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. 2021 Jun 18;10(12):2686. doi: 10.3390/jcm10122686
General Questions
A Age: 19, 20, 21, 22, 23, 24 or more
B Marital status:
Single; Married; Widow; Separated; Divorced; Other
C Sexual orientation:
Bisexual; Heterosexual; Homosexual; Other
D Contraceptive method used:
1 condom, 2 oral contraceptive, 3 none, 4 withdrawal, 5 IUD, 6 vaginal ring, 7 patches,
8 various, 9 abstinence.
E Do you have a stable partner? Yes No
The following questions refer to the last 3 months.
General sexuality items
1. Suppose the following is a scale of SEX DRIVE.
Where would you place yourself on this scale?
Low 1 2 3 4 5 6 7 High.
Masturbation items
2. Have you ever masturbated? Yes No
3. How often?
5–7 times/week
3–4 times/week
1–2 times/week
2–3 times/month
Once a month
Less than once a month
4. Suppose the following is a sexual AROUSAL scale.
Where would you place yourself on this scale when engaging in this type of sexual activity?
Low 1 2 3 4 5 6 7 High.
5. How satisfied are you with this type of sexual activity?
Dissatisfied 1 2 3 4 5 6 7 Satisfied
6. How often do you have orgasms with this type of sexual activity?
Never 1 2 3 4 5 6 7 Always
Non-vaginal sexual relations items
7. How often do you have sexual relations with your partner, excluding sexual intercourse? (Including manual stimulation, oral stimulation, etc.)?
5–7 times/week
3–4 times/week
1–2 times/week
2–3 times/month
Once a month
Never
8. Suppose the following is a scale of sexual AROUSAL.
Where would you place yourself when engaging in this type of sexual activity?
Low 1 2 3 4 5 6 7 High
9. How satisfied are you with this type of sexual activity?
Dissatisfied 1 2 3 4 5 6 7 Satisfied
10. How often do you have orgasms during this type of sexual activity?
Never 1 2 3 4 5 6 7 Always
Vaginal intercourse items
11. How often do you have vaginal intercourse with your partner?
5–7 times/week
3–4 times/week
1–2 times/week
2–3 times/month
Once a month
Never
12. Suppose the following is a scale of sexual AROUSAL.
Where would you place yourself when engaging in this type of sexual activity?
Low 1 2 3 4 5 6 7 High
13. How satisfied are you with this type of sexual activity?
Dissatisfied 1 2 3 4 5 6 7 Satisfied
14. How often do you have orgasms while engaging in this type of sexual activity?
Never 1 2 3 4 5 6 7 Always
Orgasm items
15. How do your orgasms usually take place?
During vaginal intercourse
Through fantasies and daydreams
Through stimulation by my partner
Through self-stimulation
Through several of the above methods
I do not have orgasms
By other methods
Items concerning changes in sex life
16. What aspects of your sex life would you change?
Increase the frequency of sexual relations
Have the same sex drive as my partner
Improve my ability to have orgasms
Eliminate fear of pregnancy
Increase my partner’s ability to delay orgasm.
Increased variety (time of day, position, etc.)
None
Other__Which?
Sexual partner items
17. Regarding your partner, indicate the things that you find unpleasant in your sexual relations:
He shows little enthusiasm
Penis too small
He has difficulty maintaining an erection
Too slow to ejaculate
He wants to withdraw his penis too quickly
He wants intercourse too often
Penis too large
He has difficulty achieving erection
He cannot always ejaculate
He ejaculates quickly
He wants to sleep after intercourse
He rarely wants intercourse
He is too sexually demanding
Is very unaffectionate during intercourse
He wants to do things that do not seem natural to me
Cares little about my sexual satisfaction
He does not stimulate or caress me enough before intercourse
18. Do you refuse to have intimate sexual relations when your partner wants you to?
Very often
Frequently
Sometimes
Rarely
Never
19. If you refuse to have sexual relations with your partner, how does your partner react?
Insistent or irritable
Annoyed, but not for very long
Considerate and pleasant
20. How do you feel when you are naked in front of your partner?
UncomforTable 1 2 3 4 5 6 7 Comfortable
21. How satisfied do you think your partner is with your sexual relations?
Dissatisfied 1 2 3 4 5 6 7 Very satisfied
22. With regard to yourself, what things do you think your partner finds unpleasant in your sexual relations?
I show little enthusiasm
Vagina too small
I never have an orgasm
I have an orgasm too quickly
I want intercourse too often
I am not very affectionate during intercourse
I like to do unnatural things
Vagina too big
I am too slow to have an orgasm
I want to sleep after having an orgasm
I rarely want intercourse
I do not stimulate and caress my partner sufficiently before intercourse