Female Sexual Function Index Personal InformationName First Last Today's Date MM slash DD slash YYYY Who is your therapist?Jennifer CummingSarah DominguezMichelle WebbKelsey BeachSamantha CragerNicole DeBrieChristina WisdomNo therapist assigned yet / I don't knowInstructions: These questions ask about your sexual feelings and responses during the past 4 weeks. Please answer the following questions as honestly and clearly as possible. Your responses will be kept completely confidential. In answering these questions the following definitions apply: >SEXUAL ACTIVITY can include caressing, foreplay, masturbation and vaginal intercourse. >SEXUAL INTERCOURSE is defined as penile penetration (entry) of the vagina. >SEXUAL STIMULATION includes situations like foreplay with a partner, self-stimulation (masturbation), or sexual fantasy. >SEXUAL DESIRE or INTEREST is a feeling that includes wanting to have a sexual experience, feeling receptive to a partner's sexual initiation, and thinking or fantasizing about having sex. >SEXUAL AROUSAL is a feeling that includes both physical and mental aspects of sexual excitement. It may include feelings of warmth or tingling in the genitals, lubrication (wetness), or muscle contractions.QuestionnaireCHECK ONLY ONE BOX PER QUESTION.1. Over the past 4 weeks, how often did you feel sexual desire or interest?*Almost always or always (5)Most times (more than half the time) (4)Sometimes (about half the time) (3)A few times (less than half the time) (2)Almost never or never (1)2. Over the past 4 weeks, how would you rate your level (degree) of sexual desire or interest?*Very high (5)High (4)Moderate (3)Low (2)Very low or none at all (1)3. Over the past 4 weeks, how often did you feel sexually aroused ("turned on") during sexual activity or intercourse?*No sexual activity (0)Almost always or always (5)Most times (more than half the time) (4)Sometimes (about half the time) (3)A few times (less than half the time) (2)Almost never or never (1)4. Over the past 4 weeks, how would you rate your level of sexual arousal ("turn on") during sexual activity or intercourse?*No sexual activity (0)Very high (5)High (4)Moderate (3)Low (2)Very low to none at all (1)5. Over the past 4 weeks, how confident were you about becoming sexually aroused during sexual activity or intercourse?*No sexual activity (0)Very high confidence (5)High confidence (4)Moderate confidence (3)Low confidence (2)Very low or no confidence (1)6. Over the past 4 weeks, how often have you been satisfied with your arousal (excitement) during sexual activity or intercourse?*No sexual activity (0)Almost always or always (5)Most times (more than half the time) (4)Sometimes (about half the time) (3)A few times (less than half the time) (2)Almost never or never (1)7. Over the past 4 weeks, how often did you become lubricated ("wet") during sexual activity or intercourse?*No sexual activity (0)Almost always or always (5)Most times (more than half the time) (4)Sometimes (about half the time) (3)A few times (less than half the time) (2)Almost never or never (1)8. Over the past 4 weeks, how difficult was it to become lubricated ("wet") during sexual activity or intercourse?*No sexual activity (0)Extremely difficult or impossible (1)Very difficult (2)Difficult (3)Slightly difficult (4)Not difficult (5)9. Over the past 4 weeks, how often did you maintain your lubrication ("wetness") until completion of sexual activity or intercourse?*No sexual activity (0)Almost always or always (5)Most times (more than half the time) (4)Sometimes (about half the time) (3)A few times (less than half the time) (2)Almost never or never (1)10. Over the past 4 weeks, how difficult was it to maintain your lubrication ("wetness") until completion of sexual activity or intercourse?*No sexual activity (0)Extremely difficult or impossible (1)Very difficult (2)Difficult (3)Slightly difficult (4)Not difficult (5)11. Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm (climax)?*No sexual activity (0)Almost always or always (5)Most times (more than half the time) (4)Sometimes (about half the time) (3)A few times (less than half the time) (2)Almost never or never (1)12. Over the past 4 weeks, when you had sexual stimulation or intercourse, how difficult was it for you to reach orgasm (climax)?*No sexual activity (0)Extremely difficult or impossible (1)Very difficult (2)Difficult (3)Slightly difficult (4)Not difficult (5)13. Over the past 4 weeks, how satisfied were you with your ability to reach orgasm (climax) during sexual activity or intercourse?*No sexual activity (0)Very satisfied (5)Moderately satisfied (4)About equally satisfied and dissatisfied (3)Moderately dissatisfied (2)Very dissatisfied (1)14. Over the past 4 weeks, how satisfied have you been with the amount of emotional closeness during sexual activity between you and your partner?*No sexual activity (0)Very satisfied (5)Moderately satisfied (4)About equally satisfied and dissatisfied (3)Moderately dissatisfied (2)Very dissatisfied (1)15. Over the past 4 weeks, how satisfied have you been with your sexual relationship with your partner?*Very satisfied (5)Moderately satisfied (4)About equally satisfied and dissatisfied (3)Moderately dissatisfied (2)Very dissatisfied (1)16. Over the past 4 weeks, how satisfied have you been with your overall sexual life?*Very satisfied (5)Moderately satisfied (4)About equally satisfied and dissatisfied (3)Moderately dissatisfied (2)Very dissatisfied (1)17. Over the past 4 weeks, how often did you experience discomfort or pain during vaginal penetration?*Did not attempt intercourse (0)Almost always or always (1)Most times (more than half the time) (2)Sometimes (about half the time) (3)A few times (less than half the time) (4)Almost never or never (5)18. Over the past 4 weeks, how often did you experience discomfort or pain following vaginal penetration?*Did not attempt intercourse (0)Almost always or always (1)Most times (more than half the time) (2)Sometimes (about half the time) (3)A few times (less than half the time) (4)Almost never or never (5)19.Over the past 4 weeks, how would you rate your level (degree) of discomfort or pain during or following vaginal penetration?*Did not attempt intercourse (0)Very high (1)High (2)Moderate (3)Low (4)Very low or none at all (5)CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.