Questionnaire

S. These Final Questions look at Your Sexual life Over Time.

1. In my life, my sexual satisfaction has been/was at its peak
    between ages____________ and _______________years.

2. Looking back, I have at some time had a problem in my sexual life due to the following
   (check all that apply):

Inadequate sex education
Inadequate knowledge of my body and sexual feelings
Inadequate information about the how-to of sex
Inadequate knowledge of the physical consequences of sex
Inadequate knowledge of the emotional consequences of sex
Inadequate information about birth control
Inadequate availability of birth control
None of the above

 

3. Looking back over my entire life, I regret the following about my sexual life:
   (check all that apply):

I got into sex when I was too young.
I had sex with partners I should have turned down.
I did not have sex with someone with whom I wish I had
I had sex without protection against pregnancy
I had sex without protection against disease
I was too often not assertive enough about my needs
I was too inhibited
I was celibate for too long
I did not take more time to be celibate
I married the wrong person because of sex
I stayed too long in relationship with the wrong partner
Other (please specify)
None of the above

 

4. Looking back, the most significant sources for me of sex information in each of the two following  
   categories have been:
   (check answers in each column):

	Helpful or Useful	Misleading or Harmful
Same age friend(s)
Older friend(s)
Sexual partner(s)
Parent(s)
Sex education book(s)
Fiction books (novels, romances, etc.)
Media (TV, movies, magazines, etc.)
Course(s) in school or college
Erotic or pornographic material(s)
Religious teachings
Relative(s)
Health practitioner(s)/therapist(s)
Other (PLEASE SPECIFY):

 

5. Looking back, I believe the information I got from the parent(s) or parent figure(s) who raised me
    prepared me to have a healthy and fulfilling sex life.

 

Strongly Disagree                               Strongly Agree                                 N/A
1	2	3	4	5	6	7	0

 

 

 

6. Compared to how I was during the year after I became sexually active for the first time ever with a
    partner (in a genital way, whether or not intercourse was included), I have changed in sex in the
    following ways:(check the column that best indicates how you have changed).
    If your first-ever genital contact with a partner occurred less than a year ago, circle 0 and skip to 
    question 7. 

0

I now:

Desire sex	More	Less	Same
Get aroused easily
Express my sexual needs
Am inhibited
Have erotic thoughts
Orgasm easily
Initiate
Am sexually satisfied
Have fun
Engage in casual sex
Am comfortable with sex
Focus on my partner's satisfaction
Focus on my own satisfaction

 

7. On the whole, I have been satisfied with my sexual life.

 

Strongly Disagree                                Strongly Agree                                N/A
1	2	3	4	5	6	7	0

 

 

Thank You!
This is the end of the Questionnaire.

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The questionnaire is here for VIEWING ONLY.
Please DO NOT send your answers to me.

Copyright 1998, Carol Ellison, Ph.D.