Questionnaire
Section D.
These Questions are about Your Early Sexual Experiences.
1. As a child or adolescent, the first person with
whom I engaged in an activity that I thought of as sexual at the
time was
a:
(1) male OR( 2) female)
If you have never engaged in any sexual activity with a male circle the 0 and skip to Question 4a
2 a. As a child or adolescent, my first sexual
activity that I thought of at the time as sexual with
a male occurred
when I was ______ years old.
b. This sexual activity was with my consent.
| Strongly Disagree
|
Strongly Agree
|
NA
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
0
|
c. The male involved was: (choose one best answer)
A peer (boyfriend, schoolmate, friend)_______________
A relative (please specify who) ___________________
A stranger ____________________
Other (please specify): ________________________________
If you have never had sexual intercourse, circle
the 0 and skip to Question 4a.
3 a. My first sexual intercourse was when I was____
years old.
b. My first sexual intercourse was with my consent.
c. The partner involved was: (choose one best answer)
A peer (boyfriend, schoolmate, friend)______________________
A relative (please specify who) ___________________
A stranger ________________________
Other (please specify): ________________________________
d. He was (choose one best answer)
Someone I wasn't then planning to marry_______________
Someone I was planning to marry ___________________
Someone I had already married ____________________
None of the above____________________
If you have never engaged in any sexual activity
with another female, circle the 0 and skip to Question 5.
0
4.As a child or adolescent:
a. my first sexual activity that I thought of at the time as
sexual with another female
occurred when I was______ _years old.
{author's note: in using this survey again, I would omit " As
a child or adolescent:"
from this question.}
b. This sexual activity was with my consent.
| Strongly Disagree
|
Strongly Agree
|
NA
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
0
|
c. The female involved was (choose one):
A peer (girlfriend, schoolmate, friend)________________
A relative (please specify who) ___________________
A stranger ______________________
Other (please specify) :
_______________________________________________________
5. Compared to my female classmates, during my adolescent
years:
a. I dated ( __ about as, __ more, or ___ less) often.
b. I was ( __ about as, __ more, or ___ less) often sexually
active.
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Remember
The questionnaire is here for VIEWING ONLY.
Please DO NOT send your answers to me.
Copyright 1998, Carol Ellison, Ph.D.
