Sexual Activity Questionnaire (SAQ): A Full Guide for Researchers and Clinicians
Published
The Sexual Activity Questionnaire (SAQ) measures women's sexual pleasure, discomfort and habit. Learn its sections, factor scoring and validation.
Introduction
The Sexual Activity Questionnaire (SAQ) is a brief self-report questionnaire that assesses women's sexual functioning in terms of sexual activity, pleasure and discomfort. K. Thirlaway, L. Fallowfield and J. Cuzick published it in 1996 in Quality of Life Research, and it has received at least 400 citations. It gives separate scores for pleasure, discomfort and habit.
The SAQ was designed to study the effect of long-term tamoxifen on the sexual functioning of women at high risk of breast cancer in the tamoxifen prevention trial, and it was also tested in women from the general population. This guide explains its sections, scoring and evidence.
Key Features of the Sexual Activity Questionnaire (SAQ)
Purpose and Use
The SAQ describes sexual activity, pleasure and discomfort in women, particularly in the context of breast cancer prevention and menopause.
Target Population
The SAQ was developed in women aged 35 to 65, including women at high risk of breast cancer and women with no such risk.
Structure
The SAQ has three sections:
Section 1: hormonal and relationship status, such as periods, the contraceptive pill, HRT, relationship and change of partner, and whether the woman is sexually activeSection 2: reasons for sexual inactivity, such as no partner, tiredness, lack of interest, or physical problems of either partner, with an "other reasons" optionSection 3: 10 questions on sexual functioning over the past month: importance of sex, enjoyment, tiredness, desire, vaginal dryness, pain or discomfort during penetration, satisfaction, frequency, frequency compared with usual, and satisfaction with frequencyFactor analysis of Section 3 identified three factors:
Factor
Items
Pleasure (desire, enjoyment and satisfaction)
1, 2, 4, 7, 8, 10
Discomfort (vaginal dryness and penetration pain)
5, 6
Habit
9
Item 3 (tiredness) does not contribute to any factor.
Scoring Method
Nine Section 3 items use four options: very much, somewhat, a little or not at all. Item 8 (frequency) uses 5 times or more, 3–4 times, 1–2 times or not at all, and item 9 uses much more, somewhat more, about the same or less than usual.
Weighted method: add the weighted factor loadings of the questions in each factor.Simplified method: add the raw scores of the relevant questions; this correlates 0.97 (Pleasure) and 0.99 (Discomfort) with the weighted method.Habit: a single item, recorded as answered.A high Pleasure score means high pleasure, and a low Discomfort score means low discomfort. Numeric item coding, total score ranges and cut-off scores are not reported.
Administration Format
The SAQ is self-administered. Section 1 uses yes/no answers, Section 2 uses tick-all-that-apply reasons with a free-text option, and Section 3 uses 4-point and categorical responses.
Applications of the Sexual Activity Questionnaire (SAQ)
The SAQ supports several uses:
Breast cancer prevention trials: assessing the effect of treatment such as tamoxifen on sexual functioning.Cancer survivorship research: studying sexual dysfunction in breast cancer survivors.Menopause research: examining sexual functioning in relation to hormonal status.Languages and availability
The SAQ has been cross-culturally adapted for use in Portugal in breast cancer survivors. It is free and available for academic use, sometimes with citation of the original source. The questionnaire carries a copyright notice to Fallowfield.
Reliability and Validity
The original study showed good acceptability (compliance of about 85–88%), consistent test–retest reliability, and a three-factor structure explaining 64.8% of the variance.
Validation studies:
The Sexual Activity Questionnaire: a measure of women's sexual functioning (1996): study linkSexual dysfunction in breast cancer survivors: cross-cultural adaptation of the SAQ for use in Portugal (2016): study linkFallowfield's Sexual Activity Questionnaire in women with, without and at risk of cancer (2007): study linkLimitations and Considerations
Keep these points in mind:
Early evidence: the test–retest sample was small.Sample: the sample was skewed toward higher occupational classes.Not reported: Cronbach's alpha and cut-off scores were not reported.Interpretation: draw on the published normative data and be cautious outside the original population.Other Versions And Related Questionnaires
Later work examined Fallowfield's SAQ in women with, without and at risk of cancer.
These questionnaires are related:
Derogatis Sexual Functioning InventorySexual Interaction InventorySexuality ScalePEPI (Postmenopausal Estrogen/Progestin Interventions) questionnaire items, from which some SAQ items were takenAdditional Resources
The original article: linkThe original article lists the correspondence address as the CRC Communication and Counselling Research Centre, Department of Oncology, University College London Medical School, London (K. Thirlaway). No email contact was identified.Browse more oncology questionnaires in the ResRef database.Frequently Asked Questions (FAQ)
What does the Sexual Activity Questionnaire measure?The SAQ measures women's sexual functioning through three factors: pleasure (desire, enjoyment and satisfaction), discomfort (vaginal dryness and pain on penetration) and habit (frequency compared with usual).
How is the SAQ scored?Factor scores add the weighted loadings of the relevant items, or more simply their raw scores. A high Pleasure score means more pleasure, and a low Discomfort score means less discomfort.
Why was the SAQ developed?It was developed to study the effect of long-term tamoxifen on sexual functioning in women at high risk of breast cancer in the tamoxifen prevention trial.
Is the SAQ free to use?Yes. The SAQ is free and available for academic use without payment, sometimes with citation of the original source.
A Word from ResRef About the Sexual Activity Questionnaire (SAQ)
The SAQ is a brief self-report tool for describing sexual activity, pleasure and discomfort in women aged 35–65, developed for the tamoxifen breast cancer prevention trial. It showed good acceptability (compliance of about 85–88%), consistent test–retest reliability and a three-factor structure explaining 64.8% of variance. Evidence is early and based on a small test–retest sample, a sample skewed toward higher occupational classes, and no reported Cronbach's alpha or cut-off scores, so interpretation should draw on the published normative data and be cautious outside the original population.
References
Thirlaway, K., Fallowfield, L., & Cuzick, J. (1996). The Sexual Activity Questionnaire: a measure of women's sexual functioning. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 5(1), 81–90. https://doi.org/10.1007/BF00435972da Costa, F. A., Ribeiro, M. C., Braga, S., Carvalho, E., Francisco, F., Miranda, A. C., Moreira, A., & Fallowfield, L. (2016). Sexual Dysfunction in Breast Cancer Survivors: Cross-Cultural Adaptation of the Sexual Activity Questionnaire for Use in Portugal. Acta Medica Portuguesa, 29(9), 533–541. https://doi.org/10.20344/amp.7389Atkins, L., & Fallowfield, L. J. (2007). Fallowfield's Sexual Activity Questionnaire in women with without and at risk of cancer. Menopause International, 13(3), 103–9. https://doi.org/10.1258/175404507781605578