1. Age at last birthday:
2. Sex: (as you identify) MaleFemale
3. What is your race?
White Black Asian Hispanic Other
4. How many times have you been married to a person of the other sex or lived openly with a person of the other sex?
5. Are you currently living with: Spouse Male lover Female lover Roommate Self Parents Children Other
6. List the states in which you have lived for a year or more since age 14:
7. How much formal schooling have you had? 8th grade or less Some high school High school graduate Some college College graduate Graduate school
8. What is your occupation? (Be specific)
9. What is your spouse's/partner's occupation? (Be specific)
10. What is your religious background? Catholic Protestant Jewish Other None
11. How often do you attend religious services? One or more times weekly Approx. once a month One or two times yearly Never
12. For each topic listed below, how do you think your attitudes compare with those of most people? (Check one answer for each topic.)
13. What was your age when you first knew about:
14. Did you have a course in school which dealt with human sexuality? Yes No
A. If yes, was this course given in: Elementary school High school College
B. If yes, was the information: (check one)
Mostly new: or, did it clarify misunderstandings? , or did you already know most of it?
15. How important is sex to you? Very important Somewhat important Slightly important Not at all important
16. In general, would you say your sexual satisfaction has been: Very much above average Somewhat above average About average Somewhat below average Very much below average
17. What was your age the first time you masturbated to orgasm?
Never did
(If never, proceed to question 18)
If Ever Masturbated
During the past year, how often have you masturbated to orgasm?
times per week
or
times per month
times per year
18. What was your age the first time you had sexual intercourse with someone of the other sex?Age:
(If never, proceed to question 19)
If Ever Had Sexual Intercourse
A. Counting your first partner, with how many different people have you had heterosexual intercourse?
B. During the past year, with how many different people have you had heterosexual intercourse?
C. During the past year, how often have you had heterosexual intercourse?
19. What was your age the first time you had sexual contact with someone of the same sex?
Age:
(If never, proceed to question 20)
If Ever Had Sexual Activity with Someone of the Same Sex
A. Counting your first partner, with how many different people of the same sex have you had sexual contact?
B. During the past year, with how many different people of the same sex have you had sexual contact?
C. During the past year, how often have you had sexual contact with someone else of the same sex?
20. Where would you rate yourself on the Kinsey scale? Combine both overt behavior and fantasy.
Exclusively heterosexual
Only incidental homosexuality
Both homosexual and heterosexual,but more heterosexual
Equally homosexual and heterosexual
Both heterosexual and homosexual, but more homosexual
Only incidental heterosexuality
Exclusively homosexual
21. Please choose one of the following to define yourself: Heterosexual Bisexual Homosexual
22A. Have you ever read about, or seen pictures or films of:
Self-masturbation
Yes No
Intercourse (penis-in-vagina)
Oral-genital contact, male-female
Anal intercourse, male-female
Mutual masturbation or other sexual activity
male-male
Oral-genital contact, male-male
Anal intercourse, male-male
female-female
Oral-genital contact, female-female
Group sex
Sadomasochism
Adult sexual contact with children
Rape
22B. If Yes to Any of the Above:
Pick the word that best describes your reaction to reading about or seeing the following activities:
Self-masturbation: Aroused Interested Disinterested Uncomfortable Disgusted
Intercourse (penis-in-vagina): Aroused Interested Disinterested Uncomfortable Disgusted
Oral-genital contact, male-female: Aroused Interested Disinterested Uncomfortable Disgusted
Anal-intercourse, male-female: Aroused Interested Disinterested Uncomfortable Disgusted
Mutual masturbation or other sexual activity, male-male: Aroused Interested Disinterested Uncomfortable Disgusted
Oral-genital contact, male-male: Aroused Interested Disinterested Uncomfortable Disgusted
Anal intercourse, male-male: Aroused Interested Disinterested Uncomfortable Disgusted
Masturbation or other sexual activity, female-female: Aroused Interested Disinterested Uncomfortable Disgusted
Oral-genital contact, female-female: Aroused Interested Disinterested Uncomfortable Disgusted
Group sex: Aroused Interested Disinterested Uncomfortable Disgusted
Sadomasochism: Aroused Interested Disinterested Uncomfortable Disgusted
Adult sexual contact with children: Aroused Interested Disinterested Uncomfortable Disgusted
Rape: Aroused Interested Disinterested Uncomfortable Disgusted
23. Have you ever fantasized or participated in any of the following activities:
Intercourse (penis-vagina) Have Participated Have not Participated Have Fantasized Have not Fantasized
Oral-genital contact, male-female Have Participated Have not Participated Have Fantasized Have not Fantasized
Anal intercourse, male-female Have Participated Have not Participated Have Fantasized Have not Fantasized
Mutual masturbation or other sexual activity, male-male Have Participated Have not Participated Have Fantasized Have not Fantasized
Oral-genital contact, male-male Have Participated Have not Participated Have Fantasized Have not Fantasized
Anal intercourse, male-male Have Participated Have not Participated Have Fantasized Have not Fantasized
Mutual masturbation or other sexual activity, female-female Have Participated Have not Participated Have Fantasized Have not Fantasized
Oral-genital contact, female-female Have Participated Have not Participated Have Fantasized Have not Fantasized
Group sex Have Participated Have not Participated Have Fantasized Have not Fantasized
Sadomasochism Have Participated Have not Participated Have Fantasized Have not Fantasized
Adult sexual contact with children Have Participated Have not Participated Have Fantasized Have not Fantasized
Rape Have Participated Have not Participated Have Fantasized Have not Fantasized
24. If you have participated in it, did you enjoy it?
A. Intercourse (penis-vagina): Very muchSomewhatNot too MuchNot at all
B. Oral-genital contact, male-female: Very muchSomewhatNot too MuchNot at all
C. Anal intercourse, male-female: Very muchSomewhatNot too MuchNot at all
D. Mutual masturbation or other sexual activity, male-male: Very muchSomewhatNot too MuchNot at all
E. Oral-genital contact, male-male: Very muchSomewhatNot too MuchNot at all
F. Anal intercourse, male-male: Very muchSomewhatNot too MuchNot at all
G. Mutual masturbation or other sexual activity, female-female: Very muchSomewhatNot too MuchNot at all
H. Oral-genital contact, female-female: Very muchSomewhatNot too MuchNot at all
I. Group sex: Very muchSomewhatNot too MuchNot at all
J. Sadomasochism: Very muchSomewhatNot too MuchNot at all
K. Adult sexual contact with children: Very muchSomewhatNot too MuchNot at all
L. Rape: Very muchSomewhatNot too MuchNot at all
25. Have you ever paid a woman for sex? Yes No
26. Have you ever paid a man for sex? Yes No
27. Have you ever been paid by a woman for sex? Yes No
28. Have you ever been paid by a man for sex? Yes No
29. Which of the following sex aids have you used?
A. Vibrator
YesNo
B. Dildo.
C. Ben-Wa balls
D.Cock ring.
E. Other
30. If you have used any of the above, would you say they were: Very helpful Somewhat helpful Of no help Detrimental
31. Did you use sex aids: Alone With a partner Both
32. Do you think the average person has a morbid or shameful interest in sex, nudity or excretion? Yes No
33. Do you have a morbid or shameful interest in sex, nudlty or excretion? Yes No
34. The following is a list of basic sexual rights. Please indicate whether you agree or disagree that each right should be extended to all people:
The freedom of any sexual thought, fantasy or desire Yes No The right to sexual entertainment, freely available in the market place, including sexually explicit materials dealing with the full range of sexual behavior Yes No The right not to be exposed to sexual material or behavior Yes No The right to sexual self-determination Yes No The right to seek out and engage in consensual sexual activity Yes No The right to engage in sexual acts or activities of any kind whatsoever, providing they do not involve non-consensual acts, violence, constraint,coercion or fraud Yes No The right to be free of persecution or societal intervention in private sexual behavior Yes No The recognition by society that every person, partnered or unpartnered, has the right to the pursuit of a satisfying consensual socio-sexual life free from political, legal or religious interference and that there need to be mechanisms in society where the opportunities of socio-sexual activities are available to the following: disabled persons; chronically ill persons; those incarcerated in prisons, hospitals or institutions; those disadvantaged because of age, lack of physical attractive ness or social skills; the poor and the lonely Yes No The basic right of all persons who are sexually dysfunctional to have available non-judgmental sexual health care Yes No The right to control conception Yes No If you are happy with all of your responses click here: If you wish to make any changes you may scroll back and make them. Be sure to click Submit before you leave. Thanks for your cooperation.
The freedom of any sexual thought, fantasy or desire Yes No
The right to sexual entertainment, freely available in the market place, including sexually explicit materials dealing with the full range of sexual behavior Yes No
The right not to be exposed to sexual material or behavior Yes No
The right to sexual self-determination Yes No
The right to seek out and engage in consensual sexual activity Yes No
The right to engage in sexual acts or activities of any kind whatsoever, providing they do not involve non-consensual acts, violence, constraint,coercion or fraud Yes No
The right to be free of persecution or societal intervention in private sexual behavior Yes No
The recognition by society that every person, partnered or unpartnered, has the right to the pursuit of a satisfying consensual socio-sexual life free from political, legal or religious interference and that there need to be mechanisms in society where the opportunities of socio-sexual activities are available to the following: disabled persons; chronically ill persons; those incarcerated in prisons, hospitals or institutions; those disadvantaged because of age, lack of physical attractive ness or social skills; the poor and the lonely Yes No
The basic right of all persons who are sexually dysfunctional to have available non-judgmental sexual health care Yes No
The right to control conception Yes No
If you are happy with all of your responses click here: If you wish to make any changes you may scroll back and make them. Be sure to click Submit before you leave. Thanks for your cooperation.