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Brief Sexual Symptom Checklist

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The following questionnaire is based on a checklist developed for doctors to use in their office. It appeared in an issue of the Journal of Sexual Medicine.

The results cannot be verified.

Please answer the following questions about your overall sexual function in the past 3 months or more.

Are you satisfied with your sexual function? [Select One]

38% (14) Yes
61% (22) No

36 voters have answered this question.

How long have you been dissatisfied with your sexual function? [Select One]

0% (0) 1 month
5% (2) 3 months
5% (2) 6 months
5% (2) 1 year
5% (2) 2 years
2% (1) 3 years
2% (1) 4 years
2% (1) 5 years
30% (11) More than 5 years
38% (14) I am satisfied with my sexual function

36 voters have answered this question.

The problem(s) with your sexual function is: [Select All That Apply]

33% (12) 1 Problems with little or no interest in sex
25% (9) 2 Problems with decreased genital sensation (feeling)
16% (6) 3 Problems with decreased vaginal lubrication (dryness)
44% (16) 4 Problems reaching orgasm
16% (6) 5 Problems with pain during sex
16% (6) 6 Other
33% (12) I am satisfied with my sexual function

36 voters have answered this question.

Which problem is most bothersome? [Select One]

16% (6) 1
8% (3) 2
5% (2) 3
25% (9) 4
5% (2) 5
8% (3) 6
30% (11) I am satisfied with my sexual function

36 voters have answered this question.

If given the opportunity would you like to talk to your doctor about this? [Select One]

38% (14) Yes
30% (11) No
30% (11) I am satisfied with my sexual function

36 voters have answered this question.

Would you like to see your doctor(s) use this type of checklist during your visits? [Select One]

44% (16) Yes
27% (10) No
25% (9) Maybe
2% (1) They already do

36 voters have answered this question.

This poll was created on 2005-06-05 23:48:33 by The-Clitoris.com