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
Keywords:
  1. 8/27/12 8/27/12 -
  2. 8/11/14 8/11/14 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
  4. 6/27/15 6/27/15 -
Uploaded on:

June 27, 2015

DOI:
To request one please log in.
License :
Creative Commons BY-NC 3.0 Legacy
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

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.

Header Module
Visit
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

Similar models

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial