Female Sexual Function Index (FSFI)

Female Sexual Function Index (FSFI)

Version 06.08.23
Name*

First NameLast Name
Date of birth:*

MonthDayYear
Date
Subject Identifier:*
Phone Number*
Please enter a valid phone number.
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 times (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 highHighModerateLow
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.
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
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 ever
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") duringsexual 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?*

Very 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
Thank you for completing this questionnaire
Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
Should be Empty: