Intimacy Assessment

This assessment examines the sexual interests, attitudes and behaviors to see if there are any specific issues or attitudes that can be addressed upfront. It also will help to customize an individualized plan for you to begin your intimacy coaching process. 

 

1 = NONE

5 = ALL THE TIME

I have faked an orgasm: *

Never

1

2

3

4

5

All the time

I feel comfortable with my own body:*

Never

1

2

3

4

5

All the time

I discuss sex openly with my partner outside of the bedroom:*

Never

1

2

3

4

5

All the time

My partner and I participate in foreplay:*

Never

1

2

3

4

5

All the time

I have orgasms during penetration:*

Never

1

2

3

4

5

All the time

I have tried sex toys:*

Never

1

2

3

4

5

All the time

I am present during sex: *

Never

1

2

3

4

5

All the time

I masturbate on a regular basis:*

Never

1

2

3

4

5

All the time

I talk about our sexual fantasies with my partner: *

Never

1

2

3

4

5

All the time

Mine/or my partners erections do not last: *

Never

1

2

3

4

5

All the time

Sex with my partner is too short: *

Never

1

2

3

4

5

All the time

I am satisfied with my sex life: *

Never

1

2

3

4

5

All the time

I have no desire for sex: *

Never

1

2

3

4

5

All the time

I am comfortable discussing sex: *

Never

1

2

3

4

5

All the time

I feel guilty or shameful about sex: *

Never

1

2

3

4

5

All the time

Sex causes me pain: *

Never

1

2

3

4

5

All the time

My partner and I experiment with new activities in the bedroom: *

Never

1

2

3

4

5

All the time

I feel energized when thinking about sex: *

Never

1

2

3

4

5

All the time

I watch adult entertainment with or without my partner: *

Never

1

2

3

4

5

All the time

I tell my partner what I enjoy during sex *

Never

1

2

3

4

5

All the time

I communicate things I do not like with my partner during sex: *

Never

1

2

3

4

5

All the time

If my partner expresses what they do/do not like during sex, I get upset/annoyed? *

Never

1

2

3

4

5

All the time

Sex just happens: *

Never

1

2

3

4

5

All the time

Sex is a chore: *

Never

1

2

3

4

5

All the time

I consider myself sexy: *

Never

1

2

3

4

5

All the time

I buy my partner sexy gifts: *

Never

1

2

3

4

5

All the time

I compliment my partner: *

Never

1

2

3

4

5

All the time

I expect my partner to have sex with me: *

Never

1

2

3

4

5

All the time

I understand that there are times when my partner does not want to have sex: *

Never

1

2

3

4

5

All the time

I know how to pleasure myself: *

Never

1

2

3

4

5

All the time

I enjoy giving oral sex: *

Never

1

2

3

4

5

All the time

I enjoy receiving oral sex: *

Never

1

2

3

4

5

All the time

My religious beliefs affect my sex life: *

Never

1

2

3

4

5

All the time

I am not attractive enough to have sex: *

Never

1

2

3

4

5

All the time

I am on dating apps: *

Never

1

2

3

4

5

All the time

I am open to new experiences with my partner: *

Never

1

2

3

4

5

All the time

Sex is important to any relationship:*

Never

1

2

3

4

5

All the time

Name*

First

Last

Date of Birth*

01020304050607080910111213141516171819202122232425262728293031day

 / 

JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth

 / 

2020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960year

Email*

Email confirmation*

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