O-Shot Female Sexual Function Index (FSFI)

Female Sexual Function Index (FSFI)

Confidential medical questionnaire
Date

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
INSTRUCTIONS: These questions ask about your sexual feelings and responses
during the past 4 weeks. Please answer the following questions as honestly and
clearly as possible. Your responses will be kept completely confidential. In
answering these questions the following definitions apply:

Sexual activity can include caressing, foreplay, masturbation and vaginal intercourse.

Sexual intercourse is defined as penile penetration (entry) of the vagina.

Sexual stimulation includes situations like foreplay with a partner, self-stimulation, (masturbation), or sexual fantasy.

CHECK ONLY ONE BOX PER QUESTION.
Sexual desire or interest is a feeling that includes wanting to have a sexual
experience, feeling receptive to a partner's sexual initiation, and thinking or
fantasizing about having sex
1. Over the past 4 weeks, how often did you feel sexual desire or interest?*

Almost always or alwaysMost time (more than half the time)Sometimes (about half the time)A few times (less than half the time)Almost never or never
2. Over the past 4 weeks, how would you rate your level (degree) of sexual desire or interest?*

Very highHighModerateLowVery low or none at all
3. Over the past 4 weeks, how often did you feel sexually aroused ("turned on") during sexual activity or intercourse?*

No sexual activityAlmost always or alwaysMost times (more than half the time)Sometimes (about half the time)A few times (less than half the time)Almost never or never
Sexual arousal is a feeling that includes both physical and mental aspects of sexual excitement. It may include feelings of warmth or tingling in the genitals, lubrication (wetness), or muscle contractions.
4. Over the past 4 weeks, how would you rate your level of sexual arousal ("turn on") during sexual activity or intercourse?*

No sexual activityVery highHighModerateLowVery low or none at all
5. Over the past 4 weeks, how confident were you about becoming sexually aroused during sexual activity or intercourse?*

No sexual activityVery high confidenceHigh confidenceModerate confidenceLow confidenceVery low or no confidence
6. Over the past 4 weeks, how often have you been satisfied with your arousal (excitement) during sexual activity or intercourse?*

No sexual activityAlmost always or alwaysMost times (more than half the time)Sometimes (about half the time)A few times (less than half the time)Almost never or never
7. Over the past 4 weeks, how often did you become lubricated ("wet") during sexual activity or intercourse?*

No sexual activityAlmost always or alwaysMost times (more than half the time)Sometimes (about half the time)A few times (less than half the time)Almost never or never
8. Over the past 4 weeks, how difficult was it to become lubricated ("wet") during sexual activity or intercourse?*

No sexual activityExtremely difficult or impossibleVery difficultDifficultSlightly difficultNot difficult
9. Over the past 4 weeks, how often did you maintain your lubrication ("wetness") until completion of sexual activity or intercourse?*

No sexual activityAlmost always or alwaysMost times (more than half the time)Sometimes (about half the time)A few times (less than half the time)Almost never or never
10. Over the past 4 weeks, how difficult was it to maintain your lubrication ("wetness") until completion of sexual activity or intercourse?*

No sexual activityExtremely difficult or impossibleVery difficultDifficultSlightly difficultNot difficult
11. Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm (climax)?*

No sexual activityAlmost always or alwaysMost times (more than half the time)Sometimes (about half the time)A few times (less than half the time)Almost never or never
12. Over the past 4 weeks, when you had sexual stimulation or intercourse, how difficult was it for you to reach orgasm (climax)?*

No sexual activityExtremely difficult or impossibleVery difficultDifficultSlightly difficultNot difficult
13. Over the past 4 weeks, how satisfied were you with your ability to reach orgasm (climax) during sexual activity or intercourse?*

No sexual activityVery satisfiedModerately satisfiedAbout equally satisfied and dissatisfiedModerately dissatisfiedVery dissatisfied
14. Over the past 4 weeks, how satisfied have you been with the amount of emotional closeness during sexual activity between you and your partner?*

No sexual activityVery satisfiedModerately satisfiedAbout equally satisfied and dissatisfiedModerately dissatisfiedVery dissatisfied
15. Over the past 4 weeks, how satisfied have you been with your sexual relationship with your partner?*

No sexual activityVery satisfiedModerately satisfiedAbout equally satisfied and dissatisfiedModerately dissatisfiedVery dissatisfied
16. Over the past 4 weeks, how satisfied have you been with your overall sexual life?*

Very satisfiedModerately satisfiedAbout equally satisfied and dissatisfiedModerately dissatisfiedVery dissatisfied
17. Over the past 4 weeks, how often did you experience discomfort or pain during vaginal penetration?*

Did not attempt intercourseAlmost always or alwaysMost times (more than half the time)Sometimes (about half the time)A few times (less than half the time)Almost never or never
18. Over the past 4 weeks, how often did you experience discomfort or pain following vaginal penetration?*

Did not attempt intercourseAlmost always or alwaysMost times (more than half the time)Sometimes (about half the time)A few times (less than half the time)Almost never or never
19. Over the past 4 weeks, how would you rate your level (degree) of discomfort or pain during or following vaginal penetration?*

Did not attempt intercourseVery highHighModerateLowVery low or none at all
Total Score out of 36 ( Normal is >26.55 )
Please verify that you are human*
Thank you for completing this questionnaire.

All your responses are confidential.
Validation
Meston CM. Validation of the Female Sexual Function Index (FSFI) in Women with Female Orgasmic Disorder and in Women with Hypoactive Sexual Desire Disorder. J Sex Marital Ther. 2003; 29(1): 39–46.
Should be Empty:

Female Sexual Function Index (FSFI)

Thank you for completing this questionnaire.