Intimacy and Sexual Challenges Faced by Cancer Patients and Their Partners

Please Take A Moment To Read Before Beginning.

Please answer as many questions as you like. All questions are optional. All stories are welcome but the focus is on cancer's impact on sexuality and intimacy. It can be a brief mention: "I have no sex life." or "My partner helped make me feel comfortable again." or "It hurts."

Two things to keep in mind for questions 8 and 9:

~Include as much detail as you are comfortable sharing regarding issues surrounding intimacy and sexuality.

~Write candidly, as if you were speaking to a friend. No worries about grammar or spelling, or for that matter, language.

The stories are vitally important to the success of this project. The more information that we, all of us affected by these issues, are willing to share, the better opportunity we will have to reach into the community to those who are embarrassed, afraid or simply to too shy to discuss with anyone.

Include only the contact information you wish to share. If your story requires more space than allotted, please email me. This information will be used as research for a book. No identifying information will be included but direct quotes from your story may be used. If you wish to be identified, include your contact information here **and** email me to let me know. Thank you for taking the time to share your story for this project.

All email may be sent to sharethosemoments@gmail.com.

Again, my most sincere thanks for taking the time to fill out this survey.

* 1. Are you male or female?

* 2. Are you the patient or the partner of a patient?

* 3. What type of cancer(s) were you diagnosed with and how was it treated? Check all that apply.  (Please expand in commnets regarding removal of ovaries, fallopian tubes, cervix-too many combinations to include all in answers!)

* 4. What is your age?

* 5. Do you consider yourself to be heterosexual, homosexual, bisexual or something else?

* 6. Which of the following best describes your current relationship status?

* 7. What is your current health status?

* 8. Please share your story, primarily as it relates to intimacy and/or sexual issues.

Note: Box can be expanded but dragging lower right corner to make wider and longer for easier typing. It might be easier to cut and paste from a word doc.

* 9. Want to add something else you feel might be helpful? For example, did you ever discuss issues regarding intimacy or sexuality with a doctor or other health provider?

Note: Box can be expanded but dragging lower right corner to make wider and longer for easier typing. It might be easier to cut and paste from a word doc.

* 10.

10. Contact Information (You can include all, some or no answers in this area. General location information would be of tremendous benefit when analyzing responses. "Small Town" or "rural" or "big city" can be put in City/Town box. For anyone outside of the USA, I'd love if you'd consider including your country)

NOTE:  If you would like to receive updates regarding progress, please sign up for email notifications or follow website at sharethosemoments.wordpress.com

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