1. I am not satisfied with my sex life. 2. I would like my sex life to be better. 3. I have noticed a recent change related to my sex life. 4. My sexual concerns cause me personal distress. 5. I have vaginal dryness during sex. 5. I have less pleasurable sensation, such as warmth and tingling, during sex. 7. I do not feel excited or aroused during sex. 8. I do not have orgasms. 9. It is more difficult for me to have an orgasm than it once was. 10. I find my orgasms are less intense than they once were. 11. My sexual problems began after an illness, injury or surgery. 12. My sexual problems began at about the same time as: (Check all that apply.) pregnancy childbirth birth control menopause hormone replacement therapy 13. I have one or more of the following: (Check all that apply.) menopause diabetes heart disease hypertension high cholesterol pelvic surgery, such as hysterectomy smoking or history of smoking pelvic radiation therapy 14. I think my sexual problems are physical. 15. My interest in sex has decreased. 16. I do not have erotic thoughts or fantasies. 17. I have no interest in having any kind of sexual activity. 18. I have pain during sexual intercourse. 19. My vagina tightens up during sex and is difficult to enter. 20. I have pain with any kind of vaginal penetration. 21. I have pain during sexual intercourse, but I think I have enough lubrication or wetness. 22. I have sexual difficulties when I have sex with my partner but not when I self-stimulate alone. 23. I think I suffer from depression. 24. I think my sexual problems are psychological. 25. I am not happy with my partner. 
