Intimate Medicine self-assessment

1
1. I’m satisfied with what I’m giving and what I’m receiving in my intimate relationships.
Please Select
Please Select
Definitely
Somewhat
Not really
2
2. I feel confident in reading other people’s non-verbal signals in an intimate setting.
Please Select
Please Select
Most of the time
Sometimes
Usually not
3
3. I feel my sexuality has more control over me than I have over it.
Please Select
Please Select
Most of the time
Sometimes
No, I’m in control
4
4. I have a clear sense of what I’m looking for in intimate relationships right now.
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Please Select
Very clear
Vague idea
No idea
5
5. I can feel pleasure in most parts of my body, not just erogenous zones. (Think elbows, top of the head, shins, etc.)
Please Select
Please Select
Yes!
I’ve never tried but probably some
Probably not
6
6. I turn off electronics and other distractions before entering into a sensual scene.
Please Select
Please Select
Always
Sometimes
Never
7
7. I feel my sexual practices are in line with my values.
Please Select
Please Select
Yes
Some
No
8
8. When I run into difficulties in my intimate relationships, I know that I’m not alone in what I’m experiencing.
Please Select
Please Select
I know I’m not alone in these issues
I’m sure other people are experiencing similar things but I feel alone when they’re happening to me
I feel very alone
9
9. I feel confident making the first move physically.
Please Select
Please Select
Usually/always
Sometimes
Rarely/never
10
10. I have given myself permission to explore a variety of different sexual roles and expressions.
Please Select
Please Select
I’ve explored a lot
I’ve explored a bit
I haven’t explored much
11
11. I feel solid in the way I ask for and express consent.
Please Select
Please Select
Yes
More than I used to, but still a ways to go
Not really
12
12. I’ve had other-worldly/transcendental experiences in sex.
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Please Select
Yes!
Maybe?
Not that I know of
13
13. I engage with my sexuality as an intentional spiritual practice.
Please Select
Please Select
Often/always
Sometimes
Never
14
14. I have sexual desires or curiosities that I’ve never expressed or explored.
Please Select
Please Select
Yes
No
15
15. The physical sensations I feel in sex are somewhat shallow.
Please Select
Please Select
Often/always
Sometimes
Never/rarely
16
16. When I’m getting to know someone in a romantic or sexual context, I articulate specifically what I’m looking for.
Please Select
Please Select
Often/always
Sometimes
Never/rarely
17
17. I’m in my head during sex—there is an inner monologue/chatter present.
Please Select
Please Select
Often/always
Sometimes
Never/rarely
18
18. I know how to create an intimate space that makes a female-socialized person feel safe.
Please Select
Please Select
Definitely
I think/hope
I don’t/don’t know
19
19. I know what to ask as I’m getting to know someone intimately to help me determine whether we’ll be a good fit.
Please Select
Please Select
Yes
Vaguely
No
20
20. Sexuality helps me connect to something larger than myself.
Please Select
Please Select
Yes
I’m not sure
No
21
21. I feel proud of my intimate life.
Please Select
Please Select
Often/always
Sometimes
Rarely/never
22
Anything you’d like to comment? (optional)
Huge
Large
Normal
Small
Ok
Ok
23
If you’d like me to get in touch about working together, please leave an email or Whatsapp/Signal number, and I’ll be happy to reach out. (optional)
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