Background: The three-item Sexual Distress Scale (SDS-3) has been frequently used to assess distress related to
sexuality in public health surveys and research on sexual wellbeing. However, its psychometric properties and
measurement invariance across cultural, gender and sexual subgroups have not yet been examined. This
multinational study aimed to validate the SDS-3 and test its psychometric properties, including measurement
invariance across language, country, gender identity, and sexual orientation groups.
Methods: We used global survey data from 82,243 individuals (Mean age=32.39 years; 40.3 % men, 57.0 %
women, 2.8 % non-binary, and 0.6 % other genders) participating in the International Sexual Survey (ISS; https:
//internationalsexsurvey.org/) across 42 countries and 26 languages. Participants completed the SDS-3, as well
as questions regarding sociodemographic characteristics, including gender identity and sexual orientation.
Results: Confirmatory factor analysis (CFA) supported a unidimensional factor structure for the SDS-3, and multigroup CFA (MGCFA) suggested that this factor structure was invariant across countries, languages, gender
identities, and sexual orientations. Cronbach’s α for the unidimensional score was 0.83 (range between 0.76 and
0.89), and McDonald’s ω was 0.84 (range between 0.76 and 0.90). Participants who did not experience sexual
problems had significantly lower SDS-3 total scores (M = 2.99; SD=2.54) compared to those who reported sexual
problems (M = 5.60; SD=3.00), with a large effect size (Cohen’s d = 1.01 [95 % CI=-1.03, -0.98]; p < 0.001).
Conclusion: The SDS-3 has a unidimensional factor structure and appears to be valid and reliable for measuring
sexual distress among individuals from different countries, gender identities, and sexual orientations.