1. During the last month how often have you had sexual feelings or fantasies?

2. In the past 4 weeks when you have attempted intercourse, how successful have you been?

3. When I have sex with my partner I get turned on:

4. Over the past 4 weeks, how would you rate your orgasms?

5. During the last month how often were you in the mood to have a sexual encounter with your partner?

6. When I have sex with my partner:

7. Over the past 4 weeks when I had sex (intercourse or other physical sexual stimulation with a hand, mouth or vibrator) I had orgasms:

8. When I start fantasizing about sex, I get wet, tingly and aroused.

9. How would you describe your feelings during intercourse?

10. Over the past 4 weeks how difficult was it to reach orgasm when you had sex (intercourse or other physical sexual stimulation with a hand, mouth or vibrator):

11. Rate the degree of pain, if any, you have had with intercourse during the past 4 weeks.

12. During the last month when your partner approached you for a sexual encounter, how easy or difficult was it to respond positively?

13. Over the past 4 weeks how often did you experience pain with vaginal intercourse?

14. Over the past 4 weeks how difficult was it to reach orgasm when you self-stimulated (with a hand or vibrator):

15. During the last month, which would you say best describes your behavior?

16. When I have sex my arousal can be described as:

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