| 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 |