1. Introduction
exuality has always been a great concern in human and mental health. A risky sexual behavior is mostly defined as unprotected sexual intercourse by any means [1] which can lead to sexually transmitted infections, impaired family and interpersonal relationships, unwanted pregnancies, financial issues, and some important medical issues such as increased risk of cancers [2]. Addictive or compulsive sexual behavior is mostly defined as difficulty controlling sexual impulse which can lead to high discomfort or impaired performance. In Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), although there is category titled “substance-related and addictive disorders”, sex addiction still has not been included in the category [6].
Only a few studies have assessed risky sexual behaviors in Iran; most of them had to use a researcher-made instrument for assessment due to a lack of a proper instrument adapted for Iranian population [7, 8, 9, 10, 11, 12, 13]. Among the reliable tools for this purpose are the Sexual Addiction Screening Test – Revised (SAST-R) which is a proper tool to use for patients with sexual addiction [14], the Sexual Risk Survey (SRS) which was first designed to assess risky sexual behaviors among college students, and the Youth Risk Behavior Surveillance System (YRBSS) which assesses any risky behavior including risky sexual behavior in high school students [15, 16]. This study aims to translate these three questionnaires into Persian and assess their psychometric parameters.
2. Materials and Methods  
Selected instruments were translated into Persian using back-ward translation method and necessary changes were made in order to make all the items adaptable to Iranian population according to opinions of experts with experience in sexual practice and research methodology. Then, 11 specialists evaluated the content validity of the questionnaires, and the results were analyzed according to Wilson’s method [18]. Then, the questionnaires were distributed among 5 men and 5 women, selected from the patients’ companions referred to the clinics of Iran Psychiatric Hospital. The scored were used to determine the face validity. Finally, the final versions of the questionnaires were completed by 45 men and 47 women, randomly selected from the companions of the patients referred to the clinics Iran Psychiatric Hospital in order to assess the internal consistency and factorial validity of the instruments. Data were analyzed in SPSS v. 24 software.
3. Results
The items 2, 9, 30, 35 and 45 were excluded from the Persian version of SAST-R due to low content validity or face validity or lack of meaning in Iranian culture. The Mean±SD positive answer to the questions was 6.7±5.9. Based on Exploratory Factor Analysis (EFA) of the SAST-R, 12 factors were extracted explaining 71.4% of the variances. It had high internal consistency with a Cronbach’s alpha of 0.878 for the whole questionnaire (Table 1).


In preparing the Persian version of SRS, items 3 and 4 were replaced by three similar but culturally adapted items, and items 8, 10, 11, 12, 13, 14 and 15 were omitted. The remaining 17 items had good internal consistency with (α=0.869) (Table 2).


EFA results led to extraction of 4 statistically acceptable factors including sexual risk taking with unknown partners (items 3, 4, 6, 10, 11, 13,16), initiation of sex acts in public (items 2, 4, 5), risky sex acts (items 7, 12, 14, 15), and other factors (items 1, 8, 9, 4) (Table 3).


In assessing content and face validity of the sexual behavior subscale of YRBSS, results showed its acceptable validity. Since the ratings for 10 items was not the same, we categorized 7 items as high and low risky sexual behaviors and then the EFA was carried out. Two factors were extracted including high risky sexual behavior (items 1, 2, 3, 4, 7), and unprotected sex (items 5 and 6). Their Cronbach’s alpha values were 0.709 and 0.690, respectively (Table 4).


4. Discussion and Conclusion
Persian versions of SRS and sexual behavior subscale of YRBSS had acceptable factorial structure according to EFA results, good internal consistency, and satisfactory content and face validity. The Persian version of SAST-R had a complex factorial structure, but a good internal consistency. Further evaluation of construct validity and reliability is recommended before applying these questionnaires in other researches.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Iranian University of Medical Sciences (Code: IR.IUMS.FMD.REC.1398.079). All steps of this study was performed in complete accordance to the Helsinki Declaration.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors contributions
Conceptualization: Homa Mohammad-Sadeghi, Kaveh Alavi, Parham Kouhestani; Methodology: Kaveh Alavi, Mehrdad Eftekhar; Software: Kaveh Alavi; Validation, investigation, resources, writing – review & editing, visualization: All authors; Formal analysis: Kaveh Alavi, Parham Kouhestani; Data curation: Kaveh Alavi, Parham Kouhestani; Writing – original draft preparation: Kaveh Alavi, Parham Kouhestani; Supervision: Mehrda Eftekhar, Shabnam Nohesara; Funding Acquisition: Kaveh Alavi, Parham Kouhestani.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank the professors in the Department of Psychiatry at Iran University of Medical Sciences for participating in evaluation of the content validity of the instruments, and the staff in clinics of Iran Psychiatric Hospital for their kind support and cooperation.


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