Survey: June 2004

First let me say thank you for participating in this online survey. The information will be kept as confidential, and is going to be used as a research tool to aid me in my counseling services.

Please note that there are a couple of optional questions and I have used a red type face for these. I ask that you please answer all other questions as best as is possible.

Tell me a little bit about yourself:

First Name (optional)

Age

Age I First Had Intercourse

Zip/Postal Code

E-mail (optional)

Personal Webpage (optional)
My Marital Status Is:

Never Married
Currently Married
Separated
Divorced
If unmarried, do you have a significant other?

Yes No
My sexual orientation is:

Straight
Lesbian
Bisexual
Bi-Curious
The number of sexual partners I currently have is:

None
1
2
3 or more
My current sexual partner(s) is (are):

Male
Female
Both

I enjoy (check all that apply):

Intercourse                        Giving oral sex                                
Masturbation                       Receiving oral sex

Bondage - restraining my partner   Bondage - being restrained myself

Anal sex

Do you have any of the following body piercings (check all that apply)?

None
Tongue
Navel
Nipples
Genitals

Do you use any of the following on a regular basis in your sexual encounters (check all that apply)?

None                         Vibrator                    Dildo                      
Blindfolds                   Ropes                       Whips                      
Nipple Devices	        Other        		      Handcuffs

Anal Devices

Have you ever had multiple partner sex (check all that apply)?

No
Me with a man and a woman
Me with two men
Me with two woman
If the answer to the last question is no, would you like to have sex with:

Doesn't interest me

Me with a man and a woman
Me with two men
Me with two woman
Are you multi orgasmic?

Yes No
How long does it usually take you to achieve orgasm?

Less than 5 minutes
5 - 10 minutes
10 - 20 minutes
Quite a long time
I would describe my menstrual flow as:

Light
Medium
Heavy
I enjoy sex most:

Just before my period
During my period
Just after my period
It really doesn't matter to me
How often do you masturbate?

Not at all
Less than once a month
About once a month
Every other week

About once a week

Nearly every day
When I masturbate I like to:

Use my fingers
Use a vibrator
Insert other objects
Do you enjoy adult content movies (check all that apply)?

No
Occasionally
Alone
With a partner
Briefly, my most secret and wild sexual fantasy is:
Have you ever, or do you currently, fantasize about a forbidden fruit, such as a friend or a friends partner?

Yes No
If yes above, describe the fantasy and the relationship that exists (how do you know them):

First Name (optional)
Age
Age I First Had Intercourse
Zip/Postal Code
E-mail (optional)
Personal Webpage (optional)