Sex Feedback Questionnaire

Please fill out the form to the best of your ability.

I. Overall Experience
Select a number that corresponds to how strongly you agree with the statement, a 5 means that you strongly agree and 1 means you strongly disagree.

SD D N A SA
1. My partner set an appropriate mood 1 2 3 4 5
2. My partner’s cleanliness was satisfactory 1 2 3 4 5
3. My partner was attentive the entire time 1 2 3 4 5
4. My partner responded quickly and efficiently 1 2 3 4 5
5. My partner was very pleasing overall 1 2 3 4 5

II. Foreplay
Select a number that corresponds to how strongly you agree with the statement, a 5 means that you strongly agree and 1 means you strongly disagree.

SD D N A SA
6. The length of the foreplay was satisfactory 1 2 3 4 5
7. The foreplay was physically, sensually and
erotically pleasing 1 2 3 4 5
8. I was touched and teased in the spots that I
enjoy most 1 2 3 4 5
9. The intensity of the foreplay (rough, soft,
vigorous, slow, etc) was pleasing 1 2 3 4 5
10. The foreplay made me wanting and ready
for intercourse 1 2 3 4 5

III. Intercourse
Select a number that corresponds to how strongly you agree with the statement, a 5 means that you strongly agree and 1 means you strongly disagree.

SD D N A SA
11. My partner’s lasting power (length of
intercourse) was satisfactory 1 2 3 4 5
12. The position (or positions) we chose
for intercourse were pleasing to me 1 2 3 4 5
13. My partner paid attention to my needs
throughout 1 2 3 4 5
14. My partner’s technique was pleasing
(including angle, depth of penetration,
speed, intensity, etc.) 1 2 3 4 5
15. My partner elevated the experience to
increase my pleasure (included toys,
dirty talk, video camera, etc.) 1 2 3 4 5

IV. Oral Sex (if applicable)
Select a number that corresponds to how strongly you agree with the statement, a 5 means that you strongly agree and 1 means you strongly disagree.

SD D N A SA
16. My partner gave as much as he received 1 2 3 4 5
17. My partner’s technique was pleasing 1 2 3 4 5
18. My partner’s grooming habits were
satisfactory 1 2 3 4 5
19. My partner treated me with respect 1 2 3 4 5
20. Overall, I enjoyed the oral sex part of
the experience 1 2 3 4 5

V. Open-ended Questions

21. Please note two things that your partner did exceptionally well during your experience.

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22. Please note two things that your partner did not do well and could improve upon in the future.

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23. Please note anything else you wish to add about your experience.

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24. Please circle the phrase that best describes your feelings about the size of your partner’s erection (due to the sensitivity of this particular question, the answer choices have been changed slightly).

I’m sorry :: It’s an “okay” size

It did the job well enough :: Thank you, may I have another?

Are you a porn star? :: Too big, wouldn’t fit



Thank you for taking your time to fill out this questionnaire. Please leave your completed copy face down on the table next to the door before you leave. Don’t bother trying to call your partner tomorrow, he’ll be sure to call you. Have a wonderful day.