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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