What knowledge matters for women's sexual wellbeing? Validating a questionnaire measuring sexual knowledge using public and patient involvement.

Background: Sex education is a known protective factor for female sexual health. However, data on specific aspects of sexual knowledge linked to sexual wellbeing and validated measures are missing.

Aim: This study aims to develop and validate a questionnaire measuring specific aspects of sexual knowledge and explore the interplay with sexual wellbeing.

Methods: Public & Patient Involvement (PPI) was conducted to identify important aspects of sexual knowledge for sexual wellbeing resulting in a first item set, which was reviewed after a cross-sectional pilot study in cisgender women (N = 449). The respective items were subject to Exploratory Factor Analysis. For the main analysis, the resulting questionnaire was distributed in a cross-sectional survey alongside items on sources of sex education and validated questionnaires assessing aspects of sexual wellbeing. We performed Confirmatory Factor Analysis (CFA), Multi-Group-CFA, and Structural Equation Modeling (SEM) with a regression framework to analyze the data.

Outcomes: The primary outcome was sexual knowledge represented by three constructs and the secondary outcomes were the aspects of sexual wellbeing such as sexual function, orgasm consistency, sexual desire, sexual self-esteem, and sexual communication.

Results: PPI resulted in a questionnaire assessing the three constructs (i) experiential knowledge and agency, knowledge of (ii) factual genital knowledge, and (iii) factual anatomical and functional knowledge. Of the 2880 cisgender women included in the main analysis (mean age, 31.89 years; SD, 11.16 years), one-third were able to correctly name the clitoris and vulva, respectively. Construct validity and reliability were established. Experiential knowledge and agency showed a three-factor structure in the CFA and was associated with exploration of the own body and pornography use as sources of sex education. Its generalized factor predicted all aspects of sexual wellbeing in the SEM. While factual genital knowledge and factual anatomical and functional knowledge were not correlated with any aspect of sexual wellbeing, they were associated with consumption of non-pornographic information from the internet as sources of sex education.

Clinical implications: The questionnaire can be used to measure lacks of sexual knowledge associated with poor sexual functioning.

Strengths and limitations: Strengths include the PPI-based questionnaire development and a large sample size. Due to the study design no interpretations on causal effects of sexual knowledge on sexual wellbeing can be drawn. The results are limited to the population of cisgender women.

Conclusion: Cisgender women show significant lack of knowledge in factual sexual knowledge. Only experiential knowledge and agency predicts aspects of sexual wellbeing.