
intercourse is unacceptable
21. Vaginal intercourse is the only
legitimate type of sex
24. Foreplay is a waste of time
25. Sex is meant only for procreation
26. In sex, the quickest/faster the
best
32. There is only one acceptable
way of having sex (missionary
position)
33. Sexual intercourse before marriage is a sin
F1
F2
F3
F4
F5
F6
0.52
0.04
0.25
0.10
0.34
7 0.04
0.51
0.19
0.36
0.11
0.11
0.27
0.47
0.31
0.24
0.05
0.07
7 0.05
0.63
0.07
0.14
0.09
0.41
0.12
0.53
0.47
0.16
7 0.25
0.18
7 0.09
0.70
0.72
0.11
0.07
0.35
0.08
7 0.04
0.15
0.20
0.15
7 0.11
0.22
0.72
0.67
0.29
7 0.01
0.03
0.03
0.72
0.09
7 0.05
0.21
0.01
0.00
0.76
7 0.04
7 0.10
0.14
0.00
0.06
0.09
0.42
0.31
0.20
0.25
7 0.05
0.20
0.08
0.41
0.65
7 0.18
0.18
7 0.01
7 0.01
0.21
0.13
0.39
0.06
7 0.01
0.56
0.16
0.12
0.10
7 0.05
0.07
0.54
0.11
0.34
0.18
0.17
0.16
0.49
0.33
0.11
7 0.34
0.08
0.13
0.62
7 0.11
0.41
7 0.10
0.02
0.13
0.51
0.18
0.12
0.02
0.09
Female sexual power

11.
15.
19.
27.
29.
38.
39.
40.
The consequences of a sexual

failure are catastrophic
In bed the woman is the boss
A womans body is her best
weapon
People who dont control their
sexual urges are more easily
controlled by others
If a man lets himself go sexually he is under a womans
control
A real man doesnt need much
stimulation to reach orgasm
A woman at her sexual peak
can get whatever she wants
from a man
The greater the sexual intimacy, the greater the potential
for getting hurt
(continued )
185
TABLE VI. (continued )

Factors
SDBQ items
F1
F2
F3
F4
F5
F6
0.17
0.23
0.59
0.29
7 0.12
7 0.05
0.15
7 0.01
0.06
0.11
0.46
0.52
0.30
0.43
0.28
0.13
7 0.05
0.21
0.29
0.24
0.45
0.01
0.13
0.24
0.18
0.26
0.66
0.23
0.01
0.13
0.09
0.25
0.46
0.37
0.05
7 0.14
0.18
0.01
0.53
7 0.02
0.29
7 0.31
0.21
0.01
0.09
0.60
0.28
7 0.14
0.07
0.11
0.18
0.69
7 0.09
0.13
0.18
0.27
0.28
0.47
0.17
7 0.21
0.04
0.15
0.20
0.68
0.05
0.08
0.13
0.36
0.31
0.49
0.05
0.18
0.05
0.29
0.09
7 0.00
0.60
0.11
0.25
0.02
0.10
0.16
0.41
0.15
Macho belief
1.
4.
6.
17.
28.
31.
37.
A real man has sexual intercourse very often

Homosexuality is a sickness
A real man must wait the
necessary amount of time to
sexual satisfy a woman
In sex, getting to the climax is
most important
A real man is always ready for
sex and must be capable of
satisfying any woman
A man must be capable of
maintaining an erection until
the end of any sex
Sex can be good even without
orgasma
Beliefs about womens satisfaction

3.
Penis erection is essential for a

womans sexual satisfaction
7.
A woman may have doubts
about a mans virility when he
fails an erection
16. Men who are not capable of
penetrating women cant satisfy them
35. A man who doesnt sexually
satisfy a woman is a failure
36. Whenever a situation arises, a
real man must be capable of
penetration
Restrictive attitude toward sex
8.
Repeated engagement on oral/

anal sex can cause serious
health problems
12. Women only pay attention to
attractive younger man
(continued )
186

TABLE VI. (continued )
Factors
SDBQ items
F1
13.
30.
It is not appropriate to have

sexual fantasies during sexual
intercourse
Anal sex is a perverted activity
F2
F3
F4
F5
0.29
7 0.02
0.12
F6
7 0.04
0.20
0.52
7 0.08
0.17
0.14
7 0.02
0.75
0.04
0.21
0.15
0.38
0.38
0.15
0.08
7 0.01
0.14
0.23
0.15
0.52
7 0.53
0.39
0.06
0.02
0.21
0.15
0.53
Sex as an abuse of mens power

10.
22.
34.
Sex is an abuse of males power

The quality of the erection is
what most satises women
Sex is a violation of a womans
body
Items scored in reverse order.
TABLE VII. Male SDBQ domain intercorrelations (n = 206)

Domains
F1
F2
F3
F4
F5
F6
Sexual conservatism
Female sexual power
Macho belief
F1
F2
F3
F4
F5
F6
0.52**
0.55**
0.44**
0.59**
0.61**
0.57**
0.53**
0.41**
0.46**
0.62**
0.42**
0.39**
0.34**
0.34**
0.47*
*p 5 0.05. **p 5 0.01.
TABLE VIII. Domain and total scores of the SDBQ (female version)
Domains
Item numbers
F2 Female sexual power
F3 Macho belief
F4 Beliefs about womens satisfaction
F5 Restrictive attitude toward sex
F6 Sex as an abuse of mens power
Total
2, 5, 9, 18, 21, 24, 25, 26, 32, 33

11, 15, 19, 27, 29, 38, 39, 40
1, 4, 6, 17, 28, 31, 37
3, 7, 16, 35, 36
8, 12, 13, 30
10, 22, 34
Note: Item 37 is scored in reverse order.
Minimum
Maximum
10
8
7
5
4
3
37
50
40
35
25
20
15
185
187
TABLE IX. Test retest reliability

SDBQ domains
N items
Pearson r
9
6
0.65**
0.23
5
4
6
4
34
0.65**
0.17
0.29
0.73**
0.80**
10
8
7
5
0.28
0.46
0.62
0.82**
4
3
0.71*
0.80**
37
0.73*
Female sample (n = 26)

F2 Sexual desire and pleasure as a
sin
Total
Male sample (n = 10)
F3 Macho belief
F4 Beliefs about womens
satisfaction
F6 Sex as an abuse of mens
power
Total
*p 5 0.05. **p 5 0.01.
Sexual Beliefs and Information Questionnaire (SBIQ)

In an overall analysis of the correlation between our measure and the Sexual Beliefs and
Information Questionnaire (SBIQ) we observed a moderate negative relationship
between both total scores (r = 7 0.42, p 5 0.05 in the female sample and r = 7 0.48,
p 5 0.05 for the male sample), showing that they assess somewhat similar concepts (the
negative direction is due to the inverse meaning of the scores with high scores on the
SBIQ meaning degree of accurate sexual information and high scores on our measure
meaning sexual dysfunctional beliefs). A more detailed look at the inter-correlations
between the specic dimensions of both measures, led us to the following observations
(Table XI):
In the female sample, sexual conservatism and denying affection primacy are both
signicantly related to the Time/Patience dimension of the SBIQ (r = 7 0.32, p 5 0.05
and r = 7 0.33, p 5 0.05). This SBIQs domain is characterized by the idea that time and
patience plays a central role in sexual satisfaction, sharing information about ones
desires and taking the time needed to please a partner. It is not surprising that this factor
correlates inversely with sexual conservatism (coitus primacy and negation of other
sexual activities) and denying affection primacy (negation of the affections role on sexual
activity). Another statistically signicant correlation (r = 7 0.33, p 5 0.05) is between
age related beliefs and the sexual satisfaction domain of the SBIQ. The sexual satisfaction
188

TABLE X. Internal consistency
SDBQ domains
N items
Cronbachs alpha
9
6
5
4
6
4
34
0.78
0.75
0.74
0.66
0.59
0.50
0.81
10
8
7
5
4
3
37
0.89
0.77
0.75
0.75
0.54
0.63
0.93

F2 Sexual desire and pleasure as a sin
Total
F3 Macho belief
F4 Beliefs about womens satisfaction
F6 Sex as an abuse of mens power
Total
factor is associated with correct ideas about how to sexually satisfy both males and
females. Ideas about sexual decline with age, correlate inversely with that SBIQs factor.
In the male version we may highlight the negative relation between the time/patience
factor of the SBIQ and: sexual conservatism (r = 7 0.44, p 5 0.05), restrictive attitude
toward sex (r = 7 0.43, p 5 0.05) and sex as an abuse of mens power (r = 7 0.41,
p 5 0.05). All these three dimensions from SDBQ are opposite to the idea of sharing
ones desires and taking the time needed to satisfy both partners.
Dysfunctional Attitudes Scale (DAS)
In order to assess the relationship between sexual dysfunctional beliefs and more general
dysfunctional beliefs, we analysed the relationship between our questionnaire and the
Dysfunctional Attitudes Scale (DAS). This instrument was developed to evaluate
general beliefs that proved to be related to several psychopathological situations
(Weissman & Beck, 1978; Pinto-Gouveia et al., 1987). The idea was to assess cognitive
proles that could constitute vulnerability factors to the development of emotional
disorders. We hypothesized that dysfunctional beliefs about sexuality could be related to
more general dysfunctional beliefs about ourselves and others.
When we look at the correlations between our questionnaire and the DAS (Table
XII), there is a closed relationship among several dimensions of both scales. In the
female version there are high correlations between the sexual beliefs total score and the
dependence of social approval (r = 0.71, p 5 0.01) and absolutist imperatives (r = 0.63,
p 5 0.01). Thus, we may conclude that our female sexual dysfunctional beliefs scale
189
TABLE XI. Correlations of the male and female SDBQ domains with the SBIQ total and domains
SBIQ domains
SDBQ domains
Time
patience
Stress
pressure
Ageing
Sexual
satisfaction
Basic
knowledge
7 0.32*
7 0.23
7 0.28
0.06
0.09
0.08
0.18
7 0.13
7 0.34*
7 0.18
7 0.20
0.07
7 0.19
0.03
0.26
7 0.33*
7 0.14
7 0.06
7 0.23
7 0.27
7 0.01
7 0.27
7 0.14
7 0.05
7 0.09
7 0.34
7 0.44*
7 0.04
7 0.37
7 0.24
7 0.10
0.23
7 0.02
7 0.11
7 0.09
7 0.08
0.22
7 0.12
7 0.65**
7 0.01
7 0.39
7 0.33
7 0.31
7 0.07
7 0.5
7 0.39
7 0.66**
7 0.00
7 0.32
7 0.53*
7 0.43*
7 0.17
0.24
0.02
7 0.10
7 0.11
7 0.41*
7 0.17
0.11
7 0.19
7 0.23
7 0.27
7 0.44*
0.01
0.01
7 0.40
7 0.28
7 0.48*
Total

Sexual conservatism
Sexual desire/
pleasure as a sin
Age related beliefs
Body-image beliefs
Denying affection
primacy
Motherhood primacy
Total
7 0.28
7 0.13
0.11
0.17
7 0.20
0.05
7 0.09
0.07
0.09
7 0.37*
7 0.05
7 0.27
7 0.24
7 0.18
7 0.26
7 0.42*

Sexual conservatism
Female sexual power
Macho belief
Beliefs about
womens
satisfaction
Restrictive attitude
toward sex
Sex as an abuse of
mens power
Total
*p 5 0.05. **p 5 0.01.
assesses general beliefs of dependence of approval by others and absolutist imperatives.

Apart from the close relationship that is common across several dimensions (sexual
conservatism, sex as a sin, age related beliefs, body image beliefs and motherhood
primacy), we may also highlight the correlations between perfectionism and fear of
rejection from the DAS and: sex as a sin (r = 0.44, p 5 0.05), and motherhood primacy
(r = 0.50, p 5 0.05). This could mean that behind the idea of sex as a sin and the
primacy of motherhood pleasures over sexual enjoyment, there is a fear of social
rejection and a tendency to be perfectionist in order to prevent social criticism. In the
same direction, we observed that the adaptive coping domain of the DAS is negatively
related to sex as a sin (r = 7 0.41, p 5 0.05) and age related beliefs (r = 7 0.49,
p 5 0.05). This means that females with beliefs of sex as a sin or that view ageing in
opposition of sexual expression are less capable to cope with failure situations.
When we analyse the male version, it is clear that there is an even stronger relationship
between the DAS and sexual dysfunctional beliefs. SDBQ total score presents high
190
correlations with perfectionism /rejection fear (r = 0.74, p 5 0.01), dependence of social

approval (r = 0.66, p 5 0.01), absolutist/imperative thinking (r = 0.60, p 5 0.01),
performance perfectionism (r = 0.58, p 5 0.01) and personal autonomy (r = 0.40,
p 5 0.05). We can postulate that male sexual beliefs are not only related to more general
beliefs of dependence of social approval and absolutist thinking, but also to a more
perfectionism related dimension (both work and social approval themes).
Sexual Self-Schema (SSS)
Another instrument used to assess convergent validity was the Sexual Self-Schema
(SSS, form F-female and M-male). This questionnaire was specically developed to
assess both male and female ideas about oneself as a sexual being (sexual self-view).
This measure is composed of three specic domains in both male and female forms:
Passionate/Romantic which is common for the two forms, Open/Direct and
Conservative for the female version and, Powerful/Aggressive and Liberal for the male
form. These dimensions, therefore, formed the aspects assessed as sexual self-views for
both males and females. Correlations between our measures and the SSS show that in
general, our females version total score present a moderate inverse relationship
(r = 7 0.32, p 5 0.05) with the Open/Direct dimension of the SSS female form (Table
XIII). Thus, females with high sexual dysfunctional beliefs do not present themselves as
sexually open or direct persons. When we look carefully at the specic dimensions of
both instruments, we observe that there are few statistically signicant correlations
between the assessed domains. The exception is the sexual conservatism factor of our
questionnaire which as expected, correlate highly with the open/direct (r = 7 0.46,
p 5 0.01) and the conservative dimensions (r = 0.31, p 5 0.05) of the SSS.
When we look at the male version, we observe a moderate relationship between the
liberal dimension of the SSS and sexual conservatism (r = 7 0.55, p 5 0.05), and
macho beliefs (r = 7 0.53, p = 0.05) dimensions of our measure. As in the female
version, the higher the males sexual dysfunctional beliefs (specically conservative and
macho) the smaller the tendency to present themselves as sexually liberal subjects. This
means that there is a convergence between the self-concept of sexual conservative/liberal
and the beliefs we present about sexuality.
In an overall analysis, we may conclude, that despite the relationship between the
conservative/liberal vector of the sexual self-view and some consistent sexual beliefs
(conservative in nature), none of the other dimensions of the SSS are linked to the
proposed dysfunctional sexual beliefs. The self-views of being sexually romantic or
powerful and aggressive are not related to any of the dysfunctional sexual beliefs
presented.
Male and Female Sexual Function Index (FSFI, IIEF)
Regarding the correlation between the sexual dysfunctional beliefs questionnaire and
both male and female sexual function, we found several statistically signicant
correlations. This shows that our beliefs about sexuality are somehow related to our
sexual functioning (Table XIV).
*p 5 0.05. **p 5 0.01.
Sexual conservatism
Female sexual power
Macho belief
Womens satisfaction
belief
Restrictive sex attitude
Sex as mens abuse
Total
Sexual conservatism
Sexual desire as a sin
Age related beliefs
Body-image beliefs
Denying affection
primacy
Motherhood primacy
Total
SDBQ domains
0.14
0.57**
0.42*
0.33
0.27
0.39*
0.60**
0.47*
0.55**
0.74**
0.45*
0.63**
0.51*
0.40
0.70**
0.63**
0.61**
0.61**
0.43*
0.41*
0.70**
0.50*
0.00
0.19
0.44*
0.17
0.38
0.10
Perfectionism
Absolutist
imperatives
0.27
0.33
0.66**
0.45*
0.53**
0.40*
0.53**
0.55**
0.71**
0.46*
0.35
0.70**
0.43*
7 0.20
Dependence
of social
approval
0.54**
0.51**
0.53**
0.48**
0.13
0.35
0.58**
7 0.35
7 0.40
7 0.06
7 0.00
7 0.10
7 0.37
7 0.18
7 0.43*
0.01
7 0.22
7 0.19
7 0.15
7 0.05
0.26
7 0.03
0.09
High
performance
demands
7 0.20
7 0.12
7 0.16
7 0.03
7 0.22
Adaptive
cognitions
DAS Domains
0.09
7 0.03
7 0.11
7 0.08
7 0.04
0.13
7 0.23
7 0.17
7 0.40
7 0.30
7 0.41*
7 0.49*
7 0.27
0.50*
Adaptive
coping
TABLE XII. Correlations of the male and female SDBQ domains with DAS total and domains
7 0.10
7 0.02
0.40*
0.15
0.28
0.11
0.49**
0.29
7 0.02
7 0.09
7 0.09
7 0.11
7 0.06
0.23
Autonomy
0.21
0.38
0.68**
0.51**
0.59**
0.50**
0.60**
0.38
0.38
0.17
0.30
0.46*
0.34
0.07
Total

191
192

TABLE XIII. Correlations of the male and female SDBQ domains with SSS total and domains
SSS domains
SDBQ domains
Passionate/Romantic
Open/Direct
Conservative

Sexual conservatism
Sexual desire/pleasure as a sin
Age related beliefs
Body-image beliefs
Denying affection primacy
Motherhood primacy
Total
7 0.04
7 0.19
0.01
0.04
7 0.17
7 0.04
7 0.13
7 0.46**
7 0.27
0.02
0.02
0.07
7 0.17
7 0.32*
0.31*
0.01
0.08
0.05
7 0.14
0.02
0.17

SSS domains
SDBQ domains
Sexual conservatism
Female sexual power
Macho belief
Total
Passionate/Loving
Powerful/Aggressive
0.19
7 0.48
0.08
7 0.27
0.27
7 0.01
7 0.17
7 0.33
7 0.31
7 0.24
7 0.20
7 0.26
7 0.12
7 0.41
Liberal
7 0.55*
7 0.31
7 0.53
7 0.15
7 0.50
0.00
7 0.45
*p 5 0.05. **p 5 0.01.
Looking at the female sample, the FSFI total score presented high negative correlations
with: sexual conservatism (r = 7 0.35, p 5 0.01), sex as a sin (r = 7 0.32, p 5 0.01), age
related beliefs (r = 7 0.33, p 5 0.01) and body image beliefs (r = 7 0.24, p 5 0.01).
Regarding the male sample, there were high negative correlations between the IIEF
total scores and: sexual conservatism (r = 7 0.40, p 5 0.01), beliefs about womens
satisfaction (r = 7 0.39, p 5 0.001), macho belief (r = 7 0.32, p 5 0.01), restrictive
attitude toward sex (r = 7 0.28, p 5 0.001) and female sexual power (r = 7 0.26,
p 5 0.01).
Discriminant validity
In order to analyse discriminant validity, we used t-test of mean differences between a
clinical group and a control group of community volunteers (demographic data
presented in Table II). We hypothesized that dysfunctional subjects would present
higher scores on both male and female sexual dysfunctional beliefs, supporting the
hypothesis that our questionnaires assess sexual beliefs that could represent a
vulnerability factor for developing sexual problems.
193
Results for both male and female populations, although not statistically signicant,
showed that subjects from the clinical group presented higher results on several domains
of the SDBQ compared to the control subjects (Table XV, Figure 1 and 2). Female
dysfunctional group present higher scores in sexual conservatism (t = 0.96, p = 0.34), sex
as a sin (t = 1.52, p = 0.13) and body-image beliefs (t = 0.98, p = 0.33), while
dysfunctional males showed higher scores on macho belief (t = 1.47, p = 0.15).
Discussion and Conclusions
The purpose of this study was to develop a measure of male and female sexual beliefs
that could be related to sexual disorders. Starting from a cognitivist point of view, we
hypothesised that sexual disorders are characterised by a set of beliefs about sexuality,
that could play a central role as predisposing factors of sexual dysfunction. These beliefs
or ideas about sexuality and sexual expression would guide our sexual behaviour, and
would be used in interpretation for sexual events. Thus, if a man presents a belief that he
must maintain an erection until the end of any sexual situation, he would tend to
interpret any decrease of erectile level in a sexual context as a failure (possible
developing more erectile difculties). In addition, if a woman believed that vaginal
coitus is the only acceptable way of having sex, she could present some difculties in
experiencing orgasm. These simple examples show how specic sexual beliefs could
affect sexual expression.
Using several beliefs and attitudes proposed as etiologic factors of sexual
dysfunction (Hawton, 1985; Kaplan, 1979; Lazarus, 1988; Lo Piccolo & Friedman,
1988; Masters & Johnson, 1970; Rosen & Leiblum, 1995; Tevlin & Leiblum, 1983;
Wincze & Barlow, 1997; Zilbergeld, 1992), we developed a 40 item male and female
questionnaire, after a careful item analysis of a primary pool of 95 questions. Both male
and female forms presented high internal consistency (Cronbachs alpha = 0.93 for the
male and .81 for the female version) as well as acceptable test retest reliability results
(r = 0.73 and r = 0.80 respectively).
A factor analysis of both forms was performed to study internal structure, showing
that these two versions present a six factor structure: sexual conservatism, sexual
desire and pleasure as a sin, age related beliefs, body image beliefs, denying affection
primacy and motherhood primacy for the female version; and: sexual conservatism,
female sexual power, macho belief, beliefs about womens satisfaction beliefs,
restrictive attitude toward sex and sex as an abuse of mens power for male version.
The inter-correlations between the several dimensions of both measures showed the
consistency of the questionnaires with statistically high correlations across almost all
factors.
Regarding validity studies, we analysed the relationship between our instrument and
other measures of sexual or more general beliefs. The SBIQ, a similar measure of sexual
information and beliefs, was related to our questionnaires, especially in the time/
patience dimension of the SBIQ (characterized by the idea that time and sharing plays a
central role in sexual satisfaction). Results indicate that the greater the dysfunctional
sexual beliefs, the greater the tendency to deny sharing information about ones desire
and taking the time needed to please the partner.
*p 5 0.05. **p 5 0.01.
Sexual conservatism
Female sexual power
Macho belief
Total
SDBQ domains
Sexual conservatism
Age related beliefs
Body-image beliefs
Motherhood primacy
Total
SDBQ domains
Erection
7 0.36**
7 0.25**
7 0.32**
7 0.37**
7 0.25**
7 0.11
7 0.44**
7 0.20**
7 0.13
7 0.14*
7 0.15*
7 0.19**
7 0.10
7 0.24*
7 0.30**
7 0.25**
7 0.19*
7 0.22**
7 0.07
7 0.17*
7 0.31**
Arousal
Desire
7 0.40**
7 0.36**
7 0.32**
7 0.28**
7 0.05
7 0.17*
7 0.35**
Desire
7 0.30**
7 0.25**
7 0.25**
7 0.30**
7 0.20**
7 0.07
7 0.31**
Orgasm
7 0.21**
7 0.17*
7 0.10
7 0.12
7 0.09
7 0.14
7 0.18*
Lubrication
7 0.32**
7 0.18**
7 0.20**
7 0.29**
7 0.19
7 0.03
7 0.34**
Overall
satisfaction
IIEF domains
7 0.18*
7 0.24**
7 0.17*
7 0.20**
7 0.05
7 0.15*
7 0.25**
Orgasm
FSFI domains
7 0.28**
7 0.23**
7 0.28**
7 0.29**
7 0.16*
0.01
7 0.39**
Intercourse
satisfaction
7 0.33**
7 0.24**
7 0.39**
7 0.20**
7 0.03
7 0.10
7 0.32**
Satisfaction
7 0.40**
7 0.26**
7 0.32**
7 0.39**
7 0.28**
7 0.11
7 0.44**
Total
7 0.21**
7 0.07
7 0.16*
7 0.00
7 0.00
7 0.13
7 0.17*
Pain
TABLE XIV. Correlations of the male and female automatic thoughts sub-scale domains with the FSFI and IIEF domains and total
7 0.35**
7 0.32**
7 0.33**
7 0.24**
7 0.07
7 0.14
7 0.36**
Total
194
195
TABLE XV. Means and standard deviations of male and female SDBQ domains in a clinical and control
group and between groups t-test
Female sample
Clinical group (n = 47)
Control group (n = 46)
SDBQ domains
Mean
SD
Mean
SD
Sexual conservatism
Age related beliefs
Body-image beliefs
Motherhood primacy
Total
16.51
8.52
10.20
6.34
9.10
7.53
57.68
6.23
3.94
3.56
3.09
3.55
2.64
15.93
15.11
7.47
9.95
5.75
9.29
7.50
52.00
7.05
2.38
4.17
2.63
3.42
2.30
13.95
0.96
1.52
0.30
0.98
7 0.25
0.06
1.59
Male sample
Clinical group (n = 49)
Control group (n = 49)
SDBQ domains
Mean
SD
Mean
SD
Sexual conservatism
Female sexual power
Macho belief
Total
19.72
22.21
22.89
15.96
10.23
3.48
92.88
7.99
5.49
6.28
4.82
2.93
1.69
21.49
19.62
22.93
21.04
14.89
11.35
3.85
90.26
8.63
5.16
6.00
4.55
3.45
2.20
23.99
0.06
7 0.63
1.47
1.09
7 1.68
7 0.91
0.50
The Sexual Self-Schema, a questionnaire assessing self-views in sexual context is

another measure partially related to our instruments. The conservative/liberal vector of
the SSS has shown high correlations with both male and female sexual conservative
beliefs and the male macho belief. This supports that there is a consistency between
sexual beliefs (especially the conservative ones) and subjects self-concept as sexual
conservative persons.
In order to analyse the relationship between sexual beliefs and more generic beliefs
of ourselves and others, we studied the relationship with the Dysfunctional Attitudes
Scale (DAS). These general beliefs accepted as predisposing factors of several
psychopathological situations also prove to be highly related to several dimensions of
both male and female sexual beliefs. This is especially evident for dependence of social
approval, absolutist imperatives and perfectionism. We may conclude, that behind
sexual dysfunctional beliefs, could be more general cognitive proles that have played an
important role in the development of different psychopathological situations, especially
depression (Weissman & Beck, 1978; Pinto-Gouveia et al., 1987).
Finally, with the purpose of studying the impact of sexual dysfunctional beliefs on
sexual disorders, we assessed the relationship between our measure and male and
196
FIG. 1. Mean scores of functional and dysfunctional groups in SDBQ domains (female version).
FIG. 2. Mean scores of functional and dysfunctional groups in SDBQ domains (male version).
female sexual functioning scales, and performed a discriminant analysis, evaluating its
capacity to distinguish between a clinical (sexual dysfunctional) and a control group
(sexual functional). Both analyses supported our hypothesis that sexual dysfunctional
beliefs are somehow related with sexual dysfunction. Several domains from both male
and female SDBQ showed statistically signicant negative correlations with the sexual
function scores. Discriminant analysis between a clinical and a control group although
not showing statistically signicant differences somehow supported the ndings from
the correlational studies. The less signicant results from this analysis could be related
197
with the relative small number of subjects used. Further studies with larger samples
must be conducted in order to better clarify this issue (now in progress). In general, our
results seems to validate the idea that some beliefs about sexuality could be related to
dysfunctional manifestations, supporting some theoretical conceptualisations based on
clinical observations.
Religious beliefs and conservatism (Kaplan, 1979; LoPiccolo & Friedman, 1988;
Masters & Johnson, 1970), body-image beliefs (LoPiccolo & Friedman, 1988; Rosen &
Leiblum, 1995) and lack of information regarding sexuality (Hawton, 1985) proved to be
signicantly higher in our female clinical sample. In addition, high performance beliefs,
beliefs about womens sexual satisfaction, and sexual conservatism (Hawton, 1985; Wincze
& Barlow, 1997; Zilbergeld, 1992, 1999), were higher in our male clinical sample in
comparison with the non-clinical group. Thus, these sexual beliefs maybe conceptualised as
cognitive vulnerabilities to sexual dysfunction. Using a cognitive perspective, the presence
of sexual dysfunctional beliefs stipulating a range of conditions for the activation of negative
schemas, constitute a predisposing factor for the development of sexual difculties.
The sexual dysfunctional beliefs questionnaire is a valid, reliable and important
measure for assessing ideas about sexuality that play a major role in the development of
sexual disorders. Although more consistent and larger studies both with clinical and
non-clinical populations are needed (now in progress), we think that SDBQ may be
useful in both clinical practice and educational programs as an indicator of vulnerability
to sexual dysfunction.
Acknowledgements
This research was partially supported by a grant from PRODEP. The authors would like to
thank to D. Rijo, MA, C. Salvador, MA, M. Lima, PhD, Faculdade de Psicologia,
Universidade de Coimbra, Portugal; A. Gomes, MA, L. Fonseca, MA, A. Carvalheira,
MA, J. Teixeira, MD, G. Santos, MD, J. Quartilho, MD, PhD., P. Abrantes, MD, A.
Canhao, MD, Hospitais da Universidade de Coimbra, for their suggestions and help in
sample collection. H. Ramsawh, MA , L. Scepkowski, MA and M. Santos, BA, Center for
Anxiety and Related Disorders, Boston University for reviewing the English version of the
measures. John Wincze, PhD, Brown University and Center for Anxiety and Related
Disorders, Boston University, for his review and suggestions on a previous version of the
paper. Thanks also to participants who volunteered to participate in the study.
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Contributors
PEDRO J. NOBRE, MSc, Clinical Psychologist
JOSE PINTO GOUVEIA, Associate Professor and Head of Cognitive Behaviour Department
FRANCISCO ALLEN GOMES, Hospitais da Universidade de Coimbra
Appendix
Sexual Beliefs Questionnaire (Male Version)
The list presented below contains statements related to sexuality. Please read each statement
carefully and circle the number in the right hand column which correspond to the extent to which
you agree or disagree with each statement (circle only one option per statementfrom 1
completely disagree to 5completely agree). There are no wrong or right answers, but it is very
important that you be honest and that you answer all items.
Sexual beliefs
1.
2.
3.
A real man has sexual intercourse very often

Orgasm is possible only by vaginal intercourse
Penile erection is essential for a
womans sexual satisfaction
Disagree
Dont
disagree
or agree
Agree
Completely
agree
Completely
disagree
(continued )
200

. (continued )
Sexual beliefs
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Homosexuality is a sickness
A woman has no other choice
but to be sexually subjugated by
a mans power
A real man must wait the necessary amount of time to sexually
satisfy a woman during intercourse
A woman may have doubts
about a mans virility when he
fails to get an erection during
sexual activity
Repeated engagement in oral or
anal sex can cause serious health
problems
A shorter duration of intercourse
is a sign of a mans power
Sex is an abuse of a males power
The consequences of a sexual
failure are catastrophic
Women only pay attention to
attractive younger men
It is not appropriate to have
sexual fantasies during sexual
intercourse
There are certain universal rules
about what is normal during
sexual activity
In bed the woman is the boss
Men who are not capable of
penetrating women cant satisfy
them sexually
In sex, getting to the climax is
most important
In sex anything but vaginal
intercourse is unacceptable
A womans body is her best
weapon
A woman may stop loving a man
if he his not capable of satisfying
her sexually
Vaginal intercourse is the only
legitimate type of sex
The quality of the erection is
what most satises women
Disagree
Dont
disagree
or agree
Agree
Completely
agree
1
1
2
2
3
3
4
4
5
5
1
1
2
2
3
3
4
4
5
5
1
1
2
2
3
3
4
4
5
5
Completely
disagree
(continued )
201

. (continued )
Sexual beliefs
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
A successful career implies the

control of sexual urges
Foreplay is a waste of time
Sex is meant only for procreation
In sex, the quicker/faster the
better
People who dont control their
sexual urges are more easily
controlled by others
A real man is always ready for
sex and must be capable of
satisfying any woman
If a man lets himself go sexually
he is under a womans control
A man must be capable of
maintaining an erection until
the end of any sexual activity
There is only one acceptable way
of having sex (missionary position)
Sexual intercourse before marriage is a sin
Sex is a violation of a womans
body
A man who doesnt sexually
satisfy a woman is a failure
Whenever the situation arises, a
real man must be capable of
penetration
Sex can be good even without
orgasm
A real man doesnt need much
stimulation to reach orgasm
A woman at her sexual peak can
get whatever she wants from a
man
The greater the sexual intimacy,
the greater the potential for
getting hurt
Disagree
Dont
disagree
or agree
Agree
Completely
agree
1
1
2
2
3
3
4
4
5
5
1
1
2
2
3
3
4
4
5
5
Completely
disagree
202
Sexual Beliefs Questionnaire (Female Version)

The list presented below contains statements related to sexuality. Please read each statement
carefully and circle the number in the right hand column which correspond to the extent to which
you agree or disagree with each statement (circle only one option per statementfrom 1
completely disagree to 5completely disagree). There are no wrong or right answers, but it is
very important that you be honest and that you answer all items.
.
Sexual beliefs
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Love and affection from a

partner are necessary for good
sex
Masturbation is wrong and
sinful
The most important component of sex is mutual affection
The best gift a woman could
bring to marriage is her virginity
After menopause women lose
their sexual desire
Women who have sexual fantasies are perverted
Masturbation is not a proper
activity for respectable women
After menopause women
cant reach orgasm
There are a variety of ways of
getting pleasure and reaching
orgasm
Women who are not physically attractive cant be sexually satised
In the bedroom the man is the
boss
A good mother cant be sexually active
Reaching climax /orgasm is
acceptable for men but not for
women
Sexual activity must be initiated by the man
Sex is dirty and sinful
Disagree
Dont
disagree
or agree
Agree
Completely
agree
Completely
disagree
(continued )
203

. (continued )
Sexual beliefs
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
Simultaneous orgasm for two

partners is essential for a
satisfying sexual encounter
Orgasm is possible only by
vaginal intercourse
The goal of sex is for men to
be satised
A successfully professional
career implies control of sexual behavior
As women age the pleasure
they get from sex decreases
Men only pay attention to
young, attractive women
Sex is a beautiful and pure
activity
Sex without love is like food
without avor
As long as both partners consent, anything goes
Any woman who initiates
sexual activity is immoral
Sex is meant only for procreation
Sexual intercourse during
menstruation
can
cause
health problems
Oral sex is one of the biggest
perversions
If women let themselves go
sexually they are totally under
mens control
Being nice and smiling at men
can be dangerous
The most wonderful emotions that a woman can experience are maternal feelings
In the bedroom the woman is
the boss
Sex should happen only if a
man initiates
There is just one acceptable
way of having sex (missionary
position)
Disagree
Dont
disagree
or agree
Agree
Completely
agree
1
1
2
2
3
3
4
4
5
5
Completely
disagree
(continued )
204

. (continued )
Sexual beliefs
36.
37.
38.
39.
40.
Experiencing pleasure during

sexual intercourse is not acceptable in an virtuous woman
A good mother must control
her sexual urges
An ugly woman is not capable
of sexually satisfying her partner
A woman who only derives
sexual pleasure through clitoral stimulation is sick or
perverted
Pure girls dont engage in
sexual activity
Disagree
Dont
disagree
or agree
Agree
Completely
agree
Completely
disagree

Sexual Dysfunctional Beliefs

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Sexual and Relationship Therapy, Vol 18, No.

Sexual Dysfunctional Beliefs

Universidade de Tras-os-Montes e Alto Douro, Miranda do Douro, Portugal, 2Faculdade

Pedro J. Nobre et al.

Sexual Dysfunctional Beliefs Questionnaire

Pedro J. Nobre et al.

Sexual Dysfunctional Beliefs Questionnaire

TABLE II. Demographic characteristics of the clinical and control groups

Clinical sample (n = 47)

Control sample (n = 46)

Clinical sample (n = 49)

Control sample (n = 49)

Pedro J. Nobre et al.

Time/Patience, Stress/Pressure, Ageing, Sexual Satisfaction, Miscellaneous/Basic

Sexual Dysfunctional Beliefs Questionnaire

Pedro J. Nobre et al.

Factor analysis and domain scores

Sexual Dysfunctional Beliefs Questionnaire

Pedro J. Nobre et al.

Sexual desire and pleasure as a sin

Sex is dirty and sinful

Age related beliefs

After menopause women lose

Sexual Dysfunctional Beliefs Questionnaire

TABLE III. (continued )

After menopause women cant

Women who are not physically

Sex is meant only for

Pedro J. Nobre et al.

In the bedroom the woman is the

Items scored in reverse order

TABLE IV. Female SDBQ domain intercorrelations (n = 154)

*p 5 0.05. **p 5 0.01.

TABLE V. Domain and total scores of the SDBQ (female version)

2, 4, 7, 13, 14, 17, 27, 28, 32

*Items 1, 3, 22, 23, 24 are scored in reverse order.

Sexual Dysfunctional Beliefs Questionnaire

Pedro J. Nobre et al.

Female sexual power

The consequences of a sexual

Sexual Dysfunctional Beliefs Questionnaire

TABLE VI. (continued )

A real man has sexual intercourse very often

Beliefs about womens satisfaction

Penis erection is essential for a

Repeated engagement on oral/

Pedro J. Nobre et al.

It is not appropriate to have

Sex as an abuse of mens power

Sex is an abuse of males power

Items scored in reverse order.

TABLE VII. Male SDBQ domain intercorrelations (n = 206)

*p 5 0.05. **p 5 0.01.

2, 5, 9, 18, 21, 24, 25, 26, 32, 33

Note: Item 37 is scored in reverse order.

Sexual Dysfunctional Beliefs Questionnaire

TABLE IX. Test retest reliability

Female sample (n = 26)

Sexual Beliefs and Information Questionnaire (SBIQ)

Pedro J. Nobre et al.

Female sample (n = 154)

Sexual Dysfunctional Beliefs Questionnaire

Female sample (n = 45)

Male sample (n = 23)