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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. In answering these questions the following definitions apply:

Sexual Activity: can include caressing, foreplay, masturbation and vaginal intercourse.

Sexual Intercourse: is defined as penetration (entry) of the vagina.

Sexual Stimulation: includes situations like foreplay with a partner, self-stimulation (masturbation), or sexual fantasy.

Check Only One Box Per Question.