Hurlbert Index of Sexual Assertiveness

Abstract

The Hurlbert Index of Sexual Assertiveness (HISA) is a widely utilized psychometric instrument designed to assess an individual’s subjective sense of agency, communicative competence, and behavioral assertiveness within dyadic sexual interactions. Developed by clinical sexologist David F. Hurlbert in 1991, the instrument was primarily constructed to operationalize sexual assertiveness—a specific behavioral and communicative domain distinct from global or social assertiveness. The HISA consists of 25 self-report items evaluated on a 5-point Likert-type frequency scale ranging from 0 (All of the time) to 4 (Never). The scale assesses an individual’s propensity to initiate desired sexual activities, articulate specific sexual preferences and boundaries, refuse unwanted sexual contact, communicate regarding physical pleasure and displeasure, and maintain sexual autonomy without excessive submissiveness or compliance. Psychometric evaluations across clinical and non-clinical populations demonstrate robust internal consistency (Cronbach’s α typically ranging between .85 and .93) and high test-retest reliability over four-week intervals (r = .86). Structurally, although initially operationalized as a unidimensional index of sexual assertiveness, contemporary exploratory and confirmatory factor analyses frequently identify meaningful sub-dimensions, most notably sexual initiation/refusal and sexual communication/pleasure expression. The HISA exhibits extensive convergent and construct validity through significant correlations with dyadic sexual satisfaction, orgasmic consistency, sexual functioning, safer-sex negotiations, and protective factors against sexual coercion. The scale remains a seminal tool in clinical sexology, relationship therapy, public health research, and psychological investigations of human sexuality.

Keywords

Hurlbert Index of Sexual Assertiveness, HISA, sexual assertiveness, sexual communication, sexual agency, female sexual functioning, dyadic sexual satisfaction, psychometrics, sexual compliance, clinical sexology

Authors

The Hurlbert Index of Sexual Assertiveness was authored by David F. Hurlbert, Ph.D.

• Institutional Affiliation: United States Department of Health and Human Services (Administration for Children and Families). Formerly associated with specialized clinical and sexological counseling divisions in Georgia and Texas, USA.
• Original Correspondence Address: 140 Farnworth Lane, Roswell, Georgia 30075; Electronic contact: [email protected].
• Historical Context: Dr. Hurlbert published extensively during the early 1990s on female sexual desire disorders, hypoactive sexual desire, sexual compatibility, and marital dynamics, establishing several targeted psychometric inventories within behavioral and sexological research (e.g., the Hurlbert Index of Sexual Desire, Hurlbert Index of Sexual Fantasy).

Purpose

The primary purpose of the Hurlbert Index of Sexual Assertiveness is to quantify the cognitive, communicative, and behavioral dimensions through which individuals advocate for their own sexual needs and maintain personal boundaries within consensual partnerships. In historical psychological assessment, assertiveness was traditionally evaluated via broad-spectrum constructs, such as general assertiveness inventories (e.g., the Rathus Assertiveness Schedule). However, early sexological researchers noted an empirical dissociation: individuals capable of robust assertiveness in vocational or casual social environments often exhibited profound inhibition, passivity, or compliance in intimate, erotic contexts. The HISA was engineered to bridge this diagnostic and psychometric gap by focusing specifically on the erotic dyad.

In clinical practice, the HISA serves as a diagnostic screening and outcome-monitoring instrument. Clinicians specializing in sex therapy and couple counseling utilize the scale to evaluate baseline deficits in communication, evaluate risk factors for female orgasmic disorder, and address sexual distress. Low scores on the scale often signal deep-seated communicative barriers, heightened performance anxiety, internalized sexual guilt, or fear of partner abandonment. Therapeutic interventions—such as sexual assertiveness training, sensate focus protocols, and cognitive restructuring—frequently use HISA scores before and after treatment to quantify increases in personal sexual agency and partner communication.

From an empirical and public health perspective, the scale fulfills several key roles:

• Investigation of Sexual Function and Well-being: Assessing how the capacity to articulate desires directly influences physiological arousal, sexual pleasure, and orgasmic consistency.
• Safer-Sex and Contraceptive Negotiation: Predicting an individual’s likelihood of demanding condom use, discussing sexually transmitted infection (STI) testing histories, and resisting risky sexual behaviors.
• Sexual Victimization and Compliance: Analyzing non-violent sexual compliance (engaging in unwanted sex due to perceived relationship obligation) and distinguishing consensual boundary maintenance from coerced passivity.
• Gender and Cross-Cultural Dynamics: Examining the impact of traditional gender-role socialization on sexual scripts, sexual entitlement, and relational empowerment across diverse cultural settings.

Psychological Construct

The psychological construct evaluated by the HISA is sexual assertiveness. Rooted in behavioral and cognitive frameworks, sexual assertiveness denotes an individual’s ability to communicate openly, honestly, and directly regarding their sexual feelings, desires, preferences, and limits, while respecting the boundaries of their partner. Rather than reflecting an aggressive or dominant posture, sexual assertiveness represents a balanced state of self-advocacy, bodily autonomy, and collaborative dyadic engagement.

Operationally, sexual assertiveness comprises four core behavioral and cognitive components:

1. Sexual Desire Initiation and Proactivity

This facet captures an individual’s capacity to recognize their internal states of sexual arousal or desire and autonomously act upon them by approaching their partner. High-scoring individuals initiate sexual contact when they feel desire, actively request erotic behaviors, and embrace their sexual identity. Items such as Item 3 (“I approach my partner for sex when I desire it”) and Item 18 (“I feel comfortable in initiating sex with my partner”) encapsulate this domain, highlighting agency over passive receptivity.

2. Boundary Setting and Sexual Refusal

A crucial dimension of healthy sexual functioning is the capacity to decline sexual interactions when desire or consent is absent. Non-assertive individuals frequently experience “sexual compliance,” consenting to intimate behaviors to avoid relational conflict, alleviate guilt, or placate a partner. The HISA directly operationalizes this dimension via items such as Item 9 (“It is hard for me to say no even when I do not want sex”), Item 14 (“I find myself having sex when I do not really want it”), and Item 19 (“I find myself doing sexual things that I do not like”). Assertive individuals preserve bodily integrity without fearing catastrophic relationship consequences.

3. Explicit Pleasure Communication and Instructional Feedback

Effective sexual intimacy often relies on real-time feedback regarding physiological stimulation. This component involves the willingness to direct a partner toward what produces pleasure and away from what causes discomfort or pain. Items reflecting this construct include Item 11 (“I feel uncomfortable telling my partner what feels good”), Item 15 (“When a technique does not feel good, I tell my partner”), and Item 21 (“I feel comfortable telling my partner how to touch me”). This feedback loop mitigates dyspareunia, enhances orgasmic potential, and fosters dyadic sexual responsiveness.

4. Sexual Self-Acceptance and Erotic Openness

Underpinning active behavioral communication is psychological self-acceptance of one’s identity as an erotic being. Individuals burdened by sexual shame, internalized guilt, or negative sexual socialization often demonstrate cognitive avoidance. The HISA captures this intrapsychic state via items such as Item 10 (“I am reluctant to describe myself as a sexual person”), Item 8 (“It is difficult for me to touch myself during sex”), and Item 22 (“I enjoy masturbating myself to orgasm”). Uninhibited self-acceptance serves as the cognitive foundation for interpersonal assertiveness.

Theoretical Framework

The conceptual framework of the Hurlbert Index of Sexual Assertiveness draws upon multiple integrated psychological models:

Social Learning Theory and Behavioral Assertiveness Models

The foundational architecture of assertiveness training emerged from the work of behavioral theorists such as Joseph Wolpe, as well as Robert Alberti and Michael Emmons. According to Social Learning Theory (Bandura, 1977), assertiveness is not an immutable personality trait, but a constellation of learned communicative and behavioral competencies governed by self-efficacy expectations. In the sexual domain, individuals evaluate their perceived ability to communicate (behavioral capability) alongside the anticipated consequences of their behavior (outcome expectancies). If an individual anticipates that communicating a sexual boundary will trigger emotional withdrawal or hostility from a partner, sexual self-efficacy drops, culminating in behavioral avoidance or compliance.

Sexual Script Theory

Developed by sociologists John H. Gagnon and William Simon (1973), Sexual Script Theory posits that human sexual behavior is guided by cultural scenarios, interpersonal scripts, and intrapsychic interpretations. Traditional Western sexual scripts have historically prescribed asymmetric roles: men are socialized as initiators, pursuers, and active sexual agents, whereas women are socialized as passive recipients, gatekeepers, and accommodation-oriented partners whose primary role is to satisfy their male counterpart. The HISA reflects a theoretical paradigm shift wherein traditional scripts are renegotiated into egalitarian, bi-directional sexual scripts. Item 20 (“Pleasing my partner is more important than my pleasure”) directly evaluates internalized adherence to self-sacrificing, gender-stereotyped sexual scripts.

Interpersonal Exchange and Dyadic Systems Theory

From an interpersonal systems perspective, dyadic sexual interactions represent an interdependent feedback loop. Open sexual communication allows couples to establish mutual reward systems while minimizing aversive experiences. Inhibited sexual assertiveness disrupts this exchange, replacing collaborative feedback with unspoken assumptions and silent resentment. Hurlbert’s framework posits that sexual satisfaction is directly mediated by transparent dyadic communication, reinforcing the idea that individual sexual well-being depends on communicative openness between partners.

Validity

The psychometric validity of the Hurlbert Index of Sexual Assertiveness has been confirmed across diverse cross-cultural, community, and clinical cohorts.

Construct and Convergent Validity

Construct validity is supported by strong, theoretically consistent associations with established sexological and psychological inventories:

• Sexual Satisfaction: In Hurlbert’s foundational study (1991), sexually assertive women demonstrated significantly higher scores on the Index of Sexual Satisfaction (ISS) compared to non-assertive women (t = 8.42, p < .001). Assertive women also reported higher frequencies of sexual intercourse, greater orgasmic consistency during dyadic intimacy, and enhanced relationship intimacy.
• Sexual Functioning: Subsequent validation studies utilizing the Female Sexual Function Index (FSFI) reveal moderate-to-strong positive correlations between the HISA and subscales for sexual desire, arousal, lubrication, and satisfaction (r values typically between .35 and .58, p < .001).
• Safer-Sex Negotiation: Research on health behaviors has demonstrated robust positive associations between HISA scores and condom-use self-efficacy, direct STI screening requests, and proactive contraceptive planning.

Discriminant Validity

Discriminant validity has been established by comparing the HISA against general, non-sexual psychological traits:

• General Social Assertiveness: Correlations between the HISA and general assertiveness inventories (such as the Rathus Assertiveness Schedule) are positive but low-to-moderate (r ≈ .25 to .38). This confirms that sexual assertiveness represents a distinct construct within interpersonal relationships rather than a simple manifestation of general social assertiveness.
• Social Desirability: Scores on the HISA exhibit weak, non-significant correlations with the Marlowe-Crowne Social Desirability Scale (r < .15), indicating that responses are not primarily driven by the tendency to present oneself in a socially approved manner.
• Depression and Anxiety: While negatively correlated with general psychological distress, the modest magnitude of these correlations confirms that the HISA assesses specific sexual behavior rather than broader emotional adjustment.

Criterion and Known-Groups Validity

The HISA consistently differentiates between clinical and non-clinical groups. Women diagnosed with Hypoactive Sexual Desire Disorder (HSDD), Female Orgasmic Disorder, or Genito-Pelvic Pain/Penetration Disorder consistently demonstrate significantly lower HISA scores than control subjects. Similarly, clinical interventions targeting sexual assertiveness via cognitive-behavioral therapy have documented significant post-treatment score gains that mirror improvements in sexual distress and orgasmic frequency.

Reliability

The reliability of the Hurlbert Index of Sexual Assertiveness has been documented across numerous psychometric studies:

Internal Consistency

In the original validation study by Hurlbert (1991), the HISA demonstrated an internal consistency coefficient (Cronbach’s alpha) of α = .91 among a sample of adult married women. Subsequent psychometric evaluations across varied demographics have mirrored this finding:

• Cross-cultural adaptations (e.g., Spanish validations by Santos-Iglesias, Sierra, & Vallejo-Medina, 2013) have reported alpha values ranging from .85 to .90.
• Studies focusing on mixed-gender community samples, university populations, and sexual minority cohorts consistently report alpha values between .86 and .93.
• Item-total correlations for the scale’s 25 items generally range from .35 to .72, indicating strong individual item contributions to the overarching construct.

Test-Retest Reliability and Temporal Stability

Test-retest reliability was evaluated during the initial validation by administering the inventory twice across a four-week interval. The resulting stability coefficient was r = .86 (p < .001), indicating strong temporal stability while retaining sensitivity to genuine clinical and therapeutic change. Longitudinal assessments spanning six-month observational periods have similarly shown stability coefficients exceeding .75 in the absence of targeted psychological or relational interventions.

Factor Analysis

The latent structural composition of the HISA has been evaluated through both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

Original Unidimensional Structure

In Hurlbert’s (1991) development study, principal component analysis suggested a predominant single-factor solution. The primary factor accounted for the majority of the common variance, supporting the initial use of a unitary total score representing overall sexual assertiveness.

Subsequent Multidimensional Evidence

Later psychometric investigations indicated that the 25 items of the HISA tap into multidimensional facets of sexual assertiveness. Factor-analytic research—such as studies by Quina et al. (2000) and extensive cross-cultural analyses by Santos-Iglesias and colleagues—frequently identify a robust two-factor or three-factor structure:

• Factor 1: Initiation and Refusal of Sexual Behaviors (accounting for roughly 25%–30% of variance). High-loading items include Item 3, Item 9, Item 14, Item 18, and Item 19. This factor evaluates direct behavioral actions—such as starting sex or declining unwanted activity.
• Factor 2: Sexual Communication and Expression of Needs (accounting for roughly 12%–18% of variance). High-loading items include Item 4, Item 7, Item 11, Item 15, Item 16, and Item 21. This factor reflects explicit verbal communication regarding erotic preferences and real-time physical feedback.
• Factor 3 (Identified in select models): Erotic Comfort and Self-Acceptance (accounting for roughly 6%–10% of variance). Characterized by Item 8, Item 10, Item 22, and Item 24, focusing on body comfort, masturbation, and acceptance of one’s sexual identity.

Confirmatory Fit Indices

When evaluated via modern structural equation modeling (SEM) standards, a multidimensional two-factor model often demonstrates superior fit compared to a strict single-factor model. Typical fit indices reported in literature include:

• Comparative Fit Index (CFI): .92 to .95
• Tucker-Lewis Index (TLI): .91 to .94
• Root Mean Square Error of Approximation (RMSEA): .048 to .062 (with 90% confidence intervals remaining below the standard .08 threshold)
• Standardized Root Mean Square Residual (SRMR): .045 to .055

Despite evidence for these distinct sub-dimensions, the high inter-factor correlation (typically r > .60) supports the continued use of the cumulative global score in clinical settings, while researchers often analyze subscales for more granular behavioral insights.

Instrument / Measurement Tool

• Instrument Name: Hurlbert Index of Sexual Assertiveness (HISA)
• Alternative Title: Hulbert Index of Sexual Assertiveness
• Original Author: David F. Hurlbert, Ph.D.
• Format: 25-item paper-and-pencil or computerized self-report questionnaire
• Target Population: Adults (originally validated in women; subsequently adapted and validated for individuals of all genders within intimate or sexually active partnerships)
• Administration Time: Approximately 5 to 10 minutes
• Response Scale: 5-point Likert-type frequency scale:
  • 0 = All of the time
  • 1 = Most of the time
  • 2 = Some of the time
  • 3 = Rarely
  • 4 = Never
• Scoring and Transformation Instructions:
  • Reverse-Scored Items (12 items): Items 3, 4, 5, 7, 12, 15, 16, 17, 18, 21, 22, and 23 are reverse-scored prior to summation. The scoring conversion is: 0 becomes 4, 1 becomes 3, 2 remains 2, 3 becomes 1, and 4 becomes 0.
  • Direct-Scored Items (13 items): Items 1, 2, 6, 8, 9, 10, 11, 13, 14, 19, 20, 24, and 25 retain their original assigned numeric value (0 to 4). In these items, a response of “Never” (4) indicates the highest assertiveness, while “All of the time” (0) reflects lowest assertiveness.
  • Total Score Calculation: Sum the scores of all 25 items after recoding the reverse-scored items. The potential range of the total score is 0 to 100.
  • Interpretation: Higher aggregate scores indicate greater levels of sexual assertiveness, characterized by open communication, autonomous boundary maintenance, and agency in initiating sexual intimacy. Lower scores indicate sexual passivity, difficulty refusing unwanted advances, communicative inhibition, and an increased risk of sexual compliance.

Permissions & Fee and Test Year

• Year of Initial Publication: 1991.
• Original Citation: Published in the Journal of Sex & Marital Therapy (Volume 17, Issue 3, Autumn 1991, pages 183–190).
• Copyright and Access Policy: The HISA was placed into the academic domain via scientific publication for clinical, educational, and research purposes. Non-commercial empirical investigations and individual clinical assessments typically do not require payment of licensing fees.
• Commercial and Derivative Licensing: Commercial distribution, adaptation into proprietary diagnostic software platforms, or inclusion in commercial publications requires formal permission from the copyright holder and publisher (Taylor & Francis / Routledge).

References

• Alberti, R. E., & Emmons, M. L. (2017). Your perfect right: Assertiveness and equality in your life and relationships (10th ed.). Impact Publishers.
• Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191
• Gagnon, J. H., & Simon, W. (1973). Sexual conduct: The social sources of human sexuality. Aldine Publishing Company.
• Hurlbert, D. F. (1991). The role of assertiveness in female sexuality: A comparative study between sexually assertive and sexually nonassertive women. Journal of Sex & Marital Therapy, 17(3), 183–190. https://doi.org/10.1080/00926239108404342
• Hurlbert, D. F., & Apt, C. (1994). Female sexuality: A comparative study between women in homosexual and heterosexual relationships. Journal of Sex & Marital Therapy, 20(2), 87–96. https://doi.org/10.1080/00926239408403419
• Quina, K., Harlow, L. L., Morokoff, P. J., Burkholder, G., & Deiter, P. J. (2000). Sexual communication in relationships: When words speak louder than actions. Sex Roles, 42(7–8), 523–549. https://doi.org/10.1023/A:1007043201479
• Santos-Iglesias, P., Sierra, J. C., & Vallejo-Medina, P. (2013). Predictors of sexual assertiveness in Spanish men and women: The role of sexual desire, arousal, and satisfaction. The Journal of Sex Research, 50(1), 90–100. https://doi.org/10.1080/00224499.2011.631570
• Sierra, J. C., Vallejo-Medina, P., & Santos-Iglesias, P. (2011). Propiedades psicométricas de la versión española del Hurlbert Index of Sexual Assertiveness (HISA). Anales de Psicología, 27(1), 17–26.

Items of the Scale