Description:

Z6051 Female Sexual Function Index (FSFI) NCT00726622 Laparoscopic-Assisted Resection or Open Resection in Treating Patients With Stage IIA, Stage IIIA, or Stage IIIB Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4ADB6FCE-6910-3938-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4ADB6FCE-6910-3938-E044-0003BA3F9857

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Versions (4) ▾
  1. 8/27/12
  2. 8/11/14
  3. 1/9/15
  4. 6/27/15
Uploaded on:

June 27, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Z6051 Female Sexual Function Index (FSFI) NCT00726622

INSTRUCTIONS: These questions ask about your sexual feelings and responses during the past 4 weeks. Please answer the following questions as honestly and clearly as possible. Your responses will be kept completely confidential.

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Female Sexual Function Assessment
Over the past 4 weeks, how often did you feel sexual desire or interest
Over the past 4 weeks, how would you rate your level (degree) of sexual desire or interest
Over the past 4 weeks, how often did you feel sexually aroused ('turned on') during sexual activity or intercourse?
Over the past 4 weeks, how would you rate your level of sexual arousal ('turn on') during sexual activity or intercourse?
Over the past 4 weeks, how confident were you about becoming sexually aroused during sexual activity or intercourse?
Over the past 4 weeks, how often have you been satisfied with your arousal (excitement) during sexual activity or intercourse
Over the past 4 weeks, how often did you become lubricated ('wet') during sexual activity or intercourse
Over the past 4 weeks, how difficult was it to become lubricated ('wet') during sexual activity or intercourse
Over the past 4 weeks, how often did you maintain your lubrication ('wetness') until completion of sexual activity or intercourse
Over the past 4 weeks, how difficult was it to maintain your lubrication ('wetness') until completion of sexual activity or intercourse
Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm (climax)
Over the past 4 weeks, when you had sexual stimulation or intercourse, how difficult was it for you to reach orgasm (climax)
Over the past 4 weeks, how satisfied were you with your ability to reach orgasm (climax) during sexual activity or intercourse
Over the past 4 weeks, how satisfied have you been with the amount of emotional closeness during sexual activity between you and your partner
Over the past 4 weeks, how satisfied have you been with your sexual relationship with your partner
Over the past 4 weeks, how satisfied have you been with your overall sexual life
Over the past 4 weeks, how often did you experience discomfort or pain during vaginal penetration
Over the past 4 weeks, how often did you experience discomfort or pain following vaginal penetration
Over the past 4 weeks, how would you rate your level (degree) of discomfort or pain during or following vaginal penetration

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