Interstitial Cystitis Network : Survey Center : WVU Female Sexual Function Index

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Interstitial Cystitis and Female Sexuality
A Research Survey by West Virginia School of Medicine's Center for Sexual and Voiding Dysfunction.

The ICN is delighted to assist Dr. Stanley Zaslau (Center for Sexual and Voiding Dysfunction at West Virginia University) in conducting a research survey designed to study interstitial cystitis and sexual dysfunction. The survey is a peer-reviewed, statistically valid, internationally accepted questionnaire entitled the Index of Female Sexual Function. The information gained from this survey will aid in the diagnosis and treatment of sexual dysfunction as it relates to the patient with Interstitial Cystitis.

While the questions are indeed intimate, your privacy is our priority. At the end of the survey, you will be asked for your age, city, state, country and the medications that you are currently taking. We need this information to study any regional or national differences, as well as to review any trends with respect to medications used. Your e-mail address is optional. The data gathered is being sent directly to the research team. If you have any questions about the survey, you may send them directly to Dr. Stanley Zaslau, MD at: szaslau@hsc.wvu.edu We look forward to your participation and thank you in advance for your cooperation.

INSTRUCTIONS: Please select one answer for each of the following questions. When complete, you can submit your survey by clicking the submit button at the end of the page

Question 1: Over the past four weeks, how OFTEN did you feel sexual desire or interest?
5. Almost always or always
4. Most times (more than half the time)
3. Sometimes (about half the time)
2. A few times (less than half the time)
1. Almost never or never

Question 2. Over the past four weeks, how would you rate your level (degree) of sexual desire or interest?
5. Very High
4. High
3. Moderate
2. Low
1. Very low or none at all

Question 3. Over the past four weeks, how OFTEN did you feel sexually aroused ("turned on") during sexual activity or intercourse
0. No sexual activity
5. Almost always or always
4. Most times (more than half the time)
3. Sometimes (about half the time)
2. A few times (less than half the time)
1. Almost never or never

Question 4. Over the past four weeks, how would you rate your LEVEL of sexual arousal ("turn on") during sexual activity or intercourse?
0. No sexual activity
5. Very high
4. High
3. Moderate
2. Low
1. Very low or none at all

Question 5. Over the past four weeks, how CONFIDENT were you about becoming sexually aroused during sexual activity or intercourse?
0.No Sexual Activity
5. Very High Confidence
4. High Confidence
3. Moderate Confidence
2. Low Confidence
1. Very low or no confidence

Question 6. Over the past four weeks, how OFTEN have you been satisfied with your arousal (excitement) during sexual activity or intercourse?
0. No Sexual Activity
5-Almost always or always
4. Most times (more than half the time)
3. Sometimes (about half the time)
2. A Few Times (less than half the time)
1. Almost never or never

Question 7. Over the past four weeks, how OFTEN did you become lubricated ("wet") during sexual activity or intercourse?
0. No sexual activity
5. Almost always or always
4. Most times (more than half the time)
3. Sometimes (about half the time)
2. A few times (less than half the time)
1. Almost never or never

8. Over the past four weeks, how DIFFICULT was it to become lubricated ("wet") during sexual activity or intercourse?
0. No sexual activity
1. Extremely difficult or impossible
2. Very difficult
3. Difficult
2. Slightly difficult
1. Not difficult

9. Over the past four weeks, how often did you MAINTAIN your lubrication ("wetness") until completion of sexual activity or intercourse?
0. No sexual activity
5. Almost always or always
4. Most times (more than half the time)
3. Sometimes (about half the time)
2. A few times (less than half the time)
1. Almost never or never

10. Over the past four weeks, how difficult was it to MAINTAIN your lubrication ("wetness") until completion of sexual activity or intercourse?
0. No sexual activity
1. Extremely difficult or impossible
2. Very difficult
3. Difficult
4. Slightly difficult
5. Not difficult

11. Over the past four weeks, when you had sexual stimulation or intercourse, how OFTEN did you reach orgasm (climax)?
0. No sexual activity
5. Almost always or always
4. Most times (more than half the time)
3. Sometimes (about half the time
2.. A few times
1. Almost never or never

12. Over the past four weeks, when you had sexual stimulation or intercourse, how DIFFICULT was it for you to reach orgasm (climax)?
0. No sexual activity
1. Extremely difficult or impossible
2. Very difficult
3. Difficult
4. Slightly difficult
5. Not difficult

13. Over the past four weeks, how SATISFIED were you with your ability to reach orgasm (climax) during sexual activity or intercourse?
0. No sexual activity
5. Very satisfied
4. Moderately satisfied
3. About equally satisfied and dissatisfied
2. Moderately dissatisfied
1. Very dissatisfied

14. Over the past four weeks, how SATISFIED have you been with the amount of emotional closeness during sexual activity between you and your partner?
0. No sexual activity
5. Very satisfied
4. Moderately satisfied
3. About equally satisfied and dissatisfied
2. Moderately dissatisfied
1. Very dissatisfied

15. Over the past four weeks, how SATISFIED have you been with your sexual relationship with your partner?
5. Very satisfied
4. Moderately satisfied
3. About equally satisfied and dissatisfied
2. Moderately dissatisfied
1. Very dissatisfied

16. Over the past four weeks, how SATISFIED have you been with your overall sexual life?
5. Very satisfied
4. Moderately satisfied
3. About equally satisfied and dissatisfied
2. Moderately dissatisfied
1. Very dissatisfied

17. Over the past four weeks, how OFTEN did you experience discomfort or pain during vaginal penetration?
0. Did not attempt intercoursee
1. Almost always or always
2. Most times (more than half the time)
3. Sometimes (about half the time)
4. A few times (less than half the time)
5. Almost never or never

18. Over the past four weeks, how OFTEN did you experience discomfort or pain following vaginal penetration?
0. Did not attempt intercourse
1. Almost always or always
2. Most times (more than half the time)
3. Sometimes (about half the time)
4. A few times (less than half the time)
5. Almost never or never

19. Over the past four weeks, how would you rate your LEVEL (degree) of discomfort or pain during or following vaginal penetration?
0. Did not attempt intercourse
1. Very High
2. High
3. Moderate
4. Low
5. Very Low or None At All

Your Age:
City:
State:
Postal Code:
Country:
E-mail Address (Optional)
Are you diagnosed with IC? If so, when?

Current Medications:

Any Comments?

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