The ASEX is a brief 5-item scale (2-3 minutes) assessing sexual function across five core domains: sex drive, arousal, erectile/lubrication function, orgasm ability, and orgasm satisfaction, with scores ranging 5-30 where higher scores indicate greater dysfunction.
Sexual dysfunction is indicated by total score ≥19, any item ≥5, or three items ≥4; the scale demonstrates excellent reliability (α=0.91) and validity across diverse populations, with measurement invariance established across 42 countries, genders, and sexual orientations.
Designed for routine clinical screening, the ASEX effectively detects treatment-emergent sexual dysfunction (particularly with antidepressants), establishes baseline function, monitors treatment effects, and guides clinical decision-making, though it requires permission from Arizona Board of Regents for use.
Introduction
The Arizona Sexual Experience Scale (ASEX) is a 5-item rating scale designed to quantify sexual function across five core domains: sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. Developed by McGahuey, Gelenberg, and colleagues (2000) at the University of Arizona, this brief questionnaire addresses a critical gap in clinical practice—the paucity of validated, user-friendly scales for assessing sexual dysfunction in psychiatric and medical patients.
Sexual dysfunction is remarkably common, with approximately 40% of women and 30% of men describing sexual difficulties. However, recognition in medical settings remains suboptimal due to problems in reporting and eliciting concerns relating to sexual function and satisfaction. The ASEX was specifically designed to overcome these barriers through its brevity, simplicity, and non-intrusive question format.
Addressing a Critical Clinical Need
Sexual dysfunction represents a significant but often under-addressed aspect of patient care. Its impact extends far beyond the bedroom:
Treatment compliance: Sexual side effects are a leading cause of medication non-adherence, particularly with antidepressants where rates of treatment-emergent sexual dysfunction range from 8% to 73%.
Quality of life: Sexual difficulties substantially affect overall wellbeing, relationship satisfaction, and life quality—even in patients whose primary condition is well-controlled.
Hidden prevalence: Patients rarely spontaneously report sexual concerns due to embarrassment, while clinicians often fail to inquire systematically, creating a significant detection gap.
Medication effects: Many psychiatric medications (especially SSRIs and SNRIs), antihypertensives, and other drugs can cause or worsen sexual dysfunction, yet this side effect is frequently overlooked.
The ASEX was designed to facilitate routine screening by providing a brief, straightforward assessment that can be completed in 2-3 minutes, either by patient self-report or clinician administration. Its simplicity encourages both patient compliance and clinician adoption.
Theoretical Foundation
The ASEX is grounded in a functional model of sexual response that identifies five core elements essential for satisfactory sexual function. These elements represent a streamlined approach focusing on basic, universal aspects rather than attempting to capture every nuance of sexual experience.
Development principles:
The scale was intentionally designed with specific constraints to maximize clinical utility:
Simplicity over comprehensiveness: Rather than measuring every level of every aspect of sexual activity, the ASEX focuses on core elements that, when impaired, constitute sexual dysfunction. This makes the scale practical for routine clinical use.
Universal applicability: The scale is designed for use in heterosexual or homosexual populations, regardless of availability of a sexual partner. Questions addressing frequency or preference of sexual activity were deliberately excluded as they were considered unrelated to sexual dysfunction per se.
Minimal intrusiveness: Items were worded to be straightforward yet not overly personal or detailed, reducing patient discomfort and non-compliance.
Rapid quantification: The 6-point Likert format allows for quick scoring and immediate detection of sexual dysfunction presence and severity.
Five core domains assessed:
1. Sex Drive (Libido)
Reflects the fundamental biological and psychological interest in sexual activity. Impaired sex drive—whether due to depression, medication, hormonal changes, or other factors—is often the first sign of sexual dysfunction. The ASEX item asks directly: “How strong is your sex drive?” with response options ranging from “Extremely strong” to “No sex drive.”
2. Arousal (Sexual Excitement)
Captures the ease with which an individual becomes sexually excited or “turned on.” Arousal difficulties can stem from psychological factors (stress, depression, anxiety), medication effects (particularly SSRIs), or physiological issues. The item asks: “How easily are you sexually aroused (turned on)?” with options from “Extremely easily” to “Never aroused.”
3. Erectile Function / Vaginal Lubrication
This domain assesses the physiological response necessary for sexual intercourse. The scale includes gender-specific versions of this item:
Male version: “Can you easily get and keep an erection?”
Female version: “How easily does your vagina become moist or wet during sex?”
This represents the most direct physiological marker of sexual response and is often affected by medications, vascular problems, or hormonal changes.
4. Ability to Reach Orgasm
Measures difficulty achieving orgasm, a particularly common side effect of SSRI antidepressants but also affected by psychological factors, relationship issues, and various medical conditions. The item asks: “How easily can you reach an orgasm (climax)?” Response options range from “Extremely easily” to “Never reach orgasm.”
5. Satisfaction from Orgasm
Even when orgasm is possible, the subjective satisfaction derived from it may be diminished—a subtle but important aspect of sexual dysfunction. The scale asks: “How satisfying is your orgasm (climax)?” with options from “Extremely satisfying” to “Not satisfying/no orgasm.”
Together, these five items provide a rapid yet comprehensive snapshot of sexual function that can identify dysfunction, track changes over time, and guide clinical decision-making.
📊 Clinical Utility: The ASEX’s brevity (5 items, 2-3 minutes) and simplicity make it practical for routine screening in clinical settings where comprehensive assessment is impractical.
Key Features
Assessment Characteristics
5 items covering core sexual function domains
2-3 minutes administration time
Ages 18+ through adult populations
6-point Likert scale for each item
Gender-specific versions (differing only on Item 3)
Self or clinician-administered format
Multiple language translations validated in 26+ languages
Five Sexual Function Domains Assessed
Sex Drive (Item 1):
Strength of sexual desire and libido
Interest in sexual activity
Sexual Arousal (Item 2):
Ease of becoming sexually excited
Responsiveness to sexual stimulation
Erectile Function / Vaginal Lubrication (Item 3):
Physiological sexual response
Gender-specific assessment
Ability to Reach Orgasm (Item 4):
Ease of achieving climax
Orgasmic function
Satisfaction from Orgasm (Item 5):
Subjective pleasure and satisfaction
Quality of orgasmic experience
Clinical and Research Applications
Treatment-emergent sexual dysfunction screening particularly with antidepressants
Baseline sexual function assessment before medication initiation
Medication comparison studies evaluating differential sexual side effect profiles
Treatment monitoring tracking changes in sexual function over time
Clinical trials as primary or secondary outcome measure
Primary sexual dysfunction assessment in patients presenting with sexual concerns
Medical conditions affecting sexual function (diabetes, cardiovascular disease, neurological conditions)
Quality of life research examining impact of sexual dysfunction
Brief assessment of sexual function across five core domains.
Scoring and Interpretation
Response Format
Each item is rated on a 6-point Likert scale with descriptive anchors specific to the item content.
Complete ASEX Items
Instructions: “For each item, please indicate your OVERALL level during the PAST WEEK, including TODAY.”
Item 1: Sex Drive“How strong is your sex drive?”
Extremely strong
Very strong
Somewhat strong
Somewhat weak
Very weak
No sex drive
Item 2: Sexual Arousal“How easily are you sexually aroused (turned on)?”
Extremely easily
Very easily
Somewhat easily
Somewhat difficult
Very difficult
Never aroused
Item 3a: Penile Erection (Male version)“Can you easily get and keep an erection?”
Extremely easily
Very easily
Somewhat easily
Somewhat difficult
Very difficult
Never or almost never
Item 3b: Vaginal Lubrication (Female version)“How easily does your vagina become moist or wet during sex?”
Extremely easily
Very easily
Somewhat easily
Somewhat difficult
Very difficult
Never or almost never
Item 4: Ability to Reach Orgasm“How easily can you reach an orgasm (climax)?”
Extremely easily
Very easily
Somewhat easily
Somewhat difficult
Very difficult
Never reach orgasm
Item 5: Satisfaction from Orgasm“How satisfying is your orgasm (climax)?”
Extremely satisfying
Very satisfying
Somewhat satisfying
Somewhat unsatisfying
Very unsatisfying
Not satisfying/no orgasm
Scoring Procedure
Sum all 5 item scores (range: 5-30)
Higher scores indicate greater sexual dysfunction
Lower scores indicate better sexual function
Note: Score ranges from 5 to 30, not from 0 to 30
Score Interpretation
Total Score Ranges:
Total Score
Interpretation
5-10
Normal to excellent sexual function
11-15
Mild sexual dysfunction
16-21
Moderate sexual dysfunction
22-30
Severe sexual dysfunction
Clinical Cutoffs
Sexual dysfunction is indicated by any of the following (McGahuey et al., 2000):
Total score ≥ 19
Any single item score ≥ 5
Any three items with scores ≥ 4
Population Norms (McGahuey et al., 2000)
With clinical sexual dysfunction:
Women: Mean = 21
Men: Mean = 20
Without clinical sexual dysfunction:
Women: Mean = 14
Men: Mean = 10
Item-Level Interpretation
Scores of 4-6 on any single item warrant clinical attention for that specific domain
Score of 5 or 6 indicates significant dysfunction in that domain
Profile patterns:
High drive but low arousal/orgasm: May indicate medication effect or relationship issues
Normal drive with high erectile/lubrication score: Physical/vascular issues
High scores across all items: Generalized sexual dysfunction requiring comprehensive evaluation
Special Considerations
Extremely low scores (hyperfunction): Scores of 1 across all items may indicate sexual hyperfunction (e.g., premature ejaculation, spontaneous orgasm), which can also represent dysfunction.
Etiology: The ASEX measures presence and severity of sexual dysfunction but does not establish etiology. Further assessment is needed to determine if dysfunction is due to medication, illness, psychological factors, or other causes.
Test-retest reliability: Not extensively studied in original development but demonstrated good stability in clinical use
Cross-cultural reliability: Ordinal Cronbach’s α = 0.79, McDonald’s omega = 0.85 in 42-country validation (Oliveira et al., 2024)
Clinical populations: Demonstrated good internal consistency across psychiatric, medical, and primary sexual dysfunction samples (Elnazer & Baldwin, 2020)
Validity Evidence
Construct validity:
Unidimensional structure: Confirmatory factor analysis supports single-factor structure with excellent fit indices (CFI = 0.966, TLI = 0.933, RMSEA = 0.089) (Oliveira et al., 2024)
Factor loadings: Standardized loadings range from 0.55 to 0.80, all statistically significant (Oliveira et al., 2024)
Cross-cultural invariance: Measurement invariance established across 42 countries, 26 languages, genders, and sexual orientations (Oliveira et al., 2024)
Convergent validity:
Brief Index of Sexual Functioning (BISF): Strong correlations with related BISF factors and items demonstrating convergent validity (McGahuey et al., 2000)
Gold Standard Clinician Rating (GSR): High agreement between ASEX patient self-ratings and clinician assessments verifying accuracy of patient reports (McGahuey et al., 2000)
Discriminant validity:
Depression measures: Low correlations with BDI and HDRS scores, distinguishing sexual dysfunction from depression severity per se (McGahuey et al., 2000)
Independence from mood: ASEX captures sexual function issues distinct from depressive symptoms
Criterion validity:
Patient vs. control discrimination: Significant differences in total ASEX scores between patients with sexual dysfunction and healthy controls (McGahuey et al., 2000)
Gender differences: Appropriate gender differences observed consistent with known sexual function patterns (McGahuey et al., 2000)
Diagnostic Accuracy
ROC analysis:
Area under curve: 0.786, indicating good discriminative capacity (McGahuey et al., 2000)
Schizophrenia/schizoaffective disorder (Byerly et al., 2006):
Optimal cutoff: Total score 14/15
Sensitivity: 85%
Specificity: 63.7%
Positive predictive value: 83%
Negative predictive value: 67.1%
Comparison to single-item screening (Byerly et al., 2006):
Specific one-item question about sexual dysfunction shows good agreement with ASEX
General side effect question performs poorly (sensitivity only 11.3%)
Population Studies
Prevalence findings:
Chronic hepatitis C: 35% overall prevalence of ASEX-defined sexual dysfunction (higher in women at 50%) (Elnazer & Baldwin, 2020)
Schizophrenia/schizoaffective disorder: High rates of sexual dysfunction detected with good psychometric properties (Byerly et al., 2006)
Cross-cultural findings (Oliveira et al., 2024):
Sample: 82,243 participants from 42 countries (57% women, 40% men, 3% gender-diverse)
Asian countries: Four of six highest-scoring countries were Asian, suggesting cultural or reporting differences
Normal distribution: Total scores demonstrate normal distribution across populations
Gender and orientation:
Measurement invariance established across cisgender men, cisgender women, and gender-diverse individuals
Measurement invariance established across heterosexual, gay/lesbian, bisexual, and other sexual orientations (Oliveira et al., 2024)
Sensitivity to Treatment Effects
Antidepressant effects: Successfully detects treatment-emergent sexual dysfunction with SSRIs and SNRIs (Elnazer & Baldwin, 2020)
Treatment comparison: Useful for comparing sexual side effect profiles across different medications
Intervention response: Demonstrates improvement with treatments targeting sexual dysfunction
Usage Guidelines and Applications
Primary Clinical Applications
Routine screening for sexual dysfunction in psychiatric, primary care, and specialty settings
Baseline assessment before initiating medications known to affect sexual function
Treatment monitoring tracking emergence or resolution of sexual side effects
Medication comparison evaluating differential sexual dysfunction profiles
Primary sexual dysfunction assessment in patients presenting with sexual concerns
Quality of life evaluation in chronic medical and psychiatric conditions
Clinical Decision Support
When to administer:
Before starting antidepressants to establish baseline and enable detection of treatment-emergent effects
Regular monitoring (e.g., every 3-6 months) in patients on medications affecting sexual function
Patient complaints about sexual difficulties or relationship problems
Medication changes when switching or discontinuing medications
Follow-up assessment after interventions targeting sexual dysfunction
Interpreting results:
Total score ≥19 or meeting other dysfunction criteria:
Confirm presence of sexual dysfunction
Explore patient distress and impact on quality of life
Copyright and Usage Responsibility: Check that you have the proper rights and permissions to use this assessment tool in your research. This may include purchasing appropriate licenses, obtaining permissions from authors/copyright holders, or ensuring your usage falls within fair use guidelines.
The Arizona Sexual Experience Scale (ASEX) is copyrighted by the Arizona Board of Regents. All rights are reserved.
For permission to use: Contact the Arizona Board of Regents.
Proper Attribution: When using or referencing this scale, cite the original development:
McGahuey, C. A., Gelenberg, A. J., Laukes, C. A., Moreno, F. A., Delgado, P. L., McKnight, K. M., & Manber, R. (2000). The Arizona Sexual Experience Scale (ASEX): Reliability and validity. Journal of Sex & Marital Therapy, 26(1), 25-40. https://doi.org/10.1080/009262300278623
McGahuey, C. A., Gelenberg, A. J., Laukes, C. A., Moreno, F. A., Delgado, P. L., McKnight, K. M., & Manber, R. (2000). The Arizona Sexual Experience Scale (ASEX): Reliability and validity. Journal of Sex & Marital Therapy, 26(1), 25-40. https://doi.org/10.1080/009262300278623
Comprehensive Review and Clinical Applications:
Elnazer, H. Y., & Baldwin, D. S. (2020). Structured review of the use of the Arizona sexual experiences scale in clinical settings. Human Psychopharmacology: Clinical and Experimental, 35(3), e2730. https://doi.org/10.1002/hup.2730
Diagnostic Accuracy Studies:
Byerly, M. J., Nakonezny, P. A., Fisher, R., Magouirk, B., & Rush, A. J. (2006). An empirical evaluation of the Arizona sexual experience scale and a simple one-item screening test for assessing antipsychotic-related sexual dysfunction in outpatients with schizophrenia and schizoaffective disorder. Schizophrenia Research, 81(2-3), 311-316.
Large-Scale Cross-Cultural Validation:
Oliveira, L., Carvalho, J., Štulhofer, A., Vieira, A. L., Hald, G. M., Lange, T., Carvalheira, A., Briken, P., Fugl-Meyer, K. S., Enzlin, P., et al. (2024). Cross-cultural validation of the Arizona Sexual Experience Scale (ASEX) in 42 countries and 26 languages. Sexuality Research and Social Policy. https://doi.org/10.1007/s13178-024-01040-0
A sluggish snail moving at a crawl — a symbol of diminished sexual function and low libido assessed by the ASEX (Arizona Sexual Experience Scale)
Frequently Asked Questions
What does the ASEX measure?
The Arizona Sexual Experience Scale (ASEX) measures sexual function across five core domains: sex drive, sexual arousal, erectile function/vaginal lubrication, ability to reach orgasm, and satisfaction from orgasm. It quantifies both the presence and severity of sexual dysfunction through a brief 5-item questionnaire.
How long does the ASEX take to complete?
The ASEX takes approximately 2-3 minutes to complete. Its brevity makes it practical for routine clinical screening in busy medical and psychiatric settings, encouraging both patient compliance and clinician adoption for regular monitoring of sexual function.
Is the ASEX free to use?
The ASEX is copyrighted by the Arizona Board of Regents, and all rights are reserved. Researchers and clinicians must contact the Arizona Board of Regents for permission to use the scale. Proper attribution citing the original McGahuey et al. (2000) publication is required.
How is the ASEX scored?
The ASEX is scored by summing all five item responses (range: 5-30), with higher scores indicating greater sexual dysfunction. Sexual dysfunction is indicated by: total score ≥19, any single item score ≥5, or any three items scoring ≥4. Scores 5-10 indicate normal function, 11-15 mild dysfunction, 16-21 moderate dysfunction, and 22-30 severe dysfunction.
What's the difference between ASEX and the Changes in Sexual Functioning Questionnaire (CSFQ)?
The ASEX is briefer (5 items vs. 14 items for CSFQ) and focuses on core sexual function domains, making it more practical for routine screening. The CSFQ provides more comprehensive assessment including pleasure, desire/frequency, and arousal/orgasm subscales. ASEX is better for quick screening; CSFQ offers more detailed evaluation.
How reliable is the ASEX?
The ASEX demonstrates excellent reliability with Cronbach's alpha of 0.91 in the original validation and 0.79-0.85 in cross-cultural studies. It shows good test-retest stability and maintains strong psychometric properties across 42 countries, 26 languages, different genders, and sexual orientations, confirming its reliability across diverse populations.
