1. Were you sexually abused as a child or adolescent?:

Yes
No

2. Have you subscribed to or regularly purchased sexually explicit magazines?

Yes
No

3. Did your parents have trouble with sexual behaviour?

Yes
No

4. Do you often find yourself preoccupied with sexual thoughts?

Yes
No

5. Do you feel that your sexual behaviour is not normal?

Yes
No

6.Does your spouse (or significant other) ever worry or complain about your sexual behaviour?

Yes
No

7. Do you have trouble stopping your sexual behaviour when you know it is inappropriate?

Yes
No

8. Do you ever feel bad about your sexual behaviour?

Yes
No

9. Has your sexual behaviour ever created problems for you or your family?

Yes
No

10. Have you ever sought help for sexual behaviour that you did not like?

Yes
No

11. Have you ever worried about people finding out about your sexual activities?

Yes
No

12. Has anyone been hurt emotionally because of your sexual behaviour?

Yes
No

13. Are any of your sexual activities against the law?

Yes
No

14. Have you made promises to yourself to quit some aspect of your sexual behaviour?

Yes
No

15. Have you made efforts to quit a type of sexual behaviour and failed?

Yes
No

16. Do you have to hide some aspects of your sexual behaviour from others?

Yes
No

17. Have you attempted to stop some parts of your sexual activities?

Yes
No

18. Have you ever felt degraded by your sexual behaviour?

Yes
No

19. Has sex been a way for you to escape your problems?

Yes
No

20. When you have sex, do you feel depressed afterward?

Yes
No

21. Have you felt the need to discontinue a certain form of sexual activity?

Yes
No

22. Has your sexual activity interfered with your family life?

Yes
No

23. Have you been sexual with minors?

Yes
No

24. Do you feel controlled by your sexual desire?

Yes
No

25. Do you ever think that your sexual desire is stronger than you are?

Yes
No