SD was assessed using the Arizona Sexual Experience Scale (ASEX) [58 (link)], which examines the experience of sexual difficulties throughout the sexual response cycle (e.g., sexual desire, erection/lubrication, orgasm) using a 6-point Likert scale ranging from 1 –extremely easily/strong/satisfying to 6 –very difficult/weak/unsatisfying. Lower scores represent greater levels of sexual functioning. Participants completed the version of the ASEX that corresponded to their genital sex rather than their gender (i.e., one’s personal sense of being male, female, non-binary, etc.), as some ASEX items are sex-specific (e.g., vaginal lubrication; penile erection). Two questions were added to the original ASEX to measure other sexual difficulties (i.e., pain during sex and premature ejaculation/orgasm). To reflect the diagnostic criteria used in the DSM-5 [11 ], investigated sexual difficulties had to be present for at least 6 months and respondents were invited to indicate their associated levels of distress (1 –no distress, to 6 –extreme distress). In the present study, five SDs were examined: 1) low sexual desire/arousal, 2) difficulties with lubrication/erection, 3) premature ejaculation/orgasm, 4) delayed or absent ejaculation/orgasm, and 5) pain during sex. The ASEX showed satisfactory internal consistency in the community (α = .82) and clinical samples (α = .75).
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