| 1. Over the past 4 weeks, how often did you feel sexual desire or interest? |
|
Almost always or always |
|
Most days |
|
At least once per week |
|
Only once or twice |
|
Almost never or never |
|
| 2. Over the past 4 weeks, how would you rate your level (degree) of sexual desire or interest? |
|
Very high |
|
High |
|
Moderate |
|
Low |
|
Very low or none at all |
|
| 3. Over the past 4 weeks, how often did you initiate sexual activity with your partner? |
|
Almost always or always |
|
Most times (more than half the time) |
|
Sometimes (about half the time) |
|
A few times (less than half the time) |
|
Almost never or never |
|
| 4. Over the past 4 weeks, how would you rate your level of sexual arousal or erection during sexual activity or intercourse? |
|
Very high/strong |
|
High/strong |
|
Satisfactory |
|
Quite low/weak |
|
Very low/weak |
|
No sexual activity |
|
| 5. Over the past 4 weeks, how often have you been satisfied with your sexual arousal or erection during sexual activity or intercourse? |
|
No sexual activity |
|
Almost always or always |
|
Most times (more than half the time) |
|
Sometimes (about half the time) |
|
A few times (less than half the time) |
|
Almost never or never |
|
| 6. Over the past 4 weeks, how difficult was it to become lubricated (female) or develop an erection (male) during sexual activity or intercourse? |
|
No sexual activity |
|
Extremely difficult or impossible |
|
Very difficult |
|
Difficult |
|
Slightly difficult |
|
Not difficult |
|
7. Over the past 4 weeks, how difficult was it to maintain your lubrication or erection until completion of sexual activity or intercourse? |
|
No sexual activity |
|
Extremely difficult or impossible |
|
Very difficult |
|
Difficult |
|
Slightly difficult |
|
Not difficult |
|
8. Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm and/or ejaculate? |
|
No sexual activity |
|
Almost always or always |
|
Most times (more than half the time) |
|
Sometimes (about half the time) |
|
A few times (less than half the time) |
|
Almost never or never |
|
9. Over the past 4 weeks, when you had sexual stimulation or intercourse, how difficult was it for you to reach orgasm and/or ejaculate |
|
No sexual activity |
|
Extremely difficult or impossible |
|
Very difficult |
|
Difficult |
|
Slightly difficult |
|
Not difficult |
|
| 10. How often did you find difficulty in controlling orgasm and as a consequence, reach orgasm/ejaculate prematurely during sexual activity or intercourse? |
|
No sexual activity |
|
Almost always or always |
|
Most times (more than half the time) |
|
Sometimes (about half the time) |
|
A few times (less than half the time) |
|
Almost never or never |
|
11. Over the past 4 weeks, how satisfied have you been with the amount of emotional closeness or intimacy between you and your partner? |
|
Very satisfied |
|
Moderately satisfied |
|
About equally satisfied and dissatisfied |
|
Moderately dissatisfied |
|
Very dissatisfied |
|
12. Over the past 4 weeks, how satisfied have you been with your sexual relationship with your partner? |
|
Very satisfied |
|
Moderately satisfied |
|
About equally satisfied and dissatisfied |
|
Moderately dissatisfied |
|
Very dissatisfied |
|
13. Over the past 4 weeks, how satisfied have you been with your overall sexual life? |
|
Very satisfied |
|
Moderately satisfied |
|
About equally satisfied and dissatisfied |
|
Moderately dissatisfied |
|
Very dissatisfied |
|
14. Over the past 4 weeks, how often did you experience discomfort or pain during intercourse? |
|
Did not attempt intercourse |
|
Almost always or always |
|
Most times (more than half the time) |
|
Sometimes (about half the time) |
|
A few times (less than half the time) |
|
Almost never or never |
|
| 15.Over the past 4 weeks, how would you rate your level of discomfort or pain during or following sex? |
|
Did not attempt intercourse |
|
Very high |
|
High |
|
Moderate |
|
Low |
|
Very low or none at all |