Your First Name (required)

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

2. Did your parents have trouble with sexual behavior?
YesNo

3. Do you often find yourself preoccupied with sexual thoughts?
YesNo

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

5. Do you ever feel bad about your sexual behavior?
YesNo

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

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

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

9. Are any of your sexual activities against the law?
YesNo

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

11. Do you hide some of your sexual behaviors from others?
YesNo

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

13. Have you felt degraded by your sexual behaviors?
YesNo

14. When you have sex, do you feel depressed afterwards?
YesNo

15. Do you feel controlled by your sexual desire?
YesNo

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

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

18. Is sex almost all you think about?
YesNo

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

20. Has sex become the most important thing in your life?
YesNo

21. Are you in crisis over sexual matters?
YesNo

22. The internet has created sexual problems for me.
YesNo

23. I spend too much time online for sexual purposes.
YesNo

24. I have purchased services online for erotic purposes (sites for dating, pornography, fantasy and friend finder).
YesNo

25. I have used the internet to make romantic or erotic connections with people online.
YesNo

26. People in my life have been upset about my sexual activities online.
YesNo

27. I have attempted to stop my online sexual behaviors.
YesNo

28. I have subscribed to or regularly purchased or rented sexually explicit materials (magazines, videos, books or online pornography).
YesNo

29. I have been sexual with minors.
YesNo

30. I have spent considerable time and money on strip clubs, adult bookstores, and movie houses.
YesNo

31. I have engaged prostitutes and escorts to satisfy my sexual needs.
YesNo

32. I have spent considerable time surfing pornography online.
YesNo

33. I have used magazines, videos, or online pornography even when there was a considerable risk of being caught by family members who would be upset by my behavior.
YesNo

34. I have regularly purchased romantic novels or sexually explicit magazines.
YesNo

35. I have stayed in romantic relationships after they became emotionally or abusive.
YesNo

36. I have traded sex for money or gifts.
YesNo

37. I have maintained multiple romantic or sexual relationships at the same time.
YesNo

38. After sexually acting out, I sometimes refrain from all sex for a significant period.
YesNo

39. I have regularly engaged in sadomasochistic behavior.
YesNo

40. I visit sexual bath-houses, sex clubs or video/bookstores as part of my regular sexual activity.
YesNo

41. I have engaged in unsafe or "risky" sex even though I knew it could cause me harm.
YesNo

42. I have cruised public restrooms, rest areas or parks looking for sex with strangers.
YesNo

43. I believe casual or anonymous sex has kept me from having more long-term intimate relationships.
YesNo

44. My sexual behavior has put me at risk for arrest for lewd conduct or public indecency.
YesNo

45. I have been paid for sex.
YesNo

Thank you, Please submit and allow time for the results to be analyzed and shared with you soon.