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1: Sex: 2: Martial Status: 3: How Many Years Married: 4: Age: 5: After hearing about the love styles, in my relationship with my spouse (or previous spouse if not remarried): I am probably most often a: 6: What is the most difficult problem in your sexual relationship? 7: Currently, how frequent is sex with your mate? Check those that apply: When my spouse and I make love: 8: We verbalize our care and love for one another. 9: We have satisfying foreplay 10: We have little to no foreplay 11: My eyes are usually closed 12: We kiss one another 13: Most often we each have an orgasm 14: My spouse has an orgasm more often than I do 15: I rarely (or never) have an orgasm 16: We most often snuggle and talk after sex 17: I feel detached and disconnected 18: I feel bored and dissatisfied 19: I am most often happy and satisfied with our sex life. 20: Am self conscious about my body 21: Communicate about what my spouse can do to pleasure me 22: Ask my spouse what feels good to them 23: Do what I can to hurry things along and get it over with 24: Pretend it is better than it really is 25: I Refuse to have sex If True why? 26: My spouse refuses to have sex If True why? 27: My hopes and expectation about sex in my marriage have been fulfilled 28: I would describe affection and non-sexual touch in my marriage as: 29: Sex in my marriage could be more satisfying if: 30: My spouse’s biggest complaint is: 31: On a 1-10 scale (1 is low, 10 is high) I would rate my sexual desire level at: 32: I would rate my spouse’s sexual desire level at: 33: I would rate my overall satisfaction about my sexual relationship at: In reviewing my sexual history: 34: At least one of my parents was open to educating me and talking about sex. 35: Were you promiscuous as a teenager? 36: Did you look at pornography as a teenager? 37: Do you use pornography in private now? 38: Has compulsive masturbation ever been a problem for you? 39: Struggle with homosexual thoughts or tendencies 40: Had a sexual affair? If so, how many? 41: Had a one night stand? If so, how many? 42: Had an emotional affair? If yes, how many? 43: Did you experience sexual trauma of any kind growing up? If so, what? Spiritual Views of Sex 44: Do you have a religious belief? If so, what? 45: How do your religious beliefs affect your view of sex, feelings about sex, sexual problems or practices? 46: Do you ever pray about sex? If so, what do you most often pray about? 47: Over the years, the most important things I have learned to improve my sex life are:
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