Please indicate gender:

Indicate Orientation:

Were you sexually abused as a child or adolescent?

Did your parents have trouble with sexual behavior?

Do you often find yourself preoccupied with sexual thoughts?

Do you feel that your sexual behavior is not normal?

Do you ever feel bad about your sexual behavior?

Has your sexual behavior ever created problems for you and your family?

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

Has anyone been hurt emotionally because of your sexual behavior?

Are any of your sexual activities against the law?

Have you made efforts to quit a type of sexual activity and failed?

Do you hide some of your sexual behaviors from others?

Have you attempted to stop some parts of your sexual activity?

Have you felt degraded by your sexual behaviors?

When you have sex, do you feel depressed afterwards?

Do you feel controlled by your sexual desire?

Have important parts of your life (such as job, family, friends, leisure activities) been neglected because you were spending too much time on sex?

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

Is sex almost all you think about?

Has sex (or romantic fantasies) been a way for you to escape your problems?

 Has sex become the most important thing in your life?

Are you in crisis over sexual matters?

Has the Internet created sexual problems for you?

Do you spend too much time online for sexual purposes?

Have you purchased services online for erotic purposes (sites for dating, pornography, fantasy and friend finder)?

Have you used the Internet to make romantic or erotic connections with people online?

Have people in your life been upset about your sexual activities online?

Have you attempted to stop your online sexual behaviors?

Have you subscribed to or regularly purchased or rented sexually explicit materials (magazines, videos, books or online pornography)?

Have you been sexual with minors?

 Have you spent considerable time and money on strip clubs, adult bookstores and movie houses?

Have you engaged prostitutes and escorts to satisfy your sexual needs?

Have you spent considerable time surfing pornography online?

Have you used magazines, videos or online pornography even when there was considerable risk of being caught by family members who would be upset by your behavior?

Have you regularly purchased romantic novels or sexually explicit magazines?

Have stayed in romantic relationships after they became emotionally or physically abusive?

Have you traded sex for money or gifts?

Have you maintained multiple romantic or sexual relationships at the same time?

After sexually acting out, do you sometimes refrain from all sex for a significant period?

Have you regularly engaged in sadomasochistic behavior?

Do you visit sexual bath-houses, sex clubs or adult video/bookstores as part of your regular sexual activity?

Have you engaged in unsafe or “risky” sex even though you knew it could cause you harm?

Have you cruised public restrooms, rest areas or parks looking for sex with strangers?

Do you believe casual or anonymous sex has kept you from having more long-term intimate relationships?

Has your sexual behavior put you at risk for arrest for lewd conduct or public indecency?

Have you been paid for sex?