Questionnaire I&S

Anonymous Intimacy and Sexuality Questionnaire

Goal:

The goal of this questionnaire is for me to be able to address more efficiently the needs of women with intimacy and or sexuality related blockages.

Important note:

This questionnaire is anonymous.

You can write as much as you like in each field.
=>Going in detail and being specific can help me understand to a greater extent what my course or courses should address.

The fields with the red asterixis (*) are mandatory.

* Indicates required field

Are you experiencing any discomfort and/or unease in your intimate and sexual life? *

Yes No

Please describe it or them *

What do you feel you’re lacking in your intimate and sexual life? *

What would it mean to feel free within an intimate relationship? *

Do you feel you can ask for what you want within an intimate relationship? *

When is that you don’t feel heard? *

Would you feel comfortable if your partner would ask you anything he/she desires? *

What is it that you need in your relationship? *

What’s your deepest sexual desire? *

What triggers you? *

If there is anything you feel to add or suggest, please write it down here: *

Thank you very much for taking the time to answer the questions.

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