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

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

3. Did your parents have trouble with sexual behavior?

4. Do you find yourself preoccupied with sexual struggles?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

23. Have you been sexual with minors?

24. Do you feel controlled by your sexual desire?

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

TOTAL