Sexual Satisfaction (ASEX) Questionnaire
For each item, please indicate your OVERALL level during the PAST WEEK, including TODAY.
Name
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Email
example@example.com
Are you biologically male (have a penis) or female (have a vagina)?
Male
Female
1) How strong is your sex drive?
1- Extremely Strong
2- Very Strong
3- Somewhat Strong
4- Somewhat Weak
5- Very Weak
2) How are you sexually aroused (turned on)?
1- Extremely Easy
2- Very Easily
3- Somewhat Easily
4- Somewhat Difficult
5- Very Difficult
3) Can you easily get and keep an erection?
1- Extremely Easy
2- Very Easily
3- Somewhat Easily
4- Somewhat Difficult
5- Very Difficult
3) How easily does your vagina become moist or wet during sex?
1- Extremely Easy
2- Very Easily
3- Somewhat Easily
4- Somewhat Difficult
5- Very Difficult
4)Have you had any sexual activity in the past week?
Yes
No
5) How easily can you reach an orgasm?
1- Extremely Easy
2- Very Easily
3- Somewhat Easily
4- Somewhat Difficult
5- Very Difficult
6) Are orgasms satisfying?
1- Extremely Satisfying
2- Very Satisfying
3- Somewhat Satisfying
4- Somewhat Unsatisfying
5- Very Unsatisfying
Select Your Total Score
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Calculation
Patient ASEX Score
Date
-
Month
-
Day
Year
Date
Signature
Remember your score and press submit to see your results!
Submit
Submit
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