Quality of Life Research, 5, pp.

81-90

The Sexual Activity Questionnaire:

A measure of women’s sexual functioning

K. Thirlaway,* L. Fallowfield and J. Curlck

CRC Communication and Counselling Research Centre, Department of
Oncology, University College London Medical School, 3rd Floor, Bland Sutton
Institute, 48 Riding House Street, London WIP 7PL (K. Thirlaway, L. Fallowfield);
Department of Mathematics, Statistics and Epidemiology, Imperial Cancer
Research Campaign, 61, Lincoln’s Inn Fields, London WCPA 3PX (J. Cuzick)

Sexual activity is an important dimension of quality that any treatment may have on sexual functioning
of life. Therefore it is important to assess the impact so that patients can be warned of possible side effects
that any treatment may have on sexual functioning and interventions offered to help ameliorate these.
so that patients can be warned of possible side
effects and interventions offered to help ameliorate This is particularly relevant when preventative treat-
these. The Sexual Activity Questionnaire (SAQ) was ments are offered to people who may be at risk of
developed to investigate the impact of long-term disease but are not actually ill. The Sexual Activity
tamoxifen on the sexual functioning of women at Questionnaire (SAQ) was developed to investigate
high risk of developing breast cancer. It was also the impact of long-term tamoxifen on the sexual
tested on a sample of women with no such risk.
The majority of variance in sexual functioning can functioning of women at high risk of developing
be explained by three factors: pleasure from sexual breast cancer.
intercourse, discomfort during sexual intercourse Women who have a family history of breast cancer
and habit. We found that the frequency of sexual are currently being recruited into the tamoxifen pre-
activity decreased steadily with age. Furthermore,
pleasure dropped and discomfort increased in women vention trial. It is hoped that tamoxifen will prevent
aged over 55. We report psychometric data showing breast cancer in these ‘high risk’ women: the rationale
that the SAQ is a valid, reliable and acceptable meas- for this is based on the observation that new turnouts
ure for describing the sexual functioning of women in the contralateral breast are reduced if women take
in terms of activity, pleasure and discomfort. It is
quick and easy to administer and has good face tamoxifen after surgery.’ As tamoxifen in certain situ-
validity discriminating between the sexual function- ations has anti-estrogenic effects, altering a woman’s
ing of pre- and post-menopausal women. hormonal status in this way could produce changes
in the vasomotor system, mood state and to libido.
Key words: Menopause; quality of life assessment; Consequently the sexual functioning of ‘high risk
sexual activity; sexual functioning
women participating in the tamoxifen prevention trial
is being investigated using the SAQ.
Most of the available sexual functioning question-
Introduction naires were designed specifically to investigate sexual
dysfunction, for instance the Derogatis Sexual Func-
Sexual activity is an important dimension of quality tioning Inventory,’ the Sexual Interaction Inventory3
of life. Therefore it is important to assess the impact or the Sexuality Scale.’ These were deemed unneces-
sarily explicit for the purposes of the tamoxifen
The authors acknowledge the help and assistance of the staff who prevention trial so the new instrument was devel-
run the tamoxifen prevention clinics in London and Manchester oped. In this paper we report early reliability and
and also the staff and doctors from the two general practice
surgeries. The CRC provided t3nancial support for this stud . Dr. validity data.
Amanda Rameriz was involved in the development of the l AQ.

* To whom correspondence should be addressed at CRC

Communication and Counselling Research Centre, Dept. Method
of Oncology, University College London Medical School,
3rd Floor, Bland Sutton Institute, 46 Riding House Street, The SAQ was developed as a self-report question-
London WIP 7PL. naire which would be quick to complete and

@ 1996 Rapid Science Publishers Quality of Life Research Vol5 1996 81

K. Thirlazuay et al.

acceptable to the majority of women. Some items of from two general practice surgeries in central and
the questionnaire were taken from the PEPI* which north-east London and 40 female staff from a city
is being used in the USA Tamoxifen prevention trial. comprehensive school, a health authority education
An example of the SAQ can be found in Appendix 1. department and delegates attending a psychological
The SAQ has three sections: conference.

Section 1: Hormonal status. All women complete the

first section which has six items assessing hormonal Procedure
status and whether or not women are sexually active.
Those who are not sexually active go on to complete The SAQ was given to all women who joined the
section 2 and omit section 3. Those who state that tamoxifen prevention trial, along with other ques-
they are involved in a sexual relationship complete tionnaires, at trial entry before taking any tablets.
section 3. They were asked to return these in pre-paid enve-
lopes. The general population sample were also asked
Section 2: Reasons for sexual inactivity. In this section to return their SAQ’s in pre-paid envelopes.
seven possible reasons for sexual inactivity are listed All subjects were assured of the confidential nature
and women are asked to tick those that apply to them of the study and did not have to supply their names
and are also given space to add any further reasons on the questionnaires. A factor analysis (with varimax
applicable to them. rotation)5 was performed to look at the relationships
between the 10 questions assessing sexual function-
Section 3: Sexual functioning. The section on sexual ing. Test-retest reliability was assessed by asking 29
functioning was designed to assess those aspects of of the general population sample to complete the
sexual function that may be influenced by hormonal SAQ and once again a fortnight later.
status: desire, frequency, satisfaction, dryness of The discriminative validity of the SAQ was
vagina and penetration pain. It contains 10 questions, assessed by looking for differences in sexual func-
nine of which require Likert-type responses. Actual tioning between women in different hormonal states,
numerical categories were provided for the question i.e. pre-menopausal women, those taking HRT and
on frequency post-menopausal women.

Subjects Statistical analyses

The SAQ was specifically designed for use in the Test-retest reliability. Kappa statistics and Pearson’s
tamoxifen prevention trial. Eligible women, that is, correlations were used for test-retest ratios of com-
those non-symptomatic, aged over thirty-five with a parison. Both methods resulted in consistently high
strong family history of breast cancer, were recruited correlations (Table 4).
into a psychosocial study at two centres: The Royal
Marsden in London and the Withington Hospital in Sexual activity. Differences between three different
Manchester. The SAQ was part of a battery of age groups and between pre- and post-menopausal
psychological questionnaires completed at the start women and those taking HRT were investigated us-
of the study and then at six monthly intervals for 5 ing the Mantel-Haenszel test for linear association.
years. Two groups of women have completed the All p-values are 2-sided.
SAQ; 447 women with a strong family history of
breast cancer ‘high risk’ and 81 women with no family
Monthly sexualfitnctioning and habitual sexual activity.
history of breast cancer.
Differences between three different age groups and
In order to investigate whether the sexual
between pre- and post-menopausal women and those
functioning of women with a strong family history taking HRT were investigated using the Wilcoxon
of breast cancer was different from women without Trend Test. All p-values are 2-sided.
one, a sample of 81 women were recruited from the
general population. This group comprised 41 women
Pleasure and physical discomfort. Differences between
the three age groups and between pre-or post-
menopausal women and those taking HRT were
lSchain W. The PEPI as used in the American tamoxifen investigated using the Kruskal-Wallis one way analy-
prevention study. A personal communication. sis of variance.

82 Quality of Life Research Vol 5 1996

 The sexual activity questionnaire

Table 1. Comparison of age ranges in the ‘at risk’ women and the general population sample

Me
35-45 4655 55-55
‘High risk’ women 166 (32%) 274 (52.2%) 83 (15.8%)
General population sample 38 (46.9%) 39 (48.1%) 4 (4.9%)

Table 2. A comparison of the occupational status of ‘high risk’ women and the general population sample
Occupational group
I II Ill IV V
‘High risk’ women 34 (6.5%) 151 (28.8%) 176 (33.5%) 22 (4.2%) 142 (27.0%)
General population sample 23 (28.4%) 26 (32.1%) 6 (7.4%) 2 (2.5%) 24 (29.6%)

Table 3. A comparison of the hormonal status of ‘high risk’ women and the general population sample
Hormonal status
Pre HRT Post
‘High risk’ women 209 (51.2%) 81 (19.9%) 118 (28.9%)
General population sample 47 (70.1%) 13 (19.4%) 7 (10.4%)

Table 4. The K and R2 scores for items from the SAQ based on a sample of 29 women surveyed 2 weeks
apart

Questions K R2

Section 1.
Do you still have periods? 1.oo 1 .oo
Do you take the contraceptive pill? 0.88 0.89
Are you taking HRT? 1.oo 1 .oo
Are you married or in a intimate relationship? 0.84 0.85
Have you changed your partner in the last 6 months? 0.84 0.85
Do you engage in sexual activity? 0.76 0.85
Section 3.
Was ‘having sex’ an important part of your life this month? 0.70 0.93
Did you enjoy sexual activity this month? 0.73 0.94
In general, were you too tired to have sex this month? 0.57 0.68
Did you desire to have sex with your partner(s) this month? 0.73 0.94
How frequently did you notice dryness of your vagina? 0.50 0.65
Did you feel pain or discomfort during penetration? 0.51 0.88
In general, did you feel satisfied after sexual activity? 0.70 0.90
How often did you engage in sexual activity this month? 0.76 0.93
How did this frequency compare with normal? 0.55 0.89
Were you satisfied with frequency of sexual activity? 0.54 0.92

Quality of Life Research Vo15 1996 83

K. Thirlawuy et al.

Results Significantly more women from the general popula-

tion sample were pm-menopausal than were from
There were no significant differences for any variable the ‘high risk ’ sample (p=O.O009). A similar percent-
between those women without a family history age from both groups reported taking HRT (Table 3).
recruited from the different populations. Therefore
all these women were grouped together as the general Test-retest JOY reliability. Twenty-nine women from
population sample. the general population sample completed the SAQ
twice with an intervening a period of 2 weeks. Cor-
relations between items ranged between 0.5000 and
Compliance and acceptability 1.000 by the Kappa statistic and between 0.65 and
1.000 using Pearson’s correlation coefficient (Table 4).
Of the 525 ‘high risk’ women aged between 35 and
65 given the SAQ, 447 (85.1%) completed and Factor analysis. The factor analysis was carried out
returned it. Overall compliance to the non-sexual using the entire sample. Three factors accounted for
questionnaires in the psychosocial study was 88.2%. 64.8% of the variance. The item groupings and factor
Compliance to the SAQ was not significantly different loadings are shown in Table 5. The factor analysis
from the other standard psychological questionnaires was repeated for the two separate samples (‘high
administered concurrently From the general popula- risk’ women and the general population sample).
tion sample 91 women were given the SAQ and 81 There were few differences between the two analyses
(87.9%) completed and returned them. Compliance and so the combined analysis is presented. The only
was similar in both the ‘at risk’ group and the general difference was for the third question ‘Were you too
population sample. It would appear that the SAQ is tired to have sex this month?’ It was marginally below
acceptable to the majority of women. the cut off for the total group and marginally above
in the separate analyses.

Demographics
Scoring
Age. The mean age of the ‘high risk ’ women was
48.7 years, The mean age of the general population Factor scores were obtained by adding together the
sample was 45.5 years. For the purposes of this study weighted loadings for each question that contributed
the women were divided into three categories to each factor.
according to their age (Table 1). The majority of A high score represents high pleasure (desire, en-
women from both samples were aged 46-55. How- joyment and satisfaction). Alow score represents low
ever, very few women from the general population discomfort. Habit is a single item and the values are
sample were aged 56-65. as recorded in the questionnaire (Appendix 1).
All of the questions in section 3 (sexual functioning)
Occupution. Women were classified using the Registrar of the SAQ contributed to the three factors apart from
General Classification System according to their question 3: ‘In general, were you too tired to have
occupation: I Professional, II Semi-professional, III sex this month?’ Tiredness was also listed as a pos-
Skilled, IV Unskilled and V Not classifiable. The sible reason for sexual inactivity in section 2. The
final class V included students, housewives, volun- repetition of this question may render it redundant.
tary counsellors and others with an occupation which
did not fit into the first four categories.
‘High risk’ women were mostly from groups II Simplified factor scores
and III whereas in the general population sample the
women were mainly from groups I and II. Nearly a The weighted loadings of each question making up
third of women from both groups were not classifi- the two factors were similar (Table 5). Therefore, a
able by occupation (Table 2). simplified method of calculating factor scores is
appropriate. The factors can be generated by adding
together the raw scores for each relevant question.
Hormonal status Pearson correlations between pleasure (calculated by
the weighted loadings and the simplified methods)
Women were divided into three groups: pre- and discomfort (also calculated by both methods)
menopausal, post-menopausal or taking HRT. were 0.97 and 0.99 respectively. It is useful for inter-

84 Quality of Life Research Vo15 1996

 The sexual activity questionnaire

Table 5. The three SAQ scales: pleasure, discomfort, habit generated by the factor analysis (percentage variance
and weighted factor loadings)
Factor 1: Pleasure (40.3%)
1. Was having sex an important part of your life? (0.82)
2. Did you enjoy sexual activity? (0.87)
4. Did you desire to have sex with your partner? (0.82)
7. In general were you satisfied after sexual activity? (0.80)
8. How often did you engage in sexual activity? (0.87)
10. Were you satisfied with the frequency of sex? (0.56)
Factor 2: Discomfort (14.3%)
5. Did you notice dryness of your vagina this month? (0.88)
6. Did you feel pain or discomfort this month? (0.86)
Factor 3: Habit (10.2%)
9. How did this frequency of sexual behaviour compare with what is usual for you? (0.86)

Table 6. Percentage of sexually active women among different groups

Percentage (number) of sexually active women
Entire sample (k527) 79.5% (419)
Age 35-45 (k184) 87.0% (160)
Age 46-55 (n=271) 79.7% (216)
Age 56-65 (n=72) 59.7% (43)
Pre-menopausal (n=278) 94.1% (240)
HRT (n=109) 88.2% (81)
Post menopausal (*140) 77.6% (98)

study comparisons to be able to generate factor scores The percentage of sexually active women drops
by this simplified version. In this paper normative significantly from pre-menopausal women to women
scores generated by both methods are presented in taking HRT and is lowest in post-menopausal women
Table 9 enabling other users of the SAQ to make (x2 = 22.3692, p c 0.0001).
direct comparisons with data from the present study

Normative scores. Normative scores are presented for Reasons for sexual inactivity
sexual activity, monthly frequency of sexual activity,
pleasure, discomfort and habit. Normal scores are One hundred and eight (20.5%) women reported that
presented for: the entire sample, the three age groups they were not sexually active. Reasons for sexual
previously defined and for the three groups of women inactivity are shown in Figure 1. The most frequently
with different hormonal states. There were no differ- cited reason for sexual inactivity is the lack of a
ences between the ‘high risk’ and the general partner. Among those who do have a partner lack of
population samples in terms of sexual activity, interest in sex is the predominant reason for sexual
monthly frequency of sexual activity, pleasure, dis- inactivity
comfort or habit. Therefore the two groups will be
combined to give the normal scores reported below.
Monthly frequency of sexual activity

Sexual activity The percentage of women reporting different fre-

quencies of sexual activity are shown in Table 7. These
The percentages of sexually active women are shown figures do not include those women who reported
in Table 6. The percentage of sexually active women that they were not sexually active. These were based
significantly decreases with age (x2 =20.6132, p <O.OOOl). on those women who reported themselves as sexually

Quality of Life Research Vol5 19% 85

K. Thirlmay et al.

Table 7. Monthly frequency of sexual activity, percentage (number) reporting each frequency
Monthly frequency of sexual activity: % (number)
>5 3-4 2-l 0
Entire sample (n=408) 44.1% (180) 29.7% (121) 24.3% (99) 2.0% (8)
Age 35-45 (n=158) 48.7% (77) 28.5% (45) 22.2% (35) 0.6% (1)
Age 46-55 (n=208) 42.8% (89) 30.8% (64) 23.6% (49) 2.9% (6)
Age 56-65 (n=42) 33.3% (14) 28.6% (12) 35.7% (15) 2.4% (1)
Pre-menopausal (*249) 45.0% (112) 26.9% (67) 20.5% (51) 7.6% (19)
HRT (n=92) 30.4% (28) 25.0% (23) 28.3% (26) 16.3% (15)
Post-menopausal (n=143) 32.8% (40) 26.2% (32) 18.9% (23) 22.1% (27)

Table 8. The percentage (number) of women reporting normal, increased or decreased sexual activity
Changes in frequency of sexual activity
Much more Somewhat more Same Less
Entire sample (n=407) 3.7% (15) 8.8% (36) 75.2% (306) 12.3% (50)
Age 35-45 (n=158) 5.1% (8) 10.1% (16) 76.6% (121) 8.2% (13)
Age 4655 (n=207) 3.4% (7) 9.2% (19) 72.0% (149) 15.5% (32)
Age 56-65 (n=42) 0.0% (0) 2.4% (1) 85.7% (36) 11.9% (5)
Pre-menopausal (o=238) 5.0% (12) 8.4% (20) 76.5% (182) 10.1% (24)
HRT (n=84) 1.2% (1) 11.9% (10) 65.6% (55) 21.4% (18)
Post-menopausal (ff=99) 4.0% (4) 6.1% (6) 78.8% (78) 11.1% (11)

active although they may not have participated in Pleasure (desire, enjoyment and satisfaction)
sexual activity during the month in question. There
was a significant difference in monthly frequency of The factor scores for pleasure had a skewed distri-
sexual activity between the age groups (x2=4.56, bution (Figure 2). Therefore median scores (actual
p=O.O3). Younger women reported higher frequencies and simplified) are presented for the entire sample,
of sexual activity. There was a significant difference the three age groups and pre- and post-menopausal
in monthly frequency of sexual activity between women and women taking HRT (Table 9). There is a
menopausal categories (x2 =14.60, p=O.OOOl). Pre- significant interaction between age and pleasure
menopausal women were more likely to participate scores (x2 =9.6451, p=O.O08). Older women reported
in sexual activity more than five times a month and lower levels of pleasure. There is no significant
less likely to have had no sexual activity over the interaction between hormonal status and pleasure
last month than either post-menopausal women or scores.
women taking HRT.

Discomfort
Habit (habitual sexual behaviour)
The factor scores for discomfort had a skewed
The percentage of women reporting normal sexual distribution (Figure 3). Therefore median scores (ac-
activity, more or less sexual activity than usual are tual and simplified) ranges for discomfort are
reported in Table 8. The majority of all women re- presented (Table 9). There is a significant interaction
ported that the sexual activity that they had reported between age and discomfort (x2 =13.65, p=O.OOl).
in the SAQ was usual for them. Amongst those who Older women report higher levels of discomfort.
did report that their sexual activity during the period There is a significant interaction between hormonal
in question was different from usual, older women status and discomfort (x’ =28.59, p < 0.0001). Discom-
were more likely to report reduced sexual activity fort is lowest in pm-menopausal women, higher in
and younger women increased sexual activity 01’ =5.67, women taking HRT and highest in post-menopausal
p=O.O17). women.

86 Qualrty of Life Research Vol 5 1996

 The sexual activity questionnaire

Figure 1. Reasons for celibacy (rk-108) Figure 2. Distribution of pleasure scores

N=108
60 r

80
c
E
g 60

%
2)
2 40

2
1 2 3 4 5 6 7 a 9
20
Reasons for no sexual activity

0
-32 -26 -20 -14 -6 -2 4 1.0 1.6
= 1. No partner 7 13
-29 -23 -1 7 -11 -5 1
l 2. Too tired
Actual Pleasure scores
n 3. Partner too Wed
=4. Not interested
n 5. Partner not Interested
= 6. Physlcal problem
= 7. Partner with physical problem Discussion
= 8 Relationship problem
n 9. Mutual Areement The diagnosis and treatment of cancer can often have
a negative impact on sexual functioning. It is not
always easy for the patient or doctor to talk about
such issues. A questionnaire may help doctors and
patients address this sensitive area. The SAQ was
acceptable to the majority of women in this sample.
Despite the sensitive nature of the subject compliance
Figure 3. Distribution of discomfort scores was on a par with compliance to other standardized
psychological questionnaires administered concur-
rently, i.e. the General Health Questionnaire and the
Spielberger state-trait anxiety inventory
There were no significant differences between the
250 - ‘high risk’ sample and the general population sample
on any of the variables investigated. We concluded
that the sexual functioning of ‘high risk’ women was
representative of women in the age range 35-65 and
the two samples were combined to give the normal
scores reported. The occupation status of this sample
was biased towards class I, II and III and the normal
scores presented here may not be representative of
women from all classes. The SAQ was found to be a
reliable questionnaire with very high correlations and
K scores on all questions.
The majority of variance in sexual functioning can
be explained by three factors. Pleasure from sexual
II intercourse (desire, enjoyment and satisfaction), dis-
-12-9-6-3 0 3 6 9121516212427303336
comfort during sexual intercourse (dryness and pain)
Actual Discomfort scores
and habit (how usual the reported behaviour is).
Generally women reported that sexual activity was

Quality of Life Research Vol5 1996 87

K. Thirlaway et al.

Table 9. Actual and (simplified) median scores for pleasure and discomfort
Actual and (simplified) median scores
Pleasure Discomfort
Entire sample (rk410) 0.156 (14) - 0.509 (0)
Age 35-45 (n=l56) 0.148 (14) - 0.545 (0)
Age 46-55 (n=205) 0.390 (14) - 0.502 (0)
Age 56-65 (n=-47) - 0.322 (11) 0.576 (1)
Pre-menopausal (n=228) 0.281 (14) - 0.550 (0)
HRT (ri=83) 0.027 (12) - 0.086 (1)
Post-menopausal (n=99) 0.031 (13) 0.074 (1)

pleasurable and caused little physical discomfort. The Davidson: Kinsey et aI.” and Hallstrom” have all
majority stated that sexual activity reported in the reported a decline in sexual functioning after meno-
SAQ was their normal pattern of behaviour. pause. It is quick and easy to administer and a reliable
The SAQ provided a description of sexual acceptable measure. It describes sexual functioning
functioning in this population of normal non- in terms of levels of activity, pleasure and discomfort.
symptomatic women that was very much as would
have been predicted. Sexual activity, and frequency
of sexual activity decreased steadily with age. Pleas- References
ure and discomfort during sexual activity was similar
in the two younger age groups but pleasure dropped Cuzick J, Baum M. Tamoxifen and contralateral breast
cancer. Lmcet 1985; i: 282.
and discomfort increased significantly in women over
Derogatis L.R. Psychological assessment of psychosexual
the age of 55. Sexual activity and frequency of sexual functioning. PsychiatChin N Am 1980; 3: 113-131.
activity also decreased steadily from pre-menopausal LoPiccolo J and Steger JC. The sexual interaction inven-
women and women taking HRT to its lowest in post- tory: A new instrument for assessment of sexual
menopausal women. Reported pleasure was not dysfunction. Arc Sex Beh 1974; 3: 585595.
significantly different in the three groups, although 4. Snell WE and Papini DR. The Sexuality Scale: An instru-
the trend was for pre-menopausal women to report ment to measure sexual-esteem, sexual-depression and
sexual-preoccupation. 1 Sex Res 1989; 26: 256-263.
higher levels of pleasure than either post-menopausal
5. Norusis MJ. SPSS/PC+ Statistics 4.0. Illinois: SPSS Inc,
women or those taking HRT. There was a significant 1990: B125-152.
relationship between discomfort and hormonal 6. Stone AB and Pearlstein TB. Evaluation and treahnent
group. Reported discomfort was significantly lower of changes in mood, sleep, and sexual functioning asso-
in pre-menopausal women, higher in those taking ciated with menopause. Obs Gyn Clin N Am 1994; 21:
391-403.
HRT and highest in post-menopausal women The
7. Sherwin BB. Sex hormones and psychological functioning
data reported here suggest that ageing and experi- in post menopausal women. Exp Geron 1994; 29: 423-430.
encing the menopause can have a negative impact 8. Hunter MS, Battersby R, Whitehead M. Relationships be-
on sexual functioning. Previous studies have reported tween psychological symptoms, somatic complaints and
that vaginal dryness and penetration pain in meno- menopausal status. Jvfatutitas1986; 8: 217-228.
pausal women decreases with estrogen therapy.“7 The 9. McCoy NL and Davidson JM. A longitudinal study of
the effects of menopause on sexuality. h4aturitis 1985; 7:
amount of benefit in terms of reduced discomfort
203-210.
afforded by HRT is not clear. The data from this study 10. Kinsey AC, Pomeroy WB, Martin CE, Gebhard PH. Sexual
suggests that HRT results in some limited reduction behaviour in the human female. Philadelphia: WB Saunders.
in discomfort but not to levels experienced by pre- 1953.
menopausal women. This study also replicates other 11. Hallstrom T, Samuelsson S. Changes in women’s sexual
studies that have reported no impact of estrogen desire in middle life: The longitudinal study of women
in Gothenburg. Arch Sex Behuv 1990; 19: 259-268.
therapy on sexual desire or arousal.6,7
In conclusion, the SAQ is a measure of sexual
activity which is acceptable to the majority of women
aged between 35 and 65. It has face validity, discrimi-
nating between the sexual functioning of pre- and (Received 7 June 1995;
post-menopausal women. Hunter et al,* McCoy and accepted 20 July 1995)

88 Quality of Life Research Vol 5 1996

 The sexual activity questionnaire

Appendix 1: Sexual activity questionnaire (@ Fallowfield)

STRICTLY CONFIDENTIAL

Occasionally, around the time of the menopause, some women notice hormonal changes which may affect
their sexual relationships. Although the following questions are sensitive and personal, they are important
in determinin g how hormonal treatment affects this part of your life. Please be assured that your responses
to these questions will remain confidential.
no

Are you currently married or having an intimate relationship with someone? cl

“0
Have you changed you sexual partner in the last 6 months? 0 cl
Yes no

Do you engage in sexual activity with anyone at the moment? 0

If ‘No’ please
answer remaining
questions on this
woe

I am not sexually active at the moment because:

(please tick as many of these items as apply)

a) I do not have a partner at the moment 0

b) I am too tired cl
c) My partner is too tired Cl
d) I am not interested in sex 0
e) My partner is not interested in sex q
f) I have a physical problem which makes sexual relations difficult or uncomfortable 0
g) My partner has a physical problem which makes sexual relations difficult or uncomfortable Cl
h) Other reasons (please describe) cl

Quality of Life Research Vol5 19% 89

K. Thirlaway et al.

Page 2

STRICTLY CONFIDENTIAL

Please read each of the following questions carefully and tick the box that best indicates your sexual feelings
and experiences during the past month.

very much a little not at all

During the past month:

1. Was ‘having sex’ an important part of your life this month? q Cl q q

2. Did you enjoy sexual activity this month? q q q q
3. In general, were you too tired to have sex? q q q q
4. Did you desire to have sex with your partner(s) this month? q q q q
5. During sexual relations, how frequently did you notice q q q q
dryness of your vagina this month?

6. Did you feel pain or discomfort during penetration this q q q q

month?

7. In general, did you feel satisfied after sexual activity this q q q q

month?
5 times or 3-4 hmes l-2 times not at all
more

8. How often did you engage in sexual activity this month? q q q q

much somewhat about the less than
more more same USUSI

9. How did this frequency of sexual activity compare with what q q q q

is usual for you?
very much somewhat alIttIe not at all

10. Were you satisfied with the frequency of sexual activity this q q q q
month?

Any other comments

Thank you very much for answering these questions.

90 Quality of Life Research Vol 5 1996