Sexual History Questionnaire (Couples)

    Basic Information

    Provide only the information you are comfortable having me know. If you prefer we can complete the form together. You only fill in the form to the extent that you wish. After filling in the form, please click the send button at the bottom of the page, thank you.



    Gender Identity:

    Sexual Orientation:

    I heard about your services through:


    Current Experience

    Currently, I am experiencing (Tick all that apply):

    Lack of arousal or interestDifficulty achieving orgasm with partnerBoredom/repetition/sameness in my sex lifeDifficulty achieving orgasm alonePain/discomfort/lack of pleasurePelvic Floor DifficultiesInability to be sexually satisfied by my partner some or all of the timeInability to sexually satisfy myself some or all of the timeInability to sexually satisfy my partner some or all of the timeDon't like my bodyInability to know what my sexual needs are some or all of the timeInability to communicate my sexual needs some or all of the timeGenital problems eg pain/arousal issues/drynessFears around sexual contactLimited sense of connection with partnerFeeling tense around sexual mattersLack of confidence when being intimate with my partnerDesire to widen my sexual rangeDesire to be more sexually confidentOther

    Sexual History/Experience

    Briefly describe your attitudes, thoughts, feelings, or perceptions about the following:

    Your relationship with your body

    Being in a relationship

    Being intimate with others

    Sexual intercourse



    Oral Sex

    Anal Play

    Dressing up/Role play/BDSM/Kink


    Are you taking any medication or do you regularly take any substance?

    If you are seeing a doctor or therapist for any sexual or sexually related issue, please specify. Let me know if you would like me to get in touch with them to better meet your needs. If yes, please provide their name, practice and contact details below.

    Please tick your preferred medium for your sessions (specify for Combination and Other):
    In personZoomTelephoneEmailCombinationOther


    Examples of Possible Interests

    Here are some examples of what clients may want to work on. I work in a way which will be most supportive to you. This can be talking or body work (non-erotic or erotic) or a combination. I will always go at your pace and discuss and agree any body work beforehand.

    Understanding my bodyBecoming more comfortable (and skilled) with my partner’s body and their pleasureUnderstanding my partner's bodyFinding pleasure for myselfBringing more variety to my sex lifeLearning to be more open and relaxedwith my partnerDiscovering and communicating my needs and desires with my partnerExperiencing arousal in a relaxed statewith my partnerSelf-PleasuringBuilding connection and intimacy with my partnerBeing a better lover with my partnerExamining the dynamics of my relationshipIncreasing sexual satisfactionDeveloping, extending/expanding orgasmic statesSexual exploration with my partnerLearning about pleasure with my partnerDesire to discuss sexual matters with my partner in a supportive environmentOther


    1. Please describe the sex education and messages you received about sexuality when you were growing up, and comment on the ways in which this may affect you today.

    2. What is your sex life like now? What would make it better? What would your ideal sex life look like?

    3. Do you have sexual fantasies? What do you feel about them?

    4. Please describe your current sex drive and what you feel about it?

    5. Is there any difference between your ability to orgasm when masturbating and when with a partner and the kind of orgasm you experience? How satisfying is each experience? What would make either/each better? Ideally, how would you like each to be?

    6. What, if anything do you feel is missing from your sex life?

    7. Do you have a sense that you have a wider range of sexual activities, expressions and feelings than you currently experience now? What might these be?

    8. Wonderful things I want you to know about my sexual/sensual history are:

    9. Tell me about your experience of counselling/coaching/therapy/bodywork? What was most helpful and what was least helpful?

    10. Have you had any bodywork (non-erotic or erotic) experience before? If yes, how did you find it?

    11. Would you feel comfortable about receiving physical touch? What would make this a safe and welcome experience for you?

    12. What/where do you want our initial focus to be?

    13. What do you need from me to create the environment where you can experience the changes that you want?

    14. Ideally, at the end of our work together, how would you be different? How would your life be different?

    15. Please add anything else you think is important that I should know.

    Questions on your Current Relationship

    16. How would you describe your sexual relationship at present?

    17. In what way, if anything, has it changed over time?

    18. What do you enjoy in the relationship?

    19. What could, if anything, could be better?

    20. What, if anything, would you like to experience, that you currently do not, in the relationship?

    21. How, if at all, would you like your partner to be different and how do you imagine this could happen?

    22. How, if at all, would you like to be different and what’s preventing you being different?

    23. What is the best sexual experience you have ever had in your life? What made it so?

    24. What is the best sexual experience you have ever had with your partner? What made it so?

    25. If you can imagine your ideal sexual encounter what would that be like?

    26. Ideally, what would you like your sexual relationship to be like?

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