| Symptoms
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No sexual
activity |
Almost never
/Never |
A few times |
Sometimes |
Most times |
Almost always
/Always |
| Over the past 4 weeks, how often did you feel sexual desire or interest? |
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| Over the past 4 weeks, how often did you feel sexually aroused ("turned on") during sexual activity or intercourse? |
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| Over the past 4 weeks, how often have you been satisfied with your arousal (excitement) during sexual activity or intercourse? |
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| Over the past 4 weeks, how often did you become lubricated ("wet") during sexual activity or intercourse? |
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| Over the past 4 weeks, how often did you maintain your lubrication ("wetness") until completion of sexual activity or intercourse? |
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| Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm (climax)? |
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| Over the past 4 weeks, how often did you experience discomfort or pain during vaginal penetration? |
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| Over the past 4 weeks, how often did you experience discomfort or pain following
vaginal penetration? |
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| Symptoms
|
No Activity |
Very low /None |
Low |
Moderate |
High |
Very High |
| Over the past 4 weeks, how would you rate your level (degree) of sexual desire or interest? |
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| Over the past 4 weeks, how would you rate your level of sexual arousal ("turn on") during sexual activity or intercourse? |
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| Over the past 4 weeks, how confident were you about becoming sexually aroused during sexual activity or intercourse? |
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| Over the past 4 weeks, how would you rate your level (degree) of discomfort or pain during or following vaginal penetration? |
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| Symptoms
|
No Activity |
Extremely difficult
/Impossible |
Very difficult |
Difficult |
Slightly difficult |
Not difficult |
| Over the past 4 weeks, how difficult was it to become lubricated ("wet") during sexual activity or intercourse? |
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| Over the past 4 weeks, how difficult was it to maintain your lubrication ("wetness") until completion of sexual activity or intercourse? |
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| Over the past 4 weeks, when you had sexual stimulation or intercourse, how difficult was it for you to reach orgasm (climax)? |
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| Symptoms
|
No Activity |
Very dissatisfied |
Moderately Dissatisfied |
Equally Satisfied
Dissatisfied |
Moderately Satisfied |
Very Satisfied |
| Over the past 4 weeks, how satisfied were you with your ability to reach orgasm (climax) during sexual activity or intercourse? |
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| Over the past 4 weeks, how satisfied have you been with the amount of emotional closeness during sexual activity between you and your partner? |
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| Over the past 4 weeks, how satisfied have you been with your sexual relationship with your partner? |
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| Over the past 4 weeks, how satisfied have you been with your overall sexual life? |
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