| Question | Response options |
| Q1: Over the past four weeks, how often did you feel sexual desire or interest? | 5 = Almost always or always |
| 4 = Most times (more than half the time) | |
| 3 = Sometimes (about half the time) | |
| 2 = A few times (less than half the time) | |
| 1 = Almost never or never | |
| Q2: Over the past four weeks, how would you rate your level (degree) of sexual desire or interest? | 5 = Very high |
| 4 = High | |
| 3 = Moderate | |
| 2 = Low | |
| 1 = Very low or none at all | |
| Q3: Over the past four weeks, how often did you feel sexually aroused ("turned on") during sexual activity or intercourse? | 0 = No sexual activity |
| 5 = Almost always or always | |
| 4 = Most times (more than half the time) | |
| 3 = Sometimes (about half the time) | |
| 2 = A few times (less than half the time) | |
| 1 = Almost never or never | |
| Q4: Over the past four weeks, how would you rate your level of sexual arousal ("turn on") during sexual activity or intercourse? | 0 = No sexual activity |
| 5 = Very high | |
| 4 = High | |
| 3 = Moderate | |
| 2 = Low | |
| 1 = Very low or none at all | |
| Q5: Over the past four weeks, how confident were you about becoming sexually aroused during sexual activity or intercourse? | 0 = No sexual activity |
| 5 = Very high confidence | |
| 4 = High confidence | |
| 3 = Moderate confidence | |
| 2 = Low confidence | |
| 1 = Very low or no confidence | |
| Q6: Over the past four weeks, how often have you been satisfied with your arousal (excitement) during sexual activity or intercourse? | 0 = No sexual activity |
| 5 = Almost always or always | |
| 4 = Most times (more than half the time) | |
| 3 = Sometimes (about half the time) | |
| 2 = A few times (less than half the time) | |
| 1 = Almost never or never | |
| Q7: Over the past four weeks, how often did you become lubricated ("wet") during sexual activity or intercourse? | 0 = No sexual activity |
| 5 = Almost always or always | |
| 4 = Most times (more than half the time) | |
| 3 = Sometimes (about half the time) | |
| 2 = A few times (less than half the time) | |
| 1 = Almost never or never | |
| Q8: Over the past four weeks, how difficult was it to become lubricated ("wet") during sexual activity or intercourse? | 0 = No sexual activity |
| 1 = Extremely difficult or impossible | |
| 2 = Very difficult | |
| 3 = Difficult | |
| 4 = Slightly difficult | |
| 5 = Not difficult | |
| Q9: Over the past four weeks, how often did you maintain your lubrication ("wetness") until completion of sexual activity or intercourse? | 0 = No sexual activity |
| 5 = Almost always or always | |
| 4 = Most times (more than half the time) | |
| 3 = Sometimes (about half the time) | |
| 2 = A few times (less than half the time) | |
| 1 = Almost never or never | |
| Q10: Over the past four weeks, how difficult was it to maintain your lubrication ("wetness") until completion of sexual activity or intercourse? | 0 = No sexual activity |
| 1 = Extremely difficult or impossible | |
| 2 = Very difficult | |
| 3 = Difficult | |
| 4 = Slightly difficult | |
| 5 = Not difficult | |
| Q11: Over the past four weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm (climax)? | 0 = No sexual activity |
| 5 = Almost always or always | |
| 4 = Most times (more than half the time) | |
| 3 = Sometimes (about half the time) | |
| 2 = A few times (less than half the time) | |
| 1 = Almost never or never | |
| Q12: Over the past four weeks, when you had sexual stimulation or intercourse, how difficult was it for you to reach orgasm (climax)? | 0 = No sexual activity |
| 1 = Extremely difficult or impossible | |
| 2 = Very difficult | |
| 3 = Difficult | |
| 4 = Slightly difficult | |
| 5 = Not difficult | |
| Q13: Over the past four weeks, how satisfied were you with your ability to reach orgasm (climax) during sexual activity or intercourse? | 0 = No sexual activity |
| 5 = Very satisfied | |
| 4 = Moderately satisfied | |
| 3 = About equally satisfied and dissatisfied | |
| 2 = Moderately dissatisfied | |
| 1 = Very dissatisfied | |
| Q14: Over the past four weeks, how satisfied have you been with the amount of emotional closeness during sexual activity between you and your partner? | 0 = No sexual activity |
| 5 = Very satisfied | |
| 4 = Moderately satisfied | |
| 3 = About equally satisfied and dissatisfied | |
| 2 = Moderately dissatisfied | |
| 1 = Very dissatisfied | |
| Q15: Over the past four weeks, how satisfied have you been with your sexual relationship with your partner? | 5 = Very satisfied |
| 4 = Moderately satisfied | |
| 3 = About equally satisfied and dissatisfied | |
| 2 = Moderately dissatisfied | |
| 1 = Very dissatisfied | |
| Q16: Over the past four weeks, how satisfied have you been with your overall sexual life? | 5 = Very satisfied |
| 4 = Moderately satisfied | |
| 3 = About equally satisfied and dissatisfied | |
| 2 = Moderately dissatisfied | |
| 1 = Very dissatisfied | |
| Q17: Over the past four weeks, how often did you experience discomfort or pain during vaginal penetration? | 0 = Did not attempt intercourse |
| 1 = Almost always or always | |
| 2 = Most times (more than half the time) | |
| 3 = Sometimes (about half the time) | |
| 4 = A few times (less than half the time) | |
| 5 = Almost never or never | |
| Q18: Over the past four weeks, how often did you experience discomfort or pain following vaginal penetration? | 0 = Did not attempt intercourse |
| 1 = Almost always or always | |
| 2 = Most times (more than half the time) | |
| 3 = Sometimes (about half the time) | |
| 4 = A few times (less than half the time) | |
| 5 = Almost never or never | |
| Q19: Over the past four weeks, how would you rate your level (degree) of discomfort or pain during or following vaginal penetration? | 0 = Did not attempt intercourse |
| 1 = Very high | |
| 2 = High | |
| 3 = Moderate | |
| 4 = Low | |
| 5 = Very low or none at all |
