Sexual Health Questionnaire
1. How often are you and your partner sexual?
• 1-3 times per day?
• 1-3 times per week?
• 1-3 times per month?
• 1-3 times per year?
2. When you are sexual with your partner, how satisfying is the experience?
Lousy ` OK Great
1 2 3 4 5
3. Are there aspects of your sexual life that are compulsive, secretive, or addictive in nature? Yes No Unsure
4. Do you struggle with any type of sexual functioning issues such as difficulty having an orgasm, becoming lubricated (wet), pain with sex, rapid or delayed ejaculation, having and/or keeping an erection?
Yes No Sometimes
5. The amount and accuracy of my sex education was:
Poor OK Great
1 2 3 4 5
6. Do you think about exploring alternative areas of sexuality such as open relationships, swinging, Polyamory, BDSM or other types of kink?
Yes No Maybe Unsure
7. Do you feel guilt, shame, or embarrassment about your sexual desires or activities?
Yes No Maybe
8. Have you had sexual experiences that you consider to be abusive, manipulative, or negative in some way?
Yes No Maybe
Each of us is truly the best expert on whether or not we need help when it comes to sexual matters. This is an area where most of us have been given little information or permission to talk openly and ask questions. That is where a therapist who specializes in sexuality can help. This questionnaire is designed to help illustrate areas that may be lacking or problematic within your sexual life. When you are ready to improve this wonderful area of your life, please feel free to contact me.