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This questionnaire will help start a conversation between you and your doctor. It will help guide the two of you in determining whether you have a condition related to desire, arousal, orgasm or pain.

__ 1. I am not satisfied with my sex life.

__ 2. I would like my sex life to be better.

__ 3. I have noticed a recent change related to my sex life.

__ 4. My sexual concerns cause me personal distress.

__ 5. My interest in sex has decreased.

__ 6. I do not have erotic thoughts or fantasies.

__ 7. I have no interest in having any kind of sexual activity.

__ 8. I have vaginal dryness during sex.

__ 9. I have less pleasurable sensation, such as warmth and tingling, during sex.

__ 10. I do not feel excited or aroused during sex.

__ 11. I have pain during sexual intercourse.

__ 12. My vagina tightens up during sex and is difficult to enter.

__ 13. I have pain with any kind of vaginal penetration.

__ 14. I have pain during sexual intercourse, but I think I have enough lubrication or wetness.

__ 15. I do not have orgasms.

__ 16. It is more difficult for me to have an orgasm that it once was.

__ 17. I find my orgasms are less intense than they once were.

__ 18. I have sexual difficulties when I have sex with my partner but not when I self-stimulate alone.

__ 19. I think I suffer from depression.

__ 20. I think my sexual problems are psychological.

__ 21. I am not happy with my partner.

__ 22. My sexual problems began after an illness, injury or surgery.

__ 23. My sexual problems began at about the same time as: (Check all that apply)

__ pregnancy

__ childbirth

__ birth control

__ menopause

__ hormonal replacement therapy

24. I have one or more of the following: (Check all that apply)

__ menopause

__ diabetes

__ heart disease

__ hypertension

__ high cholesterol

__ pelvic surgery, such as hysterectomy

__ pelvic radiation therapy

__ smoking or history of smoking

__ 25. I think my sexual problems are physical.


This quiz was developed by Dr. Kevin Billups, a board-certified urologist specializing in male and female sexual health; Dr. Phillip Sarrell, a board-certified gynecologist specializing in menopause and aging issues; and Dr. MaryAnn Schroder, a board-certified clinical sexologist and certified family nurse practitioner specializing in women’s sexual health.

Eros Therapy is not right for everyone, but may be an appropriate treatment if you have a condition related to problems with arousal or orgasm.

Rediscover control over your sexual response

You are not alone. Join other women and learn more about this condition. Take our quiz.

Eros Therapy: A desirable solution.

Eros Therapy is a device that provides a natural way to recondition your sexual response. It was cleared by the FDA in April 2000 to treat sexual arousal and orgasmic disorders. Since then, thousands of women have experienced the benefits of Eros Therapy that include: increased lubrication, clitoral sensation, ability to achieve an orgasm, and overall improvement in sexual satisfaction.

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Phone: 1-877-774-1442 (answered by Curt or Erika)

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