Questionnaire
E. The Questions in this Section are About Your Sexual Partners.
A sexual partner is someone with whom you currently
(or did in the past) engage in any kind of sexual activity.
1. The last time I engaged in any kind of sexual activity
with a partner was_____today.
(please circle today or write in your best estimate of approximately
of how many):
Days ago______? Months ago____?
Years ago______?
If you have more than one current partner, interpret
"current partner" to mean your "primary partner" as you fill
out this questionnaire.
2 a. My current or most recent sexual partner is/was:
male or female
b. I have been (or was) with this partner ____Months
or____years (write in how many):
3. I think of myself as currently having (write
in how many):__ Male __female sexual partners.
4. I have had about ______sexual partners in my lifetime
(write in how many):
5. In my lifetime, the number of people with whom I
have engaged in what is often called "casual sex" or a
"one-night
stand" (including instances where a relationship or friendship
developed after the sex) is
approximately ____________ .
6. My current or most recent sex partner has been (was)
a good partner for me in general, not just sexually.
| Strongly Disagree
|
Strongly Agree
|
NA
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
0
|
7. In the past, most of my sex partners were good partners
for me in general, not just sexually.
| Strongly Disagree
|
Strongly Agree
|
NA
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
0
|
8. In my life I have had at least one partner with
whom I had what I considered to be really fantastic sex.
| Strongly Disagree
|
Strongly Agree
|
NA
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
0
|
9 a. In the last 3 months, the number of individuals with whom I have
engaged in sexual activity of any kind is ________________(write
in how many)
If your answer to 9a is "0", skip 9b.
b. The partner(s) and circumstances can be described
as (circle all that apply):
A male partner___
A female partner___
My "spouse" (married or life commitment)___
A nonspouse partner I live with___
A partner I don't live with___
Someone I knew at the time for more than 1 but less
than 7 days___
Someone I knew at the time for less than 24 hours___
A partner with whom I have an ongoing affair___
A friend: we sometimes or regularly meet each other's
sexual needs___
Someone I know, in exchange for money___
A stranger, in exchange for money ___
Other (PLEASE SPECIFY): ______________
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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.
