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Sexual Health Mini-Profile
Welcome to the mini-profile on Sexual Health. In just minutes, you'll get feedback on your sexual health profile.

How many different sexual partners have you had in the past year? 0
1
2-5
More than 5
 
On average, how often do you have sexual intercourse? Never
A few times per year
A few times per month
1 or more times per week
 
When you have sex, do you or your partner use birth control? Yes
No
 
Which method(s) of birth control do you use? None - I am trying to conceive
Condoms
Diaphragm
Birth Control Pills
Cervical Cap
Spermicides (foam, jelly, cream)
IUD
Rhythm method/Fertility awareness
Withdrawal
Abstinence
Hormonal Implants (e.g. Norplant)
Hormonal Injections (e.g. Depo-Provera)
Tubal Ligation/Vasectomy
 
When you have intercourse, how often do you or your partner use a condom? Always
Most of the time
Sometimes
Rarely or never
 
Are you emotionally and physically satisfied with your sexuality? Yes
No
 
Do you ever get yeast infections?(itching or burning of vaginal lips, cottage-cheese like discharge, unusual odor)<> Yes
No
Not sure
 
Which sexually transmitted diseases have you had in your lifetime? Genital Herpes
Syphilis
Gonorrhea
Chlamydia
Human Papilloma Virus/Condyloma (genital warts)
Trichomoniasis
HIV Infection
Gardnerella
 
Do you have or suspect you may have a sexually transmitted disease that has not been successfully treated? Yes
No
 
Do you have a chronic sexually transmitted disease or sexually related problem (e.g. herpes, impotence) for which you would like counseling? Yes
No
 
Do you use or have you used intravenous drugs? Yes
No
 
Have your ever had unprotected sex (without a condom) with a prostitute? Yes
No
Not sure
 
Have your ever had unprotected sex (without a condom) with anyone who used intravenous drugs? Yes
No
Not sure
 
Have you ever had unprotected sex(without a condom) with a man who has sex with other men? Yes
No
Not sure
 
If you are sexually active (especially with multiple partners) please indicate which of the following tests you have had in the past 6 months: Gonorrhea culture
Yes
No
Not sure

VDRL/Syphilis blood test
Yes
No
Not sure

Genital Herpes examination
Yes
No
Not sure

Chlamydia test
Yes
No
Not sure

Human Papilloma Virus/Condyloma examination(genital warts)
Yes
No
Not sure
HIV test
Yes
No
Not sure

 

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