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*, JOSÉ PINTO GOUVEIA2 &
FRANCISCO ALLEN GOMES3
1
Universidade de Trás-os-Montes e Alto Douro, Miranda do Douro, Portugal, 2Faculdade
de Psicologia e Ciências da Educação da Universidade de Coimbra, Coimbra, Portugal &
3
Hospitais da Universidade de Coimbra, Coimbra, Portugal

ABSTRACT 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
specific 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 five point likert scale. Both male and
female versions present satisfactory test – retest reliability (r = 0.73 and r = 0.80 respectively), and
internal consistency (Cronbach’s 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.

Introduction

Beliefs are ideas that we have about ourselves, others, or the world, that guide the
way we interpret events, influencing 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 1468–1994 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
fulfils these conditions core cognitive schemas or core beliefs would be activated or
enhanced: ‘I’m friendless, rejected’ (social anxiety), ‘I’m a failure, worthless’
(depression) or ‘I’m 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 field. 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 women’s 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 field. Baker & De Silva,
(1988), using Zilbergeld’s (1983) myths about male sexuality, conclude that dysfunc-
tional 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 fill 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 specific 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 (I’m incompetent) whenever an erection difficulty
occurs. This negative self-schema, once activated would elicit negative automatic thoughts
(I’m 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
Coimbra’s 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 Pedro J. Nobre et al.

TABLE I. Demographic characteristics of the community sample

Female (n = 154) Male (n = 206)

Age
M 24.4 30.6
Min – Max 18 – 55 18 – 56
SD 7.2 9.4
Marital status % %
Single 82.2 55.2
Married 15.8 39.8
Divorced 0.0 2.5
Living together 2.0 2.5
Education level
0 – 4 years 3.0 8.5
5 – 6 years 3.0 3.5
7 – 9 years 2.0 5.1
10 – 12 years 23.4 17.1
13 – 15 years 8.1 7.0
16 or more years 60.5 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 specific 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 specific 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
 Sexual Dysfunctional Beliefs Questionnaire 175

functioning. The questionnaire consists of 25 items rated in a true false or don’t 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 five components:

TABLE II. Demographic characteristics of the clinical and control groups

Female

Clinical sample (n = 47) Control sample (n = 46)

Age
M 28.7 29.2
Min – Max 19 – 50 18 – 48
SD 6.7 8.6
Marital status % %
Single 63.8 60.9
Married 25.5 28.2
Divorced 4.3 0.0
Living together 6.4 6.5
Education level
0 – 4 years- 10.6 10.9
5 – 6 years 10.6 10.9
7 – 9 years 6.4 6.5
10 – 12 years 31.9 34.8
13 – 15 years 10.6 4.3
16 or more years 29.8 32.6

Male

Clinical sample (n = 49) Control sample (n = 49)

Age
M 43.0 42.7
Min – Max 18 – 67 18 – 56
SD 14.4 15.7
Marital status % %
Single 26.5 22.4
Married 61.2 71.4
Divorced 2.1 2.0
Living together 10.2 4.1
Education level
0 – 4 years- 38.8 36.0
5 – 6 years 24.5 8.0
7 – 9 years 12.2 22.0
10 – 12 years 22.4 30.0
13 – 15 years 0.0 0.0
16 or more years 2.0 4.0
176 Pedro J. Nobre et al.

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
identification 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. Cronbach’s 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 character-
istics (Weissman & Beck, 1978). A Portuguese version of the scale was developed by Pinto-
Gouveia et al. (1987). Psychometric studies of the Portuguese version conducted with 404
subjects showed acceptable test – retest reliability (r = 0.69) and internal consistency
(Cronbach’s 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, defined as the investment in achieving independent status and
individual goals. The scale contains 60 statements rated in a five point likert scale (0 –
4), 30 of which are related with sociotropy and 30 with autonomy. The scale presents
high internal reliability with Cronbach’s alpha coefficients 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
 Sexual Dysfunctional Beliefs Questionnaire 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 affiliation in the Sociotropy Scale;
independent goal attainment and sensitivity to other’s 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 (Cronbach’s 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 five domains: erectile function, orgasmic function, sexual
desire, intercourse satisfaction and overall satisfaction. Psychometric studies
supported the validity (significant mean difference scores between a clinical and a
control group) and reliability (Cronbach’s 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 specificity 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 (Cronbach’s alpha values of 0.82 and higher) and
validity (demonstrated by significant 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 didn’t load
significantly (higher than 0.4) in none of the factors. The remaining 40 items constitute
the final version of the male and female SDBQ.
178 Pedro J. Nobre et al.

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 identified using Catell’s scree test. The factors identified 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 sup-
ported the adequacy of the sample, and Bartlett’s test of sphericity was significant (Chi-
square = 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 didn’t load high on any of the factors were excluded. Based on these
criteria six items were excluded: 9—‘there is a variety of ways of getting pleasure and
reaching orgasm’, 16—‘simultaneous orgasm for two partners is essential for a satisfying
sexual encounter’, 19—‘A successful professional career implies control of sexual
behaviour’, 21—‘men only pay attention to young, attractive women’, 25—‘any woman
who initiates sexual activity is immoral’, 29—‘if women let themselves go sexually they
are totally under men’s 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 identified 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. Female’s 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 female’s 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.
 Sexual Dysfunctional Beliefs Questionnaire 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 significance
(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 identified using Catell’s 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 identified were theoretically sound, Kaiser – Meyer – Olkin of 0.85 supported the
adequacy of the sample, and Bartlett’s test of sphericity was significant (Chi-
square = 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 didn’t 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
identified 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 don’t control their
sexual urges, they will fall under women’s power.
(3) ‘Macho’ belief: factor dominated by the concept of man’s 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 women’s 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 Pedro J. Nobre et al.

TABLE III. Female SDBQ principal component analysis with varimax rotation (n = 154)

Factors

SDBQ items 1 2 3 4 5 6

Sexual conservatism
2. Masturbation is wrong and sinful 0.66 7 0.08 0.14 0.14 7 0.02 0.15
4. The best gift woman could bring 0.63 7 0.05 0.25 0.20 7 0.08 7 0.10
to marriage is her virginity
7. Masturbation is not a proper 0.53 0.20 0.23 0.41 7 0.04 7 0.09
activity for respectable women
13. Reaching climax/orgasm is ac- 0.43 7 0.11 0.27 0.14 0.27 0.02
ceptable for men but not for
women
14. Sexual activity must be initiated 0.45 0.19 0.22 0.01 0.01 0.32
by man
17. Orgasm is possible only by va- 0.46 0.15 7 0.03 0.27 0.11 0.28
ginal intercourse
27. Sexual intercourse during men- 0.40 0.33 7 0.03 7 0.03 0.17 0.12
struation can cause health pro-
blems
28. Oral sex is one of the biggest 0.64 0.35 0.05 7 0.02 0.12 0.29
perversions
32. Anal sex is a perverted activity 0.65 0.06 0.07 7 0.04 7 0.08 0.08

Sexual desire and pleasure as a sin

15. Sex is dirty and sinful 7 0.07 0.50 0.09 0.29 0.20 0.21
34. Sex should happen only if a man 0.08 0.79 0.09 0.13 7 0.00 0.02
initiates
35. There is just one acceptable way 0.13 0.72 7 0.02 0.03 7 0.01 0.28
of having sex (missionary posi-
tion)
36. Exper. pleasure during sexual 0.05 0.63 0.14 0.22 0.04 7 0.37
act. is not acceptable in a virtu-
ous woman
37. A good mother must control her 0.06 0.52 0.27 0.46 0.02 0.26
sexual urges
39. A woman who only derives sex 0.23 0.45 0.13 0.28 7 0.01 0.10
pleasure through clitoris stimu-
lation is sick

Age related beliefs

5. After menopause women lose 0.17 0.11 0.67 0.09 7 0.07 0.02
their sexual desire
6. Women who have sexual fanta- 0.11 0.47 0.52 7 0.04 0.13 7 0.09
sies are perverted

(continued )
 Sexual Dysfunctional Beliefs Questionnaire 181

TABLE III. (continued )

Factors

SDBQ items 1 2 3 4 5 6

8. After menopause women can’t 0.15 0.19 0.70 0.11 7 0.01 0.07
reach orgasm
11. In the bedroom the man is the 0.01 7 0.18 0.54 0.22 7 0.05 0.23
boss
20. As women age the pleasure they 0.17 0.18 0.62 0.17 7 0.12 0.26
get from sex decreases

Body-image beliefs

10. Women who are not physically 0.14 0.03 0.34 0.64 7 0.08 7 0.05
attractive can’t be sexually satis-
fied
12. A good mother can’t be sexually 0.01 0.12 0.25 0.71 0.02 0.27
active
38. An ugly woman is not capable of 0.12 0.24 0.04 0.53 7 0.06 0.05
sexually satisfying her partner
40. Pure girls don’t engage in sexual 0.24 0.21 0.10 0.48 7 0.04 7 0.12
activity

Affection primacy

1. Love and affection from a part- 0.06 7 0.06 0.24 7 0.38 0.52 7 0.21
ner are necessary for good sexa
3. The most important component 0.09 0.06 0.11 0.04 0.56 7 0.03
of sex is mutual affectiona
18. The goal of sex is for men to be 0.28 0.11 0.16 0.21 0.47 0.00
satisfied
22. Sex is a beautiful and pure 0.01 0.14 0.05 0.07 0.67 0.08
activitya
23. Sex without love is like food 0.25 0.08 7 0.00 0.14 0.56 0.04
without flavoura
24. As long as both consent agree 0.23 7 0.01 0.05 7 0.07 0.60 7 0.05
anything goesa

Motherhood primacy

26. Sex is meant only for 0.15 0.16 7 0.19 0.40 0.12 0.54
procreation
30. Being nice and smiling at men 0.14 0.12 0.23 0.14 0.02 0.60
can be dangerous
31. The most wonderful emotions 0.19 0.00 0.23 0.02 7 0.16 0.53
that a woman can experience are
maternal

(continued )
182 Pedro J. Nobre et al.

TABLE III. (continued )

Factors

SDBQ items 1 2 3 4 5 6

33. In the bedroom the woman is the 0.10 0.05 0.24 7 0.22 0.12 0.43
boss

a
Items scored in reverse order

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

Domains F1 F2 F3 F4 F5 F6

F1 Sexual conservatism –
F2 Sexual desire and pleasure as a 0.42** –
sin
F3 Age related beliefs 0.42** 0.43** –
F4 Body-image beliefs 0.43** 0.52** 0.42** –
F5 Denying affection primacy 0.06 0.09 7 0.08 7 0.01 –
F6 Motherhood primacy 0.41** 0.27** 0.38** 0.21** 0.01 –

*p 5 0.05. **p 5 0.01.

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

Domains Item numbers Minimum Maximum

F1 Sexual conservatism 2, 4, 7, 13, 14, 17, 27, 28, 32 9 45

F2 Sexual desire and pleasure as a sin 15, 34, 35, 36, 37, 39 6 30
F3 Age related beliefs 5, 6, 8, 11, 20 5 25
F4 Body-image beliefs 10, 12, 38, 40 4 20
F5 Denying affection primacy 1, 3, 18, 22, 23, 24 6 30
F6 Motherhood primacy 26, 30, 31, 33 4 20
Total – 34 170

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

(6) Sex as an abuse of men’s power: dimension dominated by the idea of sex as an
act of violation or abuse of woman’s 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 significant (p 5 0.01). These results show that
the scale assesses different dimensions of the same general concept. Looking more
specifically to the individual relationship, we may highlight the higher correlations of
 Sexual Dysfunctional Beliefs Questionnaire 183

the sexual conservatism dimension with all the other factors, specially, sex as an abuse
of men’s 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 admin-
istrations of the questionnaires with a four week interval. Both male and female
versions presented statistically significant 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 specifically the results for each
dimension of both male and female measures we found some non-significant
correlations (Table IX).

Internal consistency
Internal consistency of the instrument was assessed by calculating Cronbach’s alpha
statistic for the total scale and also for each dimension of both male and female
versions (Table X). Results for the total scale (Cronbach’s 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 Cronbach’s 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 men’s power of the male version. These findings
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 Pedro J. Nobre et al.

TABLE VI. Male SDBQ principal component analysis with varimax rotation (n = 206)

Factors

SDBQ items F1 F2 F3 F4 F5 F6

Sexual conservatism
2. Orgasm is possible only by 0.52 0.04 0.25 0.10 0.34 7 0.04
vaginal intercourse
5. Women have no other choice 0.51 0.19 0.36 0.11 0.11 0.27
but to be sex. Subjugated by
man’s power
9. A shorter duration of inter- 0.47 0.31 0.24 0.05 0.07 7 0.05
course is a sign of man’s power
18. In sex anything but vaginal 0.63 0.07 0.14 0.09 0.41 0.12
intercourse is unacceptable
21. Vaginal intercourse is the only 0.53 0.47 0.16 7 0.25 0.18 7 0.09
legitimate type of sex
24. Foreplay is a waste of time 0.70 0.11 0.35 7 0.04 0.20 7 0.11
25. Sex is meant only for procrea- 0.72 0.07 0.08 0.15 0.15 0.22
tion
26. In sex, the quickest/faster the 0.72 0.67 0.29 7 0.01 0.03 0.03
best
32. There is only one acceptable 0.72 0.09 7 0.05 0.21 0.01 0.00
way of having sex (missionary
position)
33. Sexual intercourse before mar- 0.76 7 0.04 7 0.10 0.14 0.00 0.06
riage is a sin

Female sexual power

11. The consequences of a sexual 0.09 0.42 0.31 0.20 0.25 7 0.05
failure are catastrophic
15. In bed the woman is the boss 0.20 0.41 7 0.18 7 0.01 0.21 0.39
19. A woman’s body is her best 0.08 0.65 0.18 7 0.01 0.13 0.06
weapon
27. People who don’t control their 7 0.01 0.56 0.16 0.12 0.10 7 0.05
sexual urges are more easily
controlled by others
29. If a man lets himself go sexu- 0.07 0.54 0.11 0.34 0.18 0.17
ally he is under a woman’s
control
38. A real man doesn’t need much 0.16 0.49 0.33 0.11 7 0.34 0.08
stimulation to reach orgasm
39. A woman at her sexual peak 0.13 0.62 7 0.11 0.41 7 0.10 0.02
can get whatever she wants
from a man
40. The greater the sexual inti- 0.13 0.51 0.18 0.12 0.02 0.09
macy, the greater the potential
for getting hurt

(continued )
 Sexual Dysfunctional Beliefs Questionnaire 185

TABLE VI. (continued )

Factors

SDBQ items F1 F2 F3 F4 F5 F6

‘Macho’ belief

1. A real man has sexual inter- 0.17 0.23 0.59 0.29 7 0.12 7 0.05
course very often
4. Homosexuality is a sickness 0.15 0.06 0.46 0.30 0.28 7 0.05
6. A real man must wait the 7 0.01 0.11 0.52 0.43 0.13 0.21
necessary amount of time to
sexual satisfy a woman
17. In sex, getting to the climax is 0.29 0.24 0.45 0.01 0.13 0.24
most important
28. A real man is always ready for 0.18 0.26 0.66 0.23 0.01 0.13
sex and must be capable of
satisfying any woman
31. A man must be capable of 0.09 0.25 0.46 0.37 0.05 7 0.14
maintaining an erection until
the end of any sex
37. Sex can be good even without 0.18 0.01 0.53 7 0.02 0.29 7 0.31
orgasma

Beliefs about women’s satisfaction

3. Penis erection is essential for a 0.21 0.01 0.09 0.60 0.28 7 0.14
woman’s sexual satisfaction
7. A woman may have doubts 0.07 0.11 0.18 0.69 7 0.09 0.13
about a man’s virility when he
fails an erection
16. Men who are not capable of 0.18 0.27 0.28 0.47 0.17 7 0.21
penetrating women can’t satis-
fy them
35. A man who doesn’t sexually 0.04 0.15 0.20 0.68 0.05 0.08
satisfy a woman is a failure
36. Whenever a situation arises, a 0.13 0.36 0.31 0.49 0.05 0.18
real man must be capable of
penetration

Restrictive attitude toward sex

8. Repeated engagement on oral/ 0.05 0.29 0.09 7 0.00 0.60 0.11

anal sex can cause serious
health problems
12. Women only pay attention to 0.25 0.02 0.10 0.16 0.41 0.15
attractive younger man

(continued )
186 Pedro J. Nobre et al.

TABLE VI. (continued )

Factors

SDBQ items F1 F2 F3 F4 F5 F6

13. It is not appropriate to have 0.29 7 0.02 7 0.04 0.20 0.52 7 0.08
sexual fantasies during sexual
intercourse
30. Anal sex is a perverted activity 0.12 0.17 0.14 7 0.02 0.75 0.04

Sex as an abuse of men’s power

10. Sex is an abuse of male’s power 0.21 0.38 0.15 7 0.01 0.23 0.52
22. The quality of the erection is 0.15 0.38 0.08 0.14 0.15 7 0.53
what most satisfies women
34. Sex is a violation of a woman’s 0.39 0.06 0.02 0.21 0.15 0.53
body

a
Items scored in reverse order.

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

Domains F1 F2 F3 F4 F5 F6

F1 Sexual conservatism –
F2 Female sexual power 0.52** –
F3 ‘Macho’ belief 0.55** 0.57** –
F4 Beliefs about women’s satisfaction 0.44** 0.53** 0.62** –
F5 Restrictive attitude toward sex 0.59** 0.41** 0.42** 0.34** –
F6 Sex as an abuse of men’s power 0.61** 0.46** 0.39** 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 Minimum Maximum

F1 Sexual conservatism 2, 5, 9, 18, 21, 24, 25, 26, 32, 33 10 50

F2 Female sexual power 11, 15, 19, 27, 29, 38, 39, 40 8 40
F3 ‘Macho’ belief 1, 4, 6, 17, 28, 31, 37 7 35
F4 Beliefs about women’s satisfaction 3, 7, 16, 35, 36 5 25
F5 Restrictive attitude toward sex 8, 12, 13, 30 4 20
F6 Sex as an abuse of men’s power 10, 22, 34 3 15
Total – 37 185

Note: Item 37 is scored in reverse order.

 Sexual Dysfunctional Beliefs Questionnaire 187

TABLE IX. Test – retest reliability

SDBQ domains N items Pearson r

Female sample (n = 26)

F1 Sexual conservatism 9 0.65**

F2 Sexual desire and pleasure as a 6 0.23
sin
F3 Age related beliefs 5 0.65**
F4 Body-image beliefs 4 0.17
F5 Denying affection primacy 6 0.29
F6 Motherhood primacy 4 0.73**
Total 34 0.80**
Male sample (n = 10)

F1 Sexual conservatism 10 0.28

F2 Female sexual power 8 0.46
F3 Macho belief 7 0.62
F4 Beliefs about women’s 5 0.82**
satisfaction
F5 Restrictive attitude toward sex 4 0.71*
F6 Sex as an abuse of men’s 3 0.80**
power
Total 37 0.73*

*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 specific dimensions of both measures, led us to the following observations
(Table XI):
In the female sample, sexual conservatism and denying affection primacy are both
significantly 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 SBIQ’s domain is characterized by the idea that time and
patience plays a central role in sexual satisfaction, sharing information about one’s
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 affection’s role on sexual
activity). Another statistically significant 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 Pedro J. Nobre et al.

TABLE X. Internal consistency

SDBQ domains N items Cronbach’s alpha

Female sample (n = 154)

F1 Sexual conservatism 9 0.78

F2 Sexual desire and pleasure as a sin 6 0.75
F3 Age related beliefs 5 0.74
F4 Body-image beliefs 4 0.66
F5 Denying affection primacy 6 0.59
F6 Motherhood primacy 4 0.50
Total 34 0.81

Male sample (n = 206)

F1 Sexual conservatism 10 0.89

F2 Female sexual power 8 0.77
F3 ‘Macho’ belief 7 0.75
F4 Beliefs about women’s satisfaction 5 0.75
F5 Restrictive attitude toward sex 4 0.54
F6 Sex as an abuse of men’s power 3 0.63
Total 37 0.93

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 SBIQ’s 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 men’s power (r = 7 0.41,
p 5 0.05). All these three dimensions from SDBQ are opposite to the idea of sharing
one’s 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
profiles 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
 Sexual Dysfunctional Beliefs Questionnaire 189

TABLE XI. Correlations of the male and female SDBQ domains with the SBIQ total and domains

SBIQ domains

Time Stress Sexual Basic

SDBQ domains patience pressure Ageing satisfaction knowledge Total

Female sample (n = 45)

Sexual conservatism 7 0.32* 7 0.28 0.09 7 0.28 0.11 7 0.37*

Sexual desire/ 7 0.23 0.06 0.08 7 0.13 0.17 7 0.05
pleasure as a sin
Age related beliefs 0.18 7 0.18 7 0.19 7 0.33* 7 0.20 7 0.27
Body-image beliefs 7 0.13 7 0.20 0.03 7 0.14 0.05 7 0.24
Denying affection 7 0.34* 0.07 0.26 7 0.06 7 0.09 7 0.18
primacy
Motherhood primacy 7 0.23 7 0.01 7 0.14 7 0.09 0.07 7 0.26
Total 7 0.27 7 0.27 7 0.05 7 0.34 0.09 7 0.42*

Male sample (n = 23)

Sexual conservatism 7 0.44* 7 0.10 7 0.09 7 0.65** 7 0.31 7 0.66**

Female sexual power 7 0.04 0.23 7 0.08 7 0.01 7 0.07 7 0.00
‘Macho’ belief 7 0.37 7 0.02 0.22 7 0.39 7 0.5 7 0.32
Beliefs about 7 0.24 7 0.11 7 0.12 7 0.33 7 0.39 7 0.53*
women’s
satisfaction
Restrictive attitude 7 0.43* 7 0.17 0.24 0.02 7 0.10 7 0.11
toward sex
Sex as an abuse of 7 0.41* 7 0.17 0.11 7 0.19 7 0.23 7 0.27
men’s power
Total 7 0.44* 0.01 0.01 7 0.40 7 0.28 7 0.48*

*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 Pedro J. Nobre et al.

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 specifically developed to
assess both male and female ideas about oneself as a sexual being (sexual self-view).
This measure is composed of three specific 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 female’s 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 specific dimensions of
both instruments, we observe that there are few statistically significant 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 male’s sexual dysfunctional beliefs (specifically 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 significant
correlations. This shows that our beliefs about sexuality are somehow related to our
sexual functioning (Table XIV).
 TABLE XII. Correlations of the male and female SDBQ domains with DAS total and domains

DAS Domains

Dependence High
Absolutist of social Adaptive performance Adaptive
SDBQ domains Perfectionism imperatives approval cognitions demands coping Autonomy Total

Female sample (n = 25)

Sexual conservatism 0.19 0.43* 0.46* 7 0.20 7 0.15 7 0.30 7 0.09 0.17
Sexual desire as a sin 0.44* 0.41* 0.35 7 0.12 7 0.05 7 0.41* 7 0.09 0.30
Age related beliefs 0.17 0.70** 0.70** 7 0.16 0.26 7 0.49* 7 0.11 0.46*
Body-image beliefs 0.38 0.50* 0.43* 7 0.03 7 0.03 7 0.27 7 0.06 0.34
Denying affection 0.10 0.00 7 0.20 7 0.22 0.09 0.50* 0.23 0.07
primacy
Motherhood primacy 0.51* 0.45* 0.55** 7 0.37 7 0.00 7 0.17 0.29 0.38
Total 0.40 0.63** 0.71** 7 0.18 7 0.10 7 0.40 7 0.02 0.38

Male sample (n = 32)

Sexual conservatism 0.70** 0.14 0.45* 7 0.43* 0.54** 7 0.08 0.15 0.51**
Female sexual power 0.63** 0.57** 0.53** 0.01 0.51** 7 0.04 0.28 0.59**
Macho belief 0.61** 0.42* 0.40* 7 0.22 0.53** 0.13 0.11 0.50**
Women’s satisfaction 0.61** 0.33 0.53** 7 0.19 0.48** 7 0.23 0.49** 0.60**
belief
Restrictive sex attitude 0.47* 0.27 0.27 7 0.35 0.13 0.09 7 0.10 0.21
Sex as men’s abuse 0.55** 0.39* 0.33 7 0.40 0.35 7 0.03 7 0.02 0.38
Total 0.74** 0.60** 0.66** 7 0.06 0.58** 7 0.11 0.40* 0.68**
Sexual Dysfunctional Beliefs Questionnaire

*p 5 0.05. **p 5 0.01.

191
192 Pedro J. Nobre et al.

TABLE XIII. Correlations of the male and female SDBQ domains with SSS total and domains

SSS domains

SDBQ domains Passionate/Romantic Open/Direct Conservative

Female sample (n = 50)

Sexual conservatism 7 0.04 7 0.46** 0.31*

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

Male sample (n = 15)

SSS domains

SDBQ domains Passionate/Loving Powerful/Aggressive Liberal

Sexual conservatism 0.19 7 0.33 7 0.55*

Female sexual power 7 0.48 7 0.31 7 0.31
‘Macho’ belief 0.08 7 0.24 7 0.53
Beliefs about women’s satisfaction 7 0.27 7 0.20 7 0.15
Restrictive attitude toward sex 0.27 7 0.26 7 0.50
Sex as an abuse of men’s power 7 0.01 7 0.12 0.00
Total 7 0.17 7 0.41 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 women’s
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.
 Sexual Dysfunctional Beliefs Questionnaire 193

Results for both male and female populations, although not statistically significant,
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 difficulties). In addition, if a woman believed that vaginal
coitus is the only acceptable way of having sex, she could present some difficulties in
experiencing orgasm. These simple examples show how specific 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 (Cronbach’s 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 women’s satisfaction beliefs,
restrictive attitude toward sex and sex as an abuse of men’s 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 one’s desire
and taking the time needed to please the partner.
 TABLE XIV. Correlations of the male and female automatic thoughts sub-scale domains with the FSFI and IIEF domains and total
194

FSFI domains

SDBQ domains Desire Arousal Lubrication Orgasm Satisfaction Pain Total

Female sample (n = 154)

Sexual conservatism 7 0.40** 7 0.30** 7 0.21** 7 0.18* 7 0.33** 7 0.21** 7 0.35**

Sexual desire/pleasure as a sin 7 0.36** 7 0.25** 7 0.17* 7 0.24** 7 0.24** 7 0.07 7 0.32**
Pedro J. Nobre et al.

Age related beliefs 7 0.32** 7 0.19* 7 0.10 7 0.17* 7 0.39** 7 0.16* 7 0.33**
Body-image beliefs 7 0.28** 7 0.22** 7 0.12 7 0.20** 7 0.20** 7 0.00 7 0.24**
Denying affection primacy 7 0.05 7 0.07 7 0.09 7 0.05 7 0.03 7 0.00 7 0.07
Motherhood primacy 7 0.17* 7 0.17* 7 0.14 7 0.15* 7 0.10 7 0.13 7 0.14
Total 7 0.35** 7 0.31** 7 0.18* 7 0.25** 7 0.32** 7 0.17* 7 0.36**

Male sample (n = 163)

IIEF domains

Overall Intercourse
SDBQ domains Desire Erection Orgasm satisfaction satisfaction Total

Sexual conservatism 7 0.20** 7 0.36** 7 0.30** 7 0.32** 7 0.28** 7 0.40**

Female sexual power 7 0.13 7 0.25** 7 0.25** 7 0.18** 7 0.23** 7 0.26**
‘Macho’ belief 7 0.14* 7 0.32** 7 0.25** 7 0.20** 7 0.28** 7 0.32**
Beliefs about women’s satisfaction 7 0.15* 7 0.37** 7 0.30** 7 0.29** 7 0.29** 7 0.39**
Restrictive attitude toward sex 7 0.19** 7 0.25** 7 0.20** 7 0.19 7 0.16* 7 0.28**
Sex as an abuse of men’s power 7 0.10 7 0.11 7 0.07 7 0.03 0.01 7 0.11
Total 7 0.24* 7 0.44** 7 0.31** 7 0.34** 7 0.39** 7 0.44**

*p 5 0.05. **p 5 0.01.

 Sexual Dysfunctional Beliefs Questionnaire 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 t

Sexual conservatism 16.51 6.23 15.11 7.05 0.96

Sexual desire/pleasure as a sin 8.52 3.94 7.47 2.38 1.52
Age related beliefs 10.20 3.56 9.95 4.17 0.30
Body-image beliefs 6.34 3.09 5.75 2.63 0.98
Denying affection primacy 9.10 3.55 9.29 3.42 7 0.25
Motherhood primacy 7.53 2.64 7.50 2.30 0.06
Total 57.68 15.93 52.00 13.95 1.59

Male sample

Clinical group (n = 49) Control group (n = 49)

SDBQ domains Mean SD Mean SD t

Sexual conservatism 19.72 7.99 19.62 8.63 0.06

Female sexual power 22.21 5.49 22.93 5.16 7 0.63
‘Macho’ belief 22.89 6.28 21.04 6.00 1.47
Beliefs about women’s satisfaction 15.96 4.82 14.89 4.55 1.09
Restrictive attitude toward sex 10.23 2.93 11.35 3.45 7 1.68
Sex as an abuse of men’s power 3.48 1.69 3.85 2.20 7 0.91
Total 92.88 21.49 90.26 23.99 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 subject’s 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 profiles 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 Pedro J. Nobre et al.

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 significant negative correlations with the sexual
function scores. Discriminant analysis between a clinical and a control group although
not showing statistically significant differences somehow supported the findings from
the correlational studies. The less significant results from this analysis could be related
 Sexual Dysfunctional Beliefs Questionnaire 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
significantly higher in our female clinical sample. In addition, high performance beliefs,
beliefs about women’s 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 difficulties.
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
JOSÉ 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 statement—from 1—
completely disagree to 5—completely agree). There are no wrong or right answers, but it is very
important that you be honest and that you answer all items.

Don’t
Completely disagree Completely
Sexual beliefs disagree Disagree or agree Agree agree

1. A real man has sexual inter- 1 2 3 4 5

course very often
2. Orgasm is possible only by va- 1 2 3 4 5
ginal intercourse
3. Penile erection is essential for a 1 2 3 4 5
woman’s sexual satisfaction

(continued )
200 Pedro J. Nobre et al.
. (continued )

Don’t
Completely disagree Completely
Sexual beliefs disagree Disagree or agree Agree agree

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

(continued )
 Sexual Dysfunctional Beliefs Questionnaire 201

. (continued )

Don’t
Completely disagree Completely
Sexual beliefs disagree Disagree or agree Agree agree

23. A successful career implies the 1 2 3 4 5

control of sexual urges
24. Foreplay is a waste of time 1 2 3 4 5
25. Sex is meant only for procrea- 1 2 3 4 5
tion
26. In sex, the quicker/faster the 1 2 3 4 5
better
27. People who don’t control their 1 2 3 4 5
sexual urges are more easily
controlled by others
28. A real man is always ready for 1 2 3 4 5
sex and must be capable of
satisfying any woman
29. If a man lets himself go sexually 1 2 3 4 5
he is under a woman’s control
30. Anal sex is a perverted activity 1 2 3 4 5
31. A man must be capable of 1 2 3 4 5
maintaining an erection until
the end of any sexual activity
32. There is only one acceptable way 1 2 3 4 5
of having sex (missionary posi-
tion)
33. Sexual intercourse before mar- 1 2 3 4 5
riage is a sin
34. Sex is a violation of a woman’s 1 2 3 4 5
body
35. A man who doesn’t sexually 1 2 3 4 5
satisfy a woman is a failure
36. Whenever the situation arises, a 1 2 3 4 5
real man must be capable of
penetration
37. Sex can be good even without 1 2 3 4 5
orgasm
38. A real man doesn’t need much 1 2 3 4 5
stimulation to reach orgasm
39. A woman at her sexual peak can 1 2 3 4 5
get whatever she wants from a
man
40. The greater the sexual intimacy, 1 2 3 4 5
the greater the potential for
getting hurt
202 Pedro J. Nobre et al.

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 statement—from 1—
completely disagree to 5—completely disagree). There are no wrong or right answers, but it is
very important that you be honest and that you answer all items.

Don’t
Completely disagree Completely
Sexual beliefs disagree Disagree or agree Agree agree

1. Love and affection from a 1 2 3 4 5

partner are necessary for good
sex
2. Masturbation is wrong and 1 2 3 4 5
sinful
3. The most important compo- 1 2 3 4 5
nent of sex is mutual affection
4. The best gift a woman could 1 2 3 4 5
bring to marriage is her virgi-
nity
5. After menopause women lose 1 2 3 4 5
their sexual desire
6. Women who have sexual fan- 1 2 3 4 5
tasies are perverted
7. Masturbation is not a proper 1 2 3 4 5
activity for respectable wo-
men
8. After menopause women 1 2 3 4 5
can’t reach orgasm
9. There are a variety of ways of 1 2 3 4 5
getting pleasure and reaching
orgasm
10. Women who are not physi- 1 2 3 4 5
cally attractive can’t be sexu-
ally satisfied
11. In the bedroom the man is the 1 2 3 4 5
boss
12. A good mother can’t be sexu- 1 2 3 4 5
ally active
13. Reaching climax /orgasm is 1 2 3 4 5
acceptable for men but not for
women
14. Sexual activity must be in- 1 2 3 4 5
itiated by the man
15. Sex is dirty and sinful 1 2 3 4 5

(continued )
 Sexual Dysfunctional Beliefs Questionnaire 203

. (continued )

Don’t
Completely disagree Completely
Sexual beliefs disagree Disagree or agree Agree agree

16. Simultaneous orgasm for two 1 2 3 4 5

partners is essential for a
satisfying sexual encounter
17. Orgasm is possible only by 1 2 3 4 5
vaginal intercourse
18. The goal of sex is for men to 1 2 3 4 5
be satisfied
19. A successfully professional 1 2 3 4 5
career implies control of sex-
ual behavior
20. As women age the pleasure 1 2 3 4 5
they get from sex decreases
21. Men only pay attention to 1 2 3 4 5
young, attractive women
22. Sex is a beautiful and pure 1 2 3 4 5
activity
23. Sex without love is like food 1 2 3 4 5
without flavor
24. As long as both partners con- 1 2 3 4 5
sent, anything goes
25. Any woman who initiates 1 2 3 4 5
sexual activity is immoral
26. Sex is meant only for procrea- 1 2 3 4 5
tion
27. Sexual intercourse during 1 2 3 4 5
menstruation can cause
health problems
28. Oral sex is one of the biggest 1 2 3 4 5
perversions
29. If women let themselves go 1 2 3 4 5
sexually they are totally under
men’s control
30. Being nice and smiling at men 1 2 3 4 5
can be dangerous
31. The most wonderful emo- 1 2 3 4 5
tions that a woman can ex-
perience are maternal feelings
32. Anal sex is a perverted activity 1 2 3 4 5
33. In the bedroom the woman is 1 2 3 4 5
the boss
34. Sex should happen only if a 1 2 3 4 5
man initiates
35. There is just one acceptable 1 2 3 4 5
way of having sex (missionary
position)

(continued )
204 Pedro J. Nobre et al.

. (continued )

Don’t
Completely disagree Completely
Sexual beliefs disagree Disagree or agree Agree agree

36. Experiencing pleasure during 1 2 3 4 5

sexual intercourse is not ac-
ceptable in an virtuous wo-
man
37. A good mother must control 1 2 3 4 5
her sexual urges
38. An ugly woman is not capable 1 2 3 4 5
of sexually satisfying her part-
ner
39. A woman who only derives 1 2 3 4 5
sexual pleasure through cli-
toral stimulation is sick or
perverted
40. Pure girls don’t engage in 1 2 3 4 5
sexual activity