Sex Questionnaire

This Sex Questionnaire is not intended to be a diagnostic tool but instead is meant to give you and I a better idea of the level of sexual intimacy in your relationship.

Answer the questions below to the best of your ability.

Rate your answers as follows:

(1) Sometimes
(2) Often
(3) Never - or I don't know

1. I am able to let go and enjoy sex with my partner most of the time.

1	2	3

2. My mind is often elsewhere when my partner and I have sex.

1	2	3

3. I often agree to have sex out of sense of obligation to my partner.

1	2	3

4. I generally feel satisfied with my sex life.

1	2	3

5. My partner is able to orgasm regularly.

1	2	3

6. I am able to orgasm regularly.

1	2	3

7. I always put my partner’s pleasure ahead of mine.

1	2	3

8. I feel comfortable with my own sexuality and express it freely with my partner

1	2	3

9. I frequently need to convince my partner to have sex with me.

1	2	3

10. My sex life with my partner often feels boring or routine.

1	2	3

11. I often feel worse after sex with my partner than I did before we started.

1	2	3

12. My partner says things about my body that makes me feel self-conscious during sex.

1	2	3

13. I feel safe telling my partner what I want during sex.

1	2	3

14. I am happy with the frequency with which my partner and I have sex.

1	2	3

15. I feel safe discussing my needs about when and how frequently we have sex.

1	2	3

16. I feel satisfied with our sex life.

1	2	3

17. When my partner and I have sex, I often fantisize about some else.

1	2	3

Congratulations on completing this questionnaire. Enter your contact information below and I will contact you within the next day to discuss your results and find out if you would like to schedule an appointment.

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Telephone:
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Dr. Randi Fredricks Ph.D. is a Psychotherapist and licensed as a Marriage Family Therapist MFC 47803. Dr. Fredricks is not licensed with the California Medical
Board or the California Bureau of Naturopathic Medicine. © 2012 Randi Fredricks, Marriage and Family Therapist, Inc. All rights reserved. Serving
San Jose, Sunnyvale, Santa Cruz, Palo Alto, Monte Sereno, Los Gatos, Cupertino, Mountain View, Scotts Valley, Campbell, Willow Glen, and Milpitas CA.