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: