1. Instructions for Survey

Hello,
 
When you fill out this survey, the answers are directly written into an HIPAA compliant, encrypted computer, and not stored anywhere else. This is the highest degree of privacy in medical record keeping. All personal information will be kept confidential.
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Female Sexual Distress Scale
 
Below is a list of feelings and problems that women sometimes have concerning their sexuality.

Please read each item carefully, and click the circle that best describes HOW
OFTEN THAT PROBLEM HAS BOTHERED YOU OR CAUSED YOU DISTRESS DURING THE PAST 30 DAYS INCLUDING TODAY.

Click only one number for each item, and take care not to
skip any items. If you change your mind, you can change the answer before submit
Save

* 1. How often did you feel ...

  Never Rarely Occasionally Frequently Always
Distressed about your sex life?
Unhappy about your sexual relationship?
Guilty about sexual difficulties?
Frustrated by your sexual problems?
Stressed about sex?
Inferior because of sexual problems?
Worried about sex?
Sexually inadequate?
Regrets about your sexuality?
Embarrassed about sexual problems?
Dissatisfied with your sex life?
Angry about your sex life?
Bothered by low sexual desire?

* 4. Your year of birth (written in 4 digits, like 1960 or 2005)

* 5. Contact info:

* 6. Do you leak urine (even small drops), wet yourself, or wet your pads or undergarments...

  None of the time Rarely Once in awhile Often Most of the time All of the time
1. When you cough or sneeze?
2. When you bend down or lift something up?
3. When you walk quickly, jog, or exercise?
4. While you are undressing in order to use the toilet?
5. Do you get such a strong and uncomfortable need to urinate that you leak urine (even small drops) or wet  yourself before reaching the toilet?
6. Do you have to rush to the bathroom because you get a sudden strong need to urinate?

* 7. Are you presently a subject in any clinical research (other than your present application for this study)?

* 8. If you are in a sexual relationship now, for how many years have you been together?

* 9. Are you able to travel to Washington DC for 3 study visits in a 12-week period?

* 10. Have you previously had satisfying orgasms?

* 11. Have you previously been treated by a physician for problems with orgasm?

* 12. Please list all prescription medications that you take. If you take no prescriptions medications, just write "none."

* 13. How many drinks of alcohol to you have per week?

* 14. Are your periods regular?

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Female Sexual Function Index (FSFI)


INSTRUCTIONS: These questions ask about your sexual feelings and responses during the past 4 weeks. 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.

Sexual stimulation includes situations like foreplay with a partner, self-stimulation (masturbation), or sexual fantasy.

CHECK ONLY ONE BOX PER QUESTION

* 15. Over the past 4 weeks, how often did you feel sexual desire or interest?

* 16.
Over the past 4 weeks, how would your rate your level (degree) of sexual desire or interest?

Sexual arousal is a feeling that includes both physical and mental aspects of sexual excitement. It may include feelings of warmth or tingling in the genitals, lubrication (wetness), or muscle contractions.

* 17. Over the past 4 weeks, how often did you feel sexually aroused ("turned on") during sexual activity or intercourse?

* 18. Over the past 4 weeks, how would you rate your level of sexual arousal ("turn on") during sexual activity or intercourse?

* 19. Over the past 4 weeks, how confident were you about becoming sexually aroused during sexual activity or intercourse?

* 20. Over the past 4 weeks, how often have you been satisfied with your arousal (excitement) during sexual activity or intercourse?

* 21. Over the past 4 weeks, how often did you become lubricated ("wet") during sexual activity or intercourse?

* 22. Over the past 4 weeks, how difficult was it to become lubricated ("wet") during sexual activity or intercourse?

* 23. During the past 4 weeks, how often did you maintain your lubrication ("wetness") until completion of sexual activity or intercourse?

* 24. Over the past 4 weeks, how difficult was it to maintain your lubrication ("wetness") until completion of sexual activity or intercourse?

* 25. Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm (climax)?

* 26. Over the past 4 weeks, when you had sexual stimulation or intercourse, how difficult was it for you to reach orgasm (climax)?

* 27. Over the past 4 weeks, how satisfied were you with your ability to reach orgasm (climax) during sexual activity or intercourse?

* 28. Over the past 4 weeks, how satisfied have you been with the amount of emotional closeness during sexual activity between you and your partner?

* 29. Over the past 4 weeks, how satisfied have you been with your sexual relationship with your partner?

* 30. Over the past 4 weeks, how satisfied have you been with your overall sexual life?

* 31. During the past 4 weeks, how often did you experience discomfort or pain during vaginal penetration?

* 32. During the past 4 weeks, how often did you experience discomfort or pain following vaginal penetration?

* 33. 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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100% of survey complete.

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