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Background Patients with liver disease (LD) or liver transplantation (LT) may experience sexual dysfunction (SD). The existing tools to assess SD are not specific to LD/LT and our aim was to develop a liver specific sexual function (SF) assessment tool.Methods This cross-sectional study assessed SD in 822 patients with LD/LT (472 men, 350 women) at King’s College Hospital. A 24-item SF assessment tool in LD/LT (SFL) for men and women were developed through a literature search, input from a multidisciplinary panel of experts and patient group feedback. The international index of erectile function (IIEF) for men, female sexual function index (FSFI) and female sexual distress scale (FSDS) for women were used as gold standard, non-liver specific SF assessment tools. Chronic liver disease questionnaire (CLDQ) was used as a liver specific quality of life (QoL) assessment tool and clinical data was gathered from patient medical records. Factor analyses (FA) were used to assess the psychometric properties of the new SFL scale.Results Exploratory FA reduced the SFL to a 13-item scale with good internal consistency reliability (α=0.96). Spearman’s coefficient showed the 13-item SFL to significantly correlate with FSFI/FSDS in women and IIEF in men (indicating criterion validity). SFL had strong correlation with the CLDQ (construct validity). The prevalence of SD were 39–46% for women and 51% for men with 23% of men having severe symptoms. A major advantage of SFL is that it can be used in all gender allowing inclusivity for transgender or for whom gender identity differs from the sex assigned at birth. SFL showed that women had greater degree of SD than men (0.50 for women vs 0.23 for men, p<0.001). CLDQ indicated a poorer quality of life in women compared to men (p<0.001). Patients with cirrhosis had greater SD and poorer quality of life according to SFL and CLDQ respectively when compared to those without cirrhosis or following LT. For women, the FSFI and FSDS were not able to detect this difference indicating the SFL can detect disease related changes in QoL. Multiple regression analysis identified age, ALBI score, feeling anxious and depressed as predictors for SD.Conclusion SD affects approximately 50% of patients with LD/LT. SFL has significant correlation with the gold standard SF assessment tools and the liver specific CLDQ. The presence of cirrhosis, ALBI score, anxiety and depression are associated with risk of SD.