Background <p>Sexual fear in patients with coronary heart disease (CHD) can negatively affect their sexual life and overall well-being. However, validated tools for assessing this fear are lacking. This study aimed to develop a sexual fear scale for patients with CHD and evaluate its psychometric properties.</p> Methods <p>A multi-stage cross-sectional study was conducted with 409 patients. The process included item generation (literature review, expert consultation, and patient interviews), item selection (critical ratio, correlation analysis, and internal consistency), and psychometric evaluation (content validity, reliability, criterion validity, and construct validity via exploratory and confirmatory factor analysis).</p> Results <p>Finally, a 19-item scale including 2 dimensions of perceived risk and fear psychology was formed. After reliability and validity test, the content validity index of the scale is 0.942, Cronbach’s α coefficient is 0.944, test-retest reliability is 0.886, and split-half reliability is 0.841. Two factors extracted from exploratory factor analysis explained 58.655% of the total variation, and confirmatory factor analysis showed that the model fit well.</p> Conclusions <p>The developed scale demonstrates sound reliability and validity and provides a practical tool for assessing sexual fear in CHD patients, supporting early identification and personalized intervention.</p> Clinical Trial Number <p>Not applicable.</p>