WOMEN'S SEXUALITIES

Generations of Women Share
Intimate Secrets of Sexual Self-Acceptance

Questionnaire
P. This Section is About Your Contraceptive Method
Q. These 4 Questions Are About Sexually Transmitted Disesases.

P. THIS SECTION IS ABOUT YOUR CONTRACEPTIVE METHOD:

If you do NOT use a contraceptive method, circle 0 and skip to Section Q.nnnnnnn0

1 a. The method of contraception I use most frequently is (PLEASE WRITE IN):

b. This method increases my sexual satisfaction.

1

2

3

4

5

6

7

0

Q. THESE 4 QUESTIONS ARE ABOUT SEXUALLY TRANSMITTED DISEASE

1. I have at some time in my life contracted a sexually transmitted disease (STD.)

1 nnnYes nnnnnnnnn nnnnnnnnnnnnn2.2.nn2.nnnNonnn

(IF YES, PLEASE SPECIFY WHAT IT WAS):

If you DO NOT use a method of disease protection, circlennnnnnnnnnnn 0

and skip to Question 3. Note the instructions above Question 3.n

2 a. The method of protection against sexually transmitted diseases I use most frequently is"

(PLEASE WRITE IN):_______________________________________________________

b. This method increases my sexual satisfaction

STRONGLY DISAGREE						STRONGLY AGREE	N/A
1	2	3	4	5	6	7	0

If you have NOT had sex with a partner in the last 3 months, please circle 0 and skip to the next section, section R. nnnnnnnnnnnn0

3. In sex with my partner(s) during the last 3 months I have felt concerned that I might get an STD.

STRONGLY DISAGREE						STRONGLY AGREE	N/A
1	2	3	4	5	6	7	0

4. In sex with my partner(s) during the last 3 months I have felt concerned that
I might transmit an STD.

STRONGLY DISAGREE						STRONGLY AGREE	N/A
1	2	3	4	5	6	7	0

Remember

The questionnaire is here for VIEWING ONLY. Please DO NOT answer the questions and send your answers to me.

Copyright 1998 Carol Ellison, Ph.D.