This in depth survey will provide valuable insights into how your experiences have shaped you. With this information in hand, you can better understand your beliefs and challenges around sex and relationships. Sometimes it can provide an insight that can create positive changes for you! It can also illuminate some topics to work on first.
As you answer these questions, do your best to answer instinctively and try not to over think each question. Take note of any physical and emotional sensations that may arise with each question.
Personal Sexual History
1. How old were you when you first heard about sex?
Describe the circumstances.
2. At what age do you remember your first sexual feelings?
Describe the circumstances.
3. How old were you when you first masturbated?
Describe the circumstances.
4. How old were you when you first engaged in sex play with other children? How was that for you?
5. How old were you when you first had intercourse?
How was that for you?
6. When was your first climax?
Describe the circumstances.
7. Were you the victim of sexual abuse as a child?
How old were you?
Did you know the person?
Did you tell anyone?
8. Have you ever been raped?
How old were you?
Did you know the person?
Did you tell anyone?
9. Have you ever had sexual contact with a member of your own family? What were your feelings around that?
How old were you?
Did you tell anyone?
10. Have you had a sexual experience with someone of the same sex?
How did you feel about it then?
How do you feel about it now?
11. How would you describe your interest in sex? (highly-sexed, disinterested, etc.)
12. Do you currently masturbate?
How often?
How do you feel about this?
13. Have you ever had an abortion or been partnered with someone who did? What was this like for you?
14. What is your favorite sexual fantasy, if any?
15. Are you easily orgasmic?
How do you feel about that?
16. Have you ever fantasized about having the genitals of the opposite sex? 17. Have you ever had more than one sexual partner at a time? How was this for you?
18. Do you use pornography?
How often?
How do you feel about this?
19. Have you experimented with sex toys?
How do you feel about this?
20. Have you experimented with dominant/submissive sex? How do you feel about this?
21. What is your idea of the proper role for a man in bed?
22. What is your idea of the proper role for a woman in bed?
Relationship Sexual History
Note: If you are not currently in a relationship, consider your last relationship to answer these questions.
1. What first attracted you to your partner?
2. What do you now like best about him or her?
3. What do you like least?
4. What was your first sexual experience with your partner like for you?
5. How would you describe your sex with your partner now?
6. Has your sexual relationship changed over the time you have been together? How do you account for that change?
7. If you could change one thing about your sexual relationship, what would it be?
8. What would you change about your partner sexually if you could?
9. What would you change about yourself sexually?
10. Is there an ongoing issue that you feel has an impact on your sexual relationship?
11. How have you as a couple handled any sexual problems so far? (sex manuals, alcohol, other partners, therapy, etc.)
12. How would your partner feel about participating in sex therapy?
13. How would you feel about it?
14. How would sex therapy help you?
15. How would it help your partner?
16. If you have ever had a same-sex sexual experience, does your partner know about it?
17. Has your partner ever had a same-sex sexual experience?
How do you know?
How do you feel about it?
18. Do you feel that your partner’s previous relationships have had an impact on this one? In what way?
19. Do you believe that your previous relationships have had an impact on this one? In what way?
20. Who is most often the initiator of sex in this relationship?
21. How often do you and your partner express affection to one another?
22. How often do you have sex?
How is that for you?
23. Do you usually reach orgasm during your sex play with your partner? How is that for you?
24. Do you and your partner engage in foreplay before sex? How do you feel about that?
25. If you masturbate, does your partner know?
26. Do you know if your partner masturbates?
How do you feel about that?
27. What is your partner’s favorite position for intercourse?
Do you like it or just cooperate?
28. What is your favorite position?
Does your partner know?
29. Do you and your partner engage in oral sex?
How often?
Do you like it?
30. Do you and your partner have anal sex?
How often?
Do you like it?
31. When you have sex with your partner, do you:
Completely remove your clothes – Never Sometimes Always
Turn off the lights – Never Sometimes Always
Touch your own genitals – Never Sometimes Always
Try new positions – Never Sometimes Always
Feel guilty – Never Sometimes Always
Experience anxiety – Never Sometimes Always
Feel sad – Never Sometimes Always
Have resentment – Never Sometimes Always
Feel ashamed or confused – Never Sometimes Always
Enjoy sex play – Never Sometimes Always
Masturbate before or after – Never Sometimes Always
Talk during sex – Never Sometimes Always
Have sexual fantasies – Never Sometimes Always
32. Which of the following are areas of conflict in this relationship?
Communication
Religion
Finances
In-laws
Affection
Control
Flirting
Drugs and Alcohol
Leisure Time
Work
Social Activities
Cooking
Faithfulness
33. Which of the above do you feel has an impact on your sexual relationship?
34. Do you believe that your sexual relationship with your partner is a metaphor for the rest of your relationship?
If so, what does your sex life say about your relationship?
35. Have either you or your partner experienced orgasm difficulties, arrested sexual desire, pain with intercourse, impotence or other sexual issues?
How was that for the other?
36. Have you had an affair during this relationship?
Does your partner know?
How do you feel about that now?
37. Has your partner had an affair during this relationship?
How did you know?
How do you think he or she feels about that now?
38. Do you and your partner talk about sex?
How often?
How do you feel about that?
39. Do you and your partner have to practice birth control?
Does this have an impact on the relationship?
40. Have you or your partner ever been violent with one another?
What impact do you think this has on your sex life together?
41. Have you or your partner ever experienced any of the following:
Feelings of inferiority – Never Sometimes Always
Oversensitivity – Never Sometimes Always
Anxiety – Never Sometimes Always
Depression – Never Sometimes Always
Appetite loss – Never Sometimes Always
Eating disorders – Never Sometimes Always
Weight loss – Never Sometimes Always
Sleep problems – Never Sometimes Always
Suicidal thoughts – Never Sometimes Always
42. Are you on medication for any of the above?
43. Which of the factors addressed in Question #41 and #42 have an impact on your sex life?
Family Sexual History
44. What kind of relationship did you have with your father as a child?
How about now?
45. What was his attitude towards sex?
46. What kind of relationship did you have with your mother as a child? How about now?
47. What was her attitude towards sex?
48. What do you think your parents’ sex life was like?
What makes you think this?
49. Did you receive sex education at home?
What was that like for you?
50. Do you feel that your relationship with siblings had any effect on your sexuality? If so, what effect?
51. (Women) When did you begin menstruating?
How did you feel about it?
52. (Men) When did you begin ejaculating?
How did you feel about it?
53. Did you receive instructions or encouragement from your parents about the above?
54. How do you feel your experience in your family of origin effects your current sex life?
55. The following questions are to be addressed by those who have children, either natural born, or in partnership.
56. How would you describe your relationship with your children?
57. How do you handle sex education for your own children?
58. What are your sexual hopes and concerns for your children?
59. Which part of your own sexual history do you NOT want your children to have? Which part do you hope they will get to have?
Body Image
1. I would say that my body is (circle one in each line)
Healthy Neutral Unhealthy
Disabled Neutral Functioning
Passive Neutral Active
Cool Neutral Warm
Old Neutral Young
Rough Neutral Soft
Flabby Neutral Firm
Plump Neutral Slim
Dry Neutral Sweaty
Plain Neutral Pretty
Weak Neutral Strong
Smelly Neutral Fragrant
Tense Neutral Relaxed
Unlovable Neutral Lovable
Untouchable Neutral Touchable
Unresponsive Neutral Responsive
Unaffectionate Neutral Affectionate
Nonsexual Neutral Sexual
Fatigued Neutral Energetic
Unenjoyable Neutral Enjoyable
Unacceptable Neutral Acceptable
Useless Neutral Useful
Lazy Neutral Hardworking
2. How would your partner complete this questionnaire about your body? (Put a star next to one choice in each line above).
3. If your mother completed this questionnaire about your body, would her answers resemble yours, your partners or neither?
4. If your father completed this questionnaire about your body, would his answers resemble yours, your partners or neither?
5. How would you complete this questionnaire about your partner’s body? (Put a check next to one choice in each line above.)
6. Who was most influential in forming your body image? (mother, father, brothers/sisters, religion, peers, boyfriends/girlfriends, teachers, popular culture, etc.)
7. Who was most influential in forming your attitude towards touching?
8. Who was most influential in forming your attitude towards masturbation?
9. Who was most influential in forming your attitude about sex?
10. Who was most influential in forming your attitude about pleasure in general?
11. Who was most influential in forming your self-confidence and general attitude towards yourself?
12. What is the thing you like best about your body?
13. If you could change one thing about your body, what would it be?
Sentence-Completion
1. I think women are
2. I think men are
3. I like women who
4. I like men who
5. Sex is
6. It is shameful to
7. Intimacy means
8. Love means
9. It is fun to
10. Pain is
11. I’m ashamed of
12. I feel guilty about
13. I think it is sinful to
14. Marriage is
15. Divorce is
16. My greatest sexual problem is
17. Growing older is
18. Touch is
19. Comfort is
20. My face is
21. My body is
22. It turns me on when
23. It turns me off when
24. I am most sexually attracted to
25. I am most sexually attractive when
Responses To Sexual History Survey
After completing the Sexual History Survey, please answer the following questions:
1. What words or images best describe your experiences while completing the Sexual History Survey?
2. What other feelings, sensations, images or responses were evoked working on the survey?
3. Do you think these responses were the result of the survey instrument, the charge you brought to the subject matter or both? Explain.
4. What section of the survey held the greatest charge for you (Personal Sexual History, Current Relationship, Medical History, Family Sexual History, or Body Image)? 5. How do you understand this?
6. What answers to the survey questions surprised you most?
7. What insights about a) yourself, b) significant others, and c) family did your answers generate
8. What do you think should have been included in this survey that wasn’t?
9. What do you think should not have been included and was?