Sex Therapy Assessment Questionnaire

Sex Therapy Assessment Questionnaire

Sex Therapy Assessment Questionnaire Directions: Sexual problems in marriage can be complex and multi-faceted. This survey will help us assess the nature of your problem and more quickly focus therapy to your needs. Your responses will be held in confidence and only shared with your spouse with your permission. Please answer questions by checking the box the most fits your current feelings and experiences.

Name

Age

Years married?

Previously married?

Typical frequency of sex?

Strongly Agree Agree Neutral Disagree

Strongly Disagree

1. I find thoughts about sex with my spouse pleasant. 0 1 2 3 4

2. When my spouse asks to have sex I readily agree. 0 1 2 3 4

3. When I think about sex I have unpleasant memories. 4 3 2 1 0

4. Sex disgusts me. 4 3 2 1 0

5. Sex feels like a chore most of the time. 4 3 2 1 0

6. It is easy for me to become aroused. 0 1 2 3 4

7. I am usually able to stay aroused throughout sex. 0 1 2 3 4

8. I am often distracted by other thoughts during sex. 4 3 2 1 0

9. Our sexual activity is rarely rushed. 0 1 2 3 4

10 Planning time to have sex seems undesirable to me. 4 3 2 1 0

11. I regularly satisfy my spouse’s sexual desires. 0 1 2 3 4

12. My spouse regularly satisfies my sexual desires. 0 1 2 3 4

13. I wish my spouse would be more adventurous in bed. 4 3 2 1 0

14. I feel pressured to try new things during sex. 4 3 2 1 0

15. We both usually orgasm during sex. 0 1 2 3 4

16. My spouse takes a long time to orgasm. 4 3 2 1 0

17. I take too long to orgasm. 4 3 2 1 0

18. I am able to orgasm alone but not with my spouse. 4 3 2 1 0

Alexandra Slater

37

15 No

©Philip G. Monroe, PsyD, 2009 | Sex Therapy Assessment Quest