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Female Sexual Function Questionnaire

Home > Female Sexual Function Questionnaire
MM slash DD slash YYYY
(male Clinic For Him Patient name, if applicable)
N/A(Required)
N/A(Required)

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.
MM slash DD slash YYYY
eg. 120/80

“If you cannot provide your blood pressure reading from your most recent doctor appointment, please visit your doctor to obtain a current blood pressure reading or use a self-service blood pressure reading machine at your local drug store like CVS or Walgreens. Email your blood pressure reading to care@clinicforhim.com with your name and phone number.

CHECK ONLY ONE BOX PER QUESTION.

Sexual desire or interest is a feeling that includes wanting to have a sexual experience, feeling receptive to a partner’s sexual initiation, and thinking or fantasizing about having sex.

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

1. Over the past 4 weeks, how often did you feel sexual desire or interest?(Required)

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

2. Over the past 4 weeks, how would you 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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

17. Over the past 4 weeks, how often did you experience discomfort or pain during vaginal penetration?

17. Over the past 4 weeks, how often did you experience discomfort or pain during vaginal penetration?

18. Over the past 4 weeks, how often did you experience discomfort or pain following vaginal penetration?

18. Over the past 4 weeks, how often did you experience discomfort or pain following vaginal penetration?

19. Over the past 4 weeks, how would you rate your level (degree) of discomfort or pain during or following vaginal penetration?

19. 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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