1. Age: 23
2. Gender: Female
3. Highest grade of school completed: B.A.
4. Racial/Ethnic background: White
5. Sexual Orientation: Bisexual
6. Have you ever been legally married to a man? No
Are you legally married now? No
7. Have you ever been sexually attracted to a woman/to women? Yes
If yes, at what age were you first attracted? 5
8. Have you ever had sex with a female? Yes
If yes, how old were you when you had your first genital sex with a female? 7
9. How many female sexual partners have you had in all? 14
How many female sexual partners have you had in the last year? 6
Of your female sex partners, how may were also romantic/love relationships? 2
10. Have you ever been sexually attracted to a man/to men? Yes
If yes, at what age were you first attracted? 5
11. Have you ever had sex with a male? Yes
If yes, how old were you when you had your first genital sex with a male? 12
12. How many male sexual partners have you had in all? 44
How many male sexual partners have you had in the last year? 19 (I include people with whom I only have oral sex.)
Of your male sex partners, how may were also romantic/love relationships? 9 (And this is a liberal definition of romantic relationship. Relationships that have lasted more than 6 weeks: 5.)
13. Think of all the sexual attractions you’ve had, whether you had sex with them or not.
Were they to:Both men and women
14. Think of all the sexual attractions you’ve had IN THE LAST YEAR.
Were these attractions to: Both men and women
15. Have you ever had any of the following diseases or conditions? Please check any you have EVER had:
Abnormal Pap Smear
Genital warts (HPV)
Now please check any that are STILL problems: (I’ve been in the clear for just shy of two years.)
16. Have you ever participated in any of these sexual activities with women?
Kissing/Deep kissing
Touching, caressing, and rubbing bodies
Touching genitals
Receiving oral sex
Giving oral sex
Finger(s) in vagina
Finger(s) in rectum
Use of dildos, vibrators, other sex toys
Spanking
Bondage
Other BDSM
Other (Anything I can think of.)
17. Have you ever participated in any of these sexual activities with men?
Kissing/Deep kissing
Touching, caressing, and rubbing bodies
Touching genitals
Receiving oral sex
Giving oral sex
Penis in vagina
Penis in rectum
Finger(s) in vagina
Finger(s) in rectum
Use of dildos, vibrators, other sex toys
Spanking
Bondage
Other BDSM
Other (Anything I can think of.)
18. The following is a list of sexual problems women can have. Please place a check next to each of them that you have ever had on an ongoing basis (more than occasionally):
Pain during vaginal penetration
Trouble lubricating
Sex not pleasurable, even if it is not painful
Feel anxious about sexual performance
Feel guilty about sex
Feel more desire than partner
19. About how often do you have sex with another person? One or more times per week
20. About how often do you masturbate? One or more times a week
21. On average, how often do you think about sex? More than once a day
22. Do you identify with the kink/leather/BDSM community? Yes
23. Do you consider yourself polyamorous (participate in ‘open relationships’)? Yes
24. Where would you put yourself on the following scale? Somewhat “femme”
25. Are you currently in a primary relationship? No
Please answer the following questions only if you are currently in a primary relationship:
(I didn’t answer any, but I left the possibilities up here for ya’ll to see.)
26. How long have you been in your current relationship (in years)?
27. Do you live together? Yes No
28. In the last year, about how often did you and your partner have sex? Select One Once a day or more One or more times per week One or more times per month Less than once a month Never
29. How often do you have sex only because your partner wants it? Select One Rarely/never Occasionally Often Mostly/always
30. When you have sex, how often do you start without feeling sexual desire, but then feel desire later, once you “get into it”? Select One Rarely/never Occasionally Often Mostly/always
31. When you and your partner have sex, do you usually orgasm? Yes No
32. When you and your partner have sex, does your partner usually orgasm? Yes No
33. How emotionally satisfying is your relationship? Select One Extremely Moderately Slightly Not at all
34. How sexually satisfying is your relationship? Select One Extremely Moderately Slightly Not at all
35. How physically affectionate is your relationship? Select One Extremely Moderately Slightly Not at all
36. Overall, how satisfying is your relationship? Select One Extremely Moderately Slightly Not at all
37. How long does a typical sexual encounter with your partner last? Select One less than 10 minutes 10-30 minutes 30-60 minutes More than 1 hour
38. Which of the following sexual activities are likely to occur in a typical sexual encounter with your partner?
Kissing/Deep kissing
Touching, caressing, and rubbing bodies
Touching genitals
Receiving oral sex
Giving oral sex
Penis in vagina
Penis in rectum
Finger(s) in vagina
Finger(s) in rectum
Use of dildos, vibrators, other sex toys
Spanking
Bondage
Other BDSM
Other
39. During this relationship, have you had outside sexual partners? Yes No
If yes, pick one: Female Male Both
If yes, did your partner know about and agree to this outside sex? Yes No
40. How many children live in your household, if any?
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I found this at: http://www.ipgcounseling.com/survey.html I encourage women to go take it.