Please enable JavaScript in your browser to complete this form. These questions ask about your sexual feelings and responses during the past 6 months. Please answer the following questions as honestly and clearly as possible. Your responses will be kept completely confidential. In answering these questions, the following definitions apply: Sexual activity can include caressing, foreplay, masturbation and vaginal intercourse. Sexual intercourse is defined as penile penetration (entry) of the vagina (female private part). Sexual stimulation includes situations like foreplay with a partner, self-stimulation (masturbation), or sexual fantasy. Desie – Interest in any kind of sexual act. Sexual Arousal - feeling that includes both physical and mental aspects of sexual excitement which includes feelings of warmth or tingling in the genitals, lubrication (wetness), or muscle contractions. Orgasm – A rush of sexual excitement; specifically, the climax or peak of sexual pleasure, which occurs during sexual activity. Name *Email *Mobile Number *AgeSex*Marital status and duration *Describe your experience in words 1 Over the past 6 months, how often did you feel sexual desire or interest?Almost always or alwaysMost times (in majority of the cases)Sometimes (nearly half of the cases)A few times (in very few cases or only once or twice)Almost never or never2 Over the past 6 months, how would you rate your level (degree) of sexual desire or interest?High (Interested in sex and waits for it)Normal (Sometimes you also initiate sex)Low (only have sex when partner initiates, doesn’t deny)Very low (Doesn’t feel like having sex but do it for the partner)No desire at all (Resists / avoids having sex even if the partner wishes)3 Over the past 6 months, do you feel that your desire has been affected because of the sexual problem of your partner (if present any)? YesNo4 Over the past 6 months, how often did you feel sexually aroused (‘turned on’) during sexual activity or intercourse?No sexual activity or avoided sexual activityAlmost always or alwaysMost times (more than half of the cases)Sometimes (less than of the cases) Almost never or never5 Over the past 6 months, how often did you become lubricated (‘wet’) during sexual activity or intercourse?No sexual activity or avoided sexual activityAlmost always or alwaysMost times (more than half of the cases)Sometimes (less than half of the cases) Almost never or never6 Over the past 6 months, how difficult was it to become lubricated (‘wet’) during sexual activity or intercourse?No sexual activity or avoided sexual activityExtremely difficult or impossible (Had very few such incidences)Difficult (have to try harder and longer for it)Slightly difficult (Sometimes it happens and Sometimes not)Not difficult (happens almost all the time)7 Over the past 6 months, how difficult was it to maintain your lubrication (‘wetness’) until completion of sexual activity or intercourse?No sexual activity or avoided sexual activityAlmost always or alwaysMost times (more than half of the cases)Sometimes (less than half of the cases) Almost never or never8 Over the past 6 months, during sexual stimulation or intercourse, how often did you reach orgasm (climax)?No sexual activity or avoided sexual activityAlmost always or alwaysMost times (more than half of the cases)Sometimes (less than half of the cases) or not sure if ever had such experienceNever experienced9 Over the past 6 months, during sexual stimulation or intercourse, how difficult was it for you to reach orgasm (climax)?No sexual activity or avoided sexual activityExtremely difficult or impossible (Had very few such incidences)Difficult (have to try harder and longer for it)Slightly difficult (Sometimes it happens and sometimes not)Not difficult (happens almost all the time)10 Over the past 6 months during sexual activity or intercourse, how often did you experience discomfort or pain during vaginal penetration?Did not attempt intercourse or avoided sexual activityAlmost always or alwaysMost times (more than half of the cases)Sometimes (less than half of the cases) Almost never or never11 Over the past 6 months during sexual activity or intercourse, how often did you experience tightness in your vagina causing no vaginal penetration?Did not attempt intercourse or avoided sexual activityAlmost always or alwaysMost times (more than half of the cases)Sometimes (less than half of the cases) Almost never or never12 Over the past 6 months, how would you rate your level (degree) of discomfort or pain during or following vaginal penetration?Did not attempt intercourse or avoided sexual activityHighModerateLowVery low or none at all13 Over the past 6 months, how satisfied have you been with the emotional closeness during sexual activity between you and your partner?No sexual activity or avoided sexual activityVery satisfiedAbout equally satisfied and dissatisfiedModerately dissatisfiedVery dissatisfied or no emotional bond at all14 Over the past 6 months, how satisfied have you been with your sexual relationship with your partner?No sexual activity or avoided sexual activityVery dissatisfiedModerately dissatisfiedAbout equally satisfied and dissatisfiedVery satisfied15 Over the past 6 months, how satisfied have you been with your overall sexual life?No sexual activity or avoided sexual activityVery satisfiedAbout equally satisfied and dissatisfiedModerately dissatisfiedVery dissatisfiedNameSubmit
