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

0

 

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.

0

3

a. My first sexual intercourse was when I was____ years old.

b. My first sexual intercourse was with my consent.

Strongly Disagree						Strongly Agree	NA
1	2	3	4	5	6	7	0

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.

{authrr's note: in using this survey again, I would omit " As a child or adolescent:" from this quesion.}

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 datd ( __ about as, __ more, or ___ less) often.

b. I was ( __ about as, __ more, or ___ less) often sexually active.

 

Remember

The questionnaire is here for VIEWING ONLY.
Please DO Not send your answers to me.

Copyright 1998 Carol Ellison, Ph.D.