|
Domain: sexual desire
|
| Question # 1 – In the last four weeks,
how often did you feel desire or sexual interest? |
1. Almost always or always |
| 2. Most of the time (more than half of the
time) |
| 3. Sometimes (about half of the time) |
| 4. A few times (less than half the time) |
| 5. Almost never, or never |
| Question # 2 – In the last four weeks,
how do you rate your level of desire or sexual interest? |
1 Very high |
| 2. High |
| 3 Moderate |
| 4 Low |
| 5 Very low or absolutely absent |
|
Domain: sexual arousal
|
| Question # 3 – In the last four weeks,
how often you felt sexually aroused during sexual activity or
intercourse? |
1. No sexual activity |
| 2. Almost always, or always |
| 3. Most of the time (more than half of the
time) |
| 4. Sometimes (about half of the time) |
| 5. A few times (less than half the time) |
| 6. Almost never, or never |
| Question # 4 – In the past 4 weeks, how
would you rate your level of sexual arousal during sexual
activity or intercourse? |
1. No sexual activity |
| 2. Very high |
| 3. High |
| 4. Moderate |
| 5. Low |
| 6. Very low, or absolutely absent |
| Question # 5 – In the last four weeks,
how do you rate your level of assurance to become sexually
aroused during sexual activity or intercourse? |
1. No sexual activity |
| 2. Very high assurance |
| 3. High assurance |
| 4. Moderate assurance |
| 5. Low assurance |
| 6. Very low or no assurance |
| Question # 6 – In the past 4 weeks, how
often you were satisfied with your sexual arousal during sexual
activity or intercourse? |
1. No sexual activity |
| 2. Almost always, or always |
| 3. Most of the time (more than half of the
time) |
| 4. Sometimes (about half of the time) |
| 5. A few times (less than half the time) |
| 6. Almost never, or never |
|
Domain: vaginal lubrication
|
| Question # 7 – In the last four weeks,
how often you had vaginal lubrication (got a "wet" vagina)
during sexual activity or intercourse? |
1. No sexual activity |
| 2. Almost always, or always |
| 3. Most of the time (more than half of the
time) |
| 4. Sometimes (about half of the time) |
| 5. A few times (less than half the time) |
| 6. Almost never, or never |
| Question # 8 – In the last four weeks,
how do you rate your difficulty in having vaginal lubrication
(got a "wet" vagina) during intercourse or sexual
activities? |
1. No sexual activity |
| 2. Extremely difficult, or impossible |
| 3. Very difficult |
| 4. Difficult |
| 5. Slightly difficult |
| 6. Not at all difficult |
| Question # 8 – In the last four weeks,
how do you rate your difficulty in having vaginal lubrication
(got a "wet" vagina) during intercourse or sexual
activities? |
1. No sexual activity |
| 2. Extremely difficult, or impossible |
| 3. Very difficult |
| 4. Difficult |
| 5. Slightly difficult |
| 6. Not at all difficult |
| Question # 9 – In the last four weeks,
how often you kept vaginal lubrication (got a "wet" vagina)
until the end of sexual activity or intercourse? |
1. No sexual activity |
| 2. Almost always, or always |
| 3. Most of the time (more than half of the
time) |
| 4. Sometimes (about half of the time) |
| 5. A few times (less than half the time) |
| 6. Almost never, or never |
| Question # 10 – In the last four weeks,
which was your difficulty in maintaining vaginal lubrication
(stay with a "wet" vagina) until the end of the sexual activity
or intercourse? |
1. No sexual activity |
| 2. Extremely difficult, or impossible |
| 3. Very difficult |
| 4. Difficult |
| 5. Slightly difficult |
| 6. Not at all difficult |
|
Domain: orgasm
|
| Question # 11 – In the last four weeks,
when you had sexual stimulation or practiced intercourse, how
often you reached orgasm ("sexual climax")? |
1. No sexual activity |
| 2. Almost always, or always |
| 3. Most of the time (more than half of the
time) |
| 4. Sometimes (about half of the time) |
| 5. A few times (less than half the time) |
| 6. Almost never, or never |
| Question # 12 – In the last four weeks,
when you had sexual stimulation or practiced intercourse, which
was your difficulty in reaching orgasm (sexual climax)? |
1. No sexual activity |
| 2. Extremely difficult, or impossible |
| 3. Very difficult |
| 4. Difficult |
| 5. Slightly difficult |
| 6. Not at all difficult |
| Question # 13 – In the past 4 weeks,
how satisfied were you with your ability to reach orgasm (sexual
climax) during sexual activity or intercourse? |
1. No sexual activity |
| 2. Very satisfied |
| 3. Moderately satisfied |
| 4. Almost equally satisfied and dissatisfied |
| 5. Moderately dissatisfied |
| 6. Very dissatisfied |
|
Domain: sexual satisfaction
|
| Question # 14 – In the past 4 weeks,
how satisfied have you been with the emotional closeness between
you and your partner during sexual activity? |
1. No sexual activity |
| 2. Very satisfied |
| 3. Moderately satisfied |
| 4. Almost equally satisfied and dissatisfied |
| 5. Moderately dissatisfied |
| 6. Very dissatisfied |
| Question # 15 – In the past 4 weeks,
how satisfied have you been with sexual relationship between you
and your partner? |
1. No sexual activity |
| 2. Very satisfied |
| 3. Moderately satisfied |
| 4. Almost equally satisfied and dissatisfied |
| 5. Moderately dissatisfied |
| 6. Very dissatisfied |
| Question # 16 – In the past 4 weeks,
how satisfied have you been with your sexual life in
general? |
1. No sexual activity |
| 2. Very satisfied |
| 3. Moderately satisfied |
| 4. Almost equally satisfied and dissatisfied |
| 5. Moderately dissatisfied |
| 6. Very dissatisfied |
|
Domain: pain
|
| Question # 17 – In the last four weeks,
how often you felt discomfort or pain during vaginal
penetration? |
1. No sexual activity |
| 2. Almost always, or always |
| 3. Most of the time (more than half of the
time) |
| 4. Sometimes (about half of the time) |
| 5. A few times (less than half the time) |
| 6. Almost never, or never |
| Question # 18 – In the last four weeks,
how often you feel discomfort or pain following vaginal
penetration? |
1. No sexual activity |
| 2. Almost always, or always |
| 3. Most of the time (more than half of the
time) |
| 4. Sometimes (about half of the time) |
| 5. A few times (less than half the time) |
| 6. Almost never, or never |
| Question 19 – In the past 4 weeks, how
would you rate your level of discomfort or pain during or
following vaginal penetration? |
1. No sexual activity |
| 2. Very high |
| 3. High |
| 4. Moderate |
| 5. Low |
| 6. Very low, or absolutely absent |
