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Sexual Self Assessment

This document appears to be part of a clinical assessment tool for evaluating levels of sexual satisfaction and relationship well-being for clients receiving sex therapy. It includes sections for demographic information, a 30-item self-assessment of factors impacting sexuality, and questions for processing the assessment. The self-assessment addresses topics like sexual education, values alignment between partners, trauma history, mental health, communication, pleasure, and physical health in relation to sexuality.

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Anne Marie Ampong
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190 views

Sexual Self Assessment

This document appears to be part of a clinical assessment tool for evaluating levels of sexual satisfaction and relationship well-being for clients receiving sex therapy. It includes sections for demographic information, a 30-item self-assessment of factors impacting sexuality, and questions for processing the assessment. The self-assessment addresses topics like sexual education, values alignment between partners, trauma history, mental health, communication, pleasure, and physical health in relation to sexuality.

Uploaded by

Anne Marie Ampong
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Name:

Class and Section:


Schedule:

SEXUAL SELF ASSESSMENT

Description: This too is designed to assess sexual and relationship satisfaction levels in couples
presenting for sex therapy; it is a clinical evaluation tool that offers a brief, comprehensive
assessment of adult clients’ levels of satisfaction in their sexual relationships.

Part 1: Demographic Profile


Kindly please fill out what is asked by ticking the box of your chosen answer or writing what’s
needed.

GENDER AGE RELATIONSHIP STATUS LENGTH OF RELATIONSHIP


• Bisexual • 15 – 20 • In a relationship • 1 – 5 Months
• Female • 21 – 25 • Not in a relationship • 6 months – 1 year
• Gay • 25 – 30 • More than a year – 3 years
• Lesbian • 31 - 35 • More than 3 years – 5 years
• Male • More than 5 years
• Queer
• Transgender
• Others

Part 2: Self-Assessment
Rate your level of agreeableness on the given statements below by putting a check mark on the
on the box that best describes how you feel.

5 – Strongly Agree
4 – Agree
3 – Neither Agree nor Disagree
2 – Disagree
1 – Strongly Disagree

Statement SD D NAND A SA
1 2 3 4 5

1. I feel informed about my sexuality due to


adequate sexual education.
2. I think my vocabulary is adequate to describe
subjective or physical sexual experience.
3. I have adequate information about human
sexual biology and men and women’s changes
with age.

4. I think have adequate information about how


gender roles influence men’s and women’s
sexuality.

5. I have adequate access to information for


birth control.
6. I have adequate access to information and
services for prevention and treatment of
sexually transmitted infections.
7. I have adequate access to information and
services for rape, sexual trauma, or domestic
violence.
8. I avoid having sex or experience distress
during sex because I feel I don’t live up to the
ideals of my culture regarding sexuality or
desirability.
9. I feel confusion or shame about my sexual
orientation or identity.
10. I feel that there are conflicts between my
sexual values and those of my partner or my
peer group.

11. I currently experience sexual inhibition,


avoidance, or distress because of betrayal or
dislike of my partner, abuse or fear of my
partner, and or his or her negative
communication patterns.
12. I have experienced inhibition, avoidance, or
distress arising from betrayal, dislike, fear or
abuse on a previous relationship.
13. I and my partner are different when it comes
to the frequency of desire for sexual activity.
14. I and my and my partner are different when it
comes to our preferences in various sexual
activities.
15. I trust my partner to be sensitive to my wants
and desires.
16. I have lost sexual interest as a result of conflict
with my partner over common issues such as
money, schedule, or people significant to us.
17. I experience sexual aversion, mistrust or
inhibition of sexual pleasure due to my
partner’s personality, such as problems with
rejection, cooperation, closeness or
criticalness.
18. I experience sexual aversion, mistrust or
inhibition of sexual pleasure due to my
partner’s depression or anxiety.
19. My partner does not force me to engage in
any sexual activities if I don’t want to.
20. My partner looks after my welfare and discuss
matters with me about the possibilities if we
engage in sexual activities.

21. I experience inhibition of sexual pleasure or


response that I believe is due to a history of
physical, sexual or emotional trauma.
22. I avoid sexual activity of fail to experience
sexual pleasure because of fears or rejection
or intimacy.
23. I experience sexual aversion, mistrust or
inhibition of sexual pleasure due to
depression or anxiety.
24. I experience sexual inhibition due to fear of
sexual acts or their possible consequences
(e.g. pain during intercourse, pregnancy,
sexually transmitted infections)
25. I limit my sexual feelings due to fear of losing
my partner.

26. I experience pain or lack of physical response


during sexual activity due to medical
conditions affecting my body.
27. I am satisfied with my ability to control my
ejaculation /orgasm.
28. I experience pain during sexual intercourse.
29. I take medications to enhance my sexual
experience.
30. I regularly engage in vigorous physical
exercise.
Part 3: Processing
After doing the self- assessment in Part 2 of this paper, kindly answer the following questions on
the space provided:

1. Total the ratings you have in all statements and divide the total with 25. What’s your
score?

2. Considering that our sexual behavior is strongly influenced with our gender preferences,
in what way do you think you can manifest responsible sexual behavior? Explain your
answer.

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