Cultural adaptation and validation of the Sinhalese version of the Female Sexual Function Index (FSFI-SL) among patients admitted to gynecological wards at a tertiary care center in Sri Lanka

Background Female sexual dysfunction (FSD) affects the overall health and quality of life of women and their partners. It has a substantial burden in South Asia, including Sri Lanka, which is often underreported due to stigma. The Female Sexual Function Index (FSFI) is a widely used, 19-item instrument comprising six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. This study aimed to translate, culturally adapt, and assess the psychometric properties of the Sinhalese version of the FSFI (FSFI-SL) among Sinhala-speaking patients in Sri Lanka. Methods The original FSFI questionnaire underwent a forward-backward translation process, which was reviewed by a panel of experts and pretested among participants to ascertain face, content, and cross-cultural validity. Adult patients admitted to gynecological wards in a tertiary care facility in Kandy, Sri Lanka, were recruited for a cross-sectional survey to assess the structural validity and reliability of the instrument. Confirmatory factor analysis (CFA) was performed on the basis of the original domain configuration, followed by exploratory factor analysis (EFA) via the principal axis factor method with Promax rotation. Horn’s parallel analysis was used for factor retention. Reliability was examined via the internal consistency of the full scale and subscales. Results Among the 152 Sinhala-speaking females who took part, the mean age was 34.5 years. Most were married, educated, state-sector employed, middle-income women with children. CFA revealed that the original six-factor structure did not produce an acceptable fit. EFA produced a three-factor solution with salient factor loadings, composed of sexual engagement (desire, arousal, and lubrication domains), sexual fulfillment (orgasm and satisfaction), and pain . The final scale was revised by eliminating three items that had undue cross-loading. The full scale and subscales of the revised FSFI-SL instrument showed excellent reliability. Conclusion The FSFI-SL demonstrated satisfactory psychometric properties among Sinhala-speaking patients. It is an accurate, reliable, and acceptable instrument for the clinical evaluation of FSD and sexual health research in Sri Lanka.