1. How enjoyable has sexual activity been for you?
choose
1 - not at all enjoyable
2
3
4 - moderately enjoyable
5
6
7 - extremely enjoyable
n/a
2. How have you felt about the frequency of your sexual activity?
choose
1 - too infrequent
2
3
4 - frequency just right
5
6
7 - too frequent
n/a
3. Give a rough estimate of how often you have had sexual thoughts or fantasies during the last 4 weeks .
choose
1 - never
2
3 - once a week
4
5 - once a day
6
7 - more than 10x a day
4. How excited or aroused have you been during sexual activity (for instance increased heartbeat/flushing/heavy breathing, etc.)?
choose
1 - not at all excited
2
3
4 - moderately excited
5
6
7 - extremely excited
n/a
5. How would you describe your level of sexual interest (i.e. sex drive) during the past 4 weeks?
choose
1 - extremely low
2
3
4 - moderate
5
6
7 - extremely high
n/a
6. How would you describe your natural vaginal lubrication (wetness during sexual arousal) during the past 4 weeks?
choose
1 - absent
2
3
4 - adequate
5
6
7 - excessive
n/a
7. How sexually attractive have you felt?
choose
1 - not at all sexually attractive
2
3
4 - moderately sexually attractive
5
6
7 - extremely sexual attractive
n/a
8. How sexually attractive have you felt to your primary sexual partner?
choose
1 - not at all sexually attractive
2
3
4 - moderately sexually attractive
5
6
7 - extremely sexual attractive
n/a
9. How often has your satisfaction from sexual activity decreased because your primary partner has not had enough sexual interest in you?
choose
1 - every time
2
3
4 - about half the time
5
6
7 - never
n/a
10. How satisfied have you been with your primary partner as a lover?
choose
1 - not at all satisfied
2
3
4 - moderately satisfied
5
6
7 - extremely satisfied
n/a
11. How satisfied have you been with your primary partner as a human being/friend?
choose
1 - not at all satisfied
2
3
4 - moderately satisfied
5
6
7 - extremely satisfied
n/a
12. During the past 4 weeks, estimate the total number of times you've had sexual intercourse (vaginal penetration)?
IF YOUR ANSWER TO #12 IS ZERO, STOP HERE AND CLICK "SUBMIT" TO SEND THE FORM. IF YOU ENTERED ANY OTHER ANSWER, PLEASE CONTINUE TO #13.
13. How enjoyable has sexual intercourse been for you?
choose
1 - not at all enjoyable
2
3
4 - moderately enjoyable
5
6
7 - extremely enjoyable
14. How often have you had an orgasm during sexual intercourse?
choose
1 - every time
2
3
4 - about half the time
5
6
7 - never
15. On the average, how pleasurable were the orgasm(s) you have had during sexual intercourse over the past 4 weeks?
choose
1 - slightly pleasurable
2
3
4 - pleasurable
5
6
7 - extremely pleasurable
n/a
16. In order to have an orgasm during sexual intercourse, how often have you required manual (hand) or vibratory (vibrator) stimulation at the point of orgasm?
choose
1 - every time
2
3
4 - about half the time
5
6
7 - never
n/a
17. How often have you had insufficient (natural) vaginal lubrication during sexual intercourse?
choose
1 - every time
2
3
4 - about half the time
5
6
7 - never
18. How often have you had pain during sexual intercourse?
choose
1 - every time
2
3
4 - about half the time
5
6
7 - never
19. How often have you been prevented from having sexual intercourse because your primary partner could not achieve or maintain an erection?
choose
1 - every time
2
3
4 - about half the time
5
6
7 - never
n/a
