Sexual Wellness QuestionnaireSection IGeneral Sexual HealthDo you consider your sex life to be satisfying? Do you consider your sex life to be satisfying?YesNoSometimesHave you noticed a change in your sexual function over time? Have you noticed a change in your sexual function over time?YesNoAre you experiencing distress or frustration related to your sexual function? Are you experiencing distress or frustration related to your sexual function?YesNoSection IISexual Desire (Libido)How often do you feel sexual desire? How often do you feel sexual desire?NeverRarelySometimesOftenHas there been a decrease in your sexual desire compared to the past? Has there been a decrease in your sexual desire compared to the past? YesNoDo you feel uninterested in sexual activity, even when in a comfortable setting? Do you feel uninterested in sexual activity, even when in a comfortable setting? YesNoDo you find yourself avoiding intimacy due to a lack of interest? Do you find yourself avoiding intimacy due to a lack of interest? YesNoSection IIIArousal & Lubrication (For people with vulvas & those experiencing vaginal penetration)Do you experience difficulty becoming physically aroused during sexual activity? Do you experience difficulty becoming physically aroused during sexual activity? YesNoDo you experience vaginal dryness, making sex uncomfortable or painful? Do you experience vaginal dryness, making sex uncomfortable or painful? YesNoDo you feel emotionally aroused but struggle with physical responses? Do you feel emotionally aroused but struggle with physical responses? YesNoSection IVErectile Function (For people with penises)Do you have difficulty achieving an erection when sexually aroused? Do you have difficulty achieving an erection when sexually aroused? YesNoDo you have difficulty maintaining an erection during sexual activity? Do you have difficulty maintaining an erection during sexual activity? YesNoDo you feel anxious about your ability to get or maintain an erection? Do you feel anxious about your ability to get or maintain an erection? YesNoSection VOrgasm & PleasureDo you experience difficulty reaching orgasm? Do you experience difficulty reaching orgasm? YesNoDo you find that orgasm takes significantly longer or feels less intense than before? Do you find that orgasm takes significantly longer or feels less intense than before? YesNoHave you experienced pain, discomfort, or unusual sensations during orgasm? Have you experienced pain, discomfort, or unusual sensations during orgasm? YesNoDo you feel dissatisfied with your ability to reach climax? Do you feel dissatisfied with your ability to reach climax? YesNoSection VIPain During Sexual ActivityDo you experience pain during sexual intercourse? Do you experience pain during sexual intercourse?(Yes / No)If yes, is the pain: (Mild / Moderate / Severe)Do you experience pain only with penetration, or at other times as well? Do you experience pain only with penetration, or at other times as well?Do you have a history of pelvic pain, genital pain, or medical conditions affecting sexual function? Do you have a history of pelvic pain, genital pain, or medical conditions affecting sexual function?Section VIIRelationship & CommunicationDo you feel comfortable communicating your sexual needs and desires with your partner(s)? Do you feel comfortable communicating your sexual needs and desires with your partner(s)? YesNoHas there been a change in your relationship that may have affected your sexual function? Has there been a change in your relationship that may have affected your sexual function? YesNoSection VIIIMedical & Lifestyle FactorsDo you have any medical conditions that might impact sexual function? Do you have any medical conditions that might impact sexual function? e.g., diabetes, hypertension, hormonal imbalances, neurological disordersYesNoAre you currently taking medications that may affect sexual function? Are you currently taking medications that may affect sexual function?e.g., antidepressants, blood pressure meds, hormonal therapyYesNoDo you smoke, consume alcohol, or use recreational drugs that could impact sexual health? Do you smoke, consume alcohol, or use recreational drugs that could impact sexual health? YesNoDo you feel fatigue or experience low energy levels that impact sexual interest? Do you feel fatigue or experience low energy levels that impact sexual interest? YesNoSection IXOverall Sexual Well-beingHow important is sexual function to your overall quality of life? How important is sexual function to your overall quality of life? Not at allSomewhatVery importantAre you open to seeking medical or psychological support to address sexual concerns? Are you open to seeking medical or psychological support to address sexual concerns? YesNoWould you like educational resources, therapy, or medical evaluation to improve your sexual health? Would you like educational resources, therapy, or medical evaluation to improve your sexual health? YesNoIs there anything else you would like us to know about your health or concerns? Is there anything else you would like us to know about your health or concerns?
Do you consider your sex life to be satisfying?
Have you noticed a change in your sexual function over time?
Are you experiencing distress or frustration related to your sexual function?
How often do you feel sexual desire?
Has there been a decrease in your sexual desire compared to the past?
Do you feel uninterested in sexual activity, even when in a comfortable setting?
Do you find yourself avoiding intimacy due to a lack of interest?
Do you experience difficulty becoming physically aroused during sexual activity?
Do you experience vaginal dryness, making sex uncomfortable or painful?
Do you feel emotionally aroused but struggle with physical responses?
Do you have difficulty achieving an erection when sexually aroused?
Do you have difficulty maintaining an erection during sexual activity?
Do you feel anxious about your ability to get or maintain an erection?
Do you experience difficulty reaching orgasm?
Do you find that orgasm takes significantly longer or feels less intense than before?
Have you experienced pain, discomfort, or unusual sensations during orgasm?
Do you feel dissatisfied with your ability to reach climax?
Do you experience pain during sexual intercourse?
(Yes / No)If yes, is the pain: (Mild / Moderate / Severe)
Do you experience pain only with penetration, or at other times as well?
Do you have a history of pelvic pain, genital pain, or medical conditions affecting sexual function?
Do you feel comfortable communicating your sexual needs and desires with your partner(s)?
Has there been a change in your relationship that may have affected your sexual function?
Do you have any medical conditions that might impact sexual function?
e.g., diabetes, hypertension, hormonal imbalances, neurological disorders
Are you currently taking medications that may affect sexual function?
e.g., antidepressants, blood pressure meds, hormonal therapy
Do you smoke, consume alcohol, or use recreational drugs that could impact sexual health?
Do you feel fatigue or experience low energy levels that impact sexual interest?
How important is sexual function to your overall quality of life?
Are you open to seeking medical or psychological support to address sexual concerns?
Would you like educational resources, therapy, or medical evaluation to improve your sexual health?
Is there anything else you would like us to know about your health or concerns?
