FACTORS IN THE SEXUAL SATISFACTION
OF
OBESE WOMEN IN RELATIONSHIPS
Appendix B
Questionnaire
LARGE WOMEN IN RELATIONSHIPS
DISSERTATION SURVEY
This questionnaire is anonymous. It was designed to gather data on a wide variety of topics including body image, sexual behaviors, and partner attitudes. All information you give will be kept in strictest confidence and will be used for research purposes only.
Please answer every question as accurately as possible.
Even though questions are asked in present time, any questions that pertain to partners or relationships should be answered about either 1) your current relationship (if you have one), or 2) your most recent past relationship that lasted at least 6 months. Body image questions should be answered in regard to your feelings during that same relationship.
This dissertation may eventually be written up as a book. Not every response will be part of the final dissertation. Any further comments you have in response to the questions will be welcome; just write them in the margins.
If you would be interested in the results of this dissertation, or in talking further about these issues, please include your name, address, and telephone number at the end of the questionnaire, or send it to me under separate cover.
DEMOGRAPHICS
1. Age _______
2. Height _______
3. Weight _______
4. Body Mass Index (BMI) (if known) ________
5. Circle years of education: 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
6. List major studies or interests:
List any special training:
7. Main occupations of your life:
8. What is your present work?
9. Ethnic background: Mother: Father:
10. Racial background: Mother: Father:
11. Your Parents' religious upbringing:
a. ___Protestant Mother/father
b. ___Jewish Mother/father
c. ___Catholic Mother/father
d. ___Agnostic Mother/father
e. ___Atheist Mother/father
f. ___Other (describe):
12. Your childhood religious upbringing:
13. Your present religion: Active? ____Yes ____No
14. Approximate personal yearly income: $
15. Current marital status:
16. Are you presently in a long-term sexual relationship? ____Yes ____No
17. If yes, how long have you been in this relationship? ____________________ ____N/A
18. If no, how long has it been since you were in a long-term sexual relationship? __________
How long was that last relationship? ____N/A
DIET HISTORY
1. Please identify the methods you have used over your lifetime to assist you in losing weight.
a. Place a check mark to the left of the methods you have used.
b. Indicate approximate number of times or years you have used that
method.
c. Use the scale to indicate your short and long term success rate.
d. Indicate whether or not you have tried this method within the last
5 years (yes or no).
SCALE: 0 = no wt loss 1 = very little wt loss 2 = average wt loss
3 = good wt loss 4 = reached goal
| ck | Approx number
of times per year |
Short Term
success rate 0-4 |
Long Term
success rate 0-4 |
Tried in
Last 5 years Yes/No |
|
| Calorie and/or fat counting | |||||
| Starving or fasting | |||||
| Vomiting | |||||
| Over exercising | |||||
| Diet pills (amphetamines) | |||||
| Laxatives | |||||
| Diuretics | |||||
| Fen/Phen | |||||
| Liquid diets | |||||
| Overeaters Anonymous | |||||
| Diet clubs | |||||
| Diet spas | |||||
| Thin Within Method | |||||
| Overcoming Overeating Method | |||||
| Geneen Roth Method | |||||
| Support groups | |||||
| Surgical procedure | |||||
| Eating less with exercise | |||||
| Body Acceptance classes | |||||
| Counseling or therapy |
2. If you answered yes to counseling or therapy above, please answer the following regarding the kind of counseling or style of therapy that you received.
a. Place a check mark to the left of the methods you have used.
b. Indicate if you lost weight (circle yes or no).
c. Indicate if gained some body acceptance (circle yes or no).
d. Indicate if benefited in other ways (circle yes or no).
| ck | Lost Wt? | Gained body
acceptance? |
Benefited in
other ways? |
|
| Group therapy | Yes No | Yes No | Yes No | |
| Individual therapy | Yes No | Yes No | Yes No | |
| Body therapies
(Ongoing Massage, Rolfing, Bio-Energetics, etc.) |
Yes No | Yes No | Yes No | |
| Size acceptance seminar | Yes No | Yes No | Yes No | |
| Support group | Yes No | Yes No | Yes No | |
| Specialized therapy
(Gestalt, Psycho Drama, Family Therapy, etc.) |
Yes No | Yes No | Yes No | |
| Other | Yes No | Yes No | Yes No |
3. Did your counselor/therapist/group have a particular style?
(i.e. Gestalt, Freudian, Family Therapy, Adler, Jung, mixture, etc.)
Write in all that apply:
WEIGHT HISTORY
Please answer these questions using the following scale:
SCALE: 1 = a little bigger 2 = somewhat bigger 3 = much bigger 4 = very much bigger 5 = supersize
1. During your childhood (1-12 yrs), were you larger than your peers?
__Yes ___No
If yes, how did you compare in size to your peers? (1-5) _______
2. During your adolescence (13-18 yrs), were you larger than your peers?
__Yes ___No
If yes, how did you compare in size to your peers? (1-5) _______
3. During your young adulthood (19-30 yrs), were you larger than your
peers? __Yes ___No
If yes, how did you compare in size to your peers? (1-5) _______
4. Currently (the last 5 years), are you larger than your peers? __Yes
___No
If yes, how do you compare in size to your peers? (1-5) _______
5. What were your mother's attitudes toward your appearance when you
were growing up?
a. ____ very positive and accepting
b. ____ generally positive
c. ____ neutral
d. ____somewhat negative and critical
e. ____very negative
f. ____don't know
g. ____N/A
6. What were your father's attitudes toward your appearance when you
were growing up?
a. ____ very positive and accepting
b. ____ generally positive
c. ____ neutral
d. ____somewhat negative and critical
e. ____very negative
f. ____don't know
g. ____N/A
7. What were your classmates' attitudes toward your appearance when
you were growing up?
a. ____ very positive and accepting
b. ____ generally positive
c. ____ neutral
d. ____somewhat negative and critical
e. ____very negative
f. ____don't know
g. ____N/A
8. Are you satisfied with your current weight?
a. ____very satisfied
b. ____somewhat satisfied
c. ____neutral
d. ____somewhat dissatisfied
e. ____very dissatisfied
9. How often do you weigh yourself?
a. ____rarely
b. ____once a month
c. ____once a week
d. ____every few days
e. ____once a day
f. ____twice a day or more
10. Are you self-conscious about your appearance in general?
a. ____always
b. ____often
c. ____sometimes
d. ____rarely
e. ____never
11. Are you self-conscious about your appearance around potential sexual
partners?
a. ____always
b. ____often
c. ____sometimes
d. ____rarely
e. ____never
12. When you check yourself in the mirror without clothes, how do you
feel?
a. ____very positive and accepting
b. ____generally positive
c. ____neutral
d. ____somewhat negative and critical
e. ____very negative
13. How do you usually feel about your nude body in sexual encounters?
a. ____ very positive and accepting
b. ____generally positive
c. ____neutral
d. ____somewhat negative and critical
e. ____very negative
14. When asked, do you feel comfortable sharing the truth about your
weight?
a. ____always
b. ____sometimes
c. ____rarely
d. ____never
15. How physically active are you?
a. ____very active
b. ____somewhat active
c. ____average
d. ____somewhat inactive
e. ____very inactive
16. Do you think your body is sexually appealing?
a. ____extremely
b. ____quite
c. ____somewhat
d. ____not very
e. ____not at all
17. How do your current feelings about your body compare to how you
felt 10 years ago?
a. ____much better
b. ____somewhat better
c. ____about the same
d. ____somewhat worse
e. ____much worse
18. If you were verbally, physically, and/or sexually abused as a child
or as a young person, please answer the following section. Check all that
apply.
a. Place a check mark to the left of the kind of abuse you experienced.
b. Rate how strongly the abuse affected you emotionally and/or sexually
using the following scale.
SCALE: 0 = not at all 1 = once or very little 2 = some 3 = a medium amount 4 = very often/much 5 = severely ____N/A
Approx. number Affected you
Affected you
of times/years emotionally
(0-5) sexually (0-5)
___Verbal Abuse __________ ___________ _________
___Physical Abuse __________ ___________ _________
___Sexual Abuse __________
___________
_________
19. If you were thinner, but had the same sexual partner, do you think
you would enjoy your sexual life more? ___Yes ___No
If yes, why?
If no, why not?
20. Has your weight become a disability for you in your daily life?
___Yes ___No
If yes, please explain:
21. Are you physically disable from any other cause? ___Yes ___No
If yes, in what ways?
22. Does your weight affect your capacity to express yourself sexually?
___Yes ___No
If yes, please explain:
SEXUAL ATTITUDES
Using this scale, please indicate how often you are satisfied:
SCALE: 1 = not at all 2 = occasionally 3 = quite often 4 = very often 5 = almost always
1. with the amount of time you are spending on your sexual relationship? ______
2. with the amount of time you are spending with your partner during lovemaking? ______
3. with the quality of time you and your partner spend during lovemaking? ______
4. with the importance you and your partner place on lovemaking in the relationship? ______
5. with your ability to make your physical needs known to one another? ______
6. with the frequency with which you have orgasms with your partner? ______
7. with your sexual relationship in general? ______
Please answer using: 1 = mostly true 2 = mostly NOT true
1. Expressing your sexuality is important to you. ______
2. In general, your sexual adjustment has been easy. ______
3. You are comfortable discussing sexual attitudes and activities with close friends. ______
4. You are comfortable discussing sexual attitudes and activities with your sexual partner. ______
5. You enjoy sharing your body during lovemaking. ______
6. Your weight has often influenced your choice of a sexual partner. ______
7. Your weight frequently interferes with your sexual behaviors. ______
8. Your weight frequently interferes with your sexual feelings. ______
9. Negative events from your childhood have hurt your sexuality. ______
10. You are comfortable with your own sexuality. ______
11. You enjoy trying something new sexually. ______
12. You are aware of your sexual desires. ______
13. You feel that you are a sensual person. ______
14. You are comfortable pleasuring yourself sexually. ______
15. Dressing in a manner that makes you feel sexually attractive is comfortable for you. ______
16. If you had the same weight and the same partner but a different
attitude about sex, would you be able to enjoy your sexual life more? ___Yes
___No
If yes, why?
If no, why not?
PARTNER QUESTIONS
In this section please answer the questions in regard to your current partner (if you have one), or your most recent past relationship that lasted at least six months.
1. In general, are you sexually attracted to
a. ___only women
b. ___mostly women
c. ___both men and women
d. ___mostly men
e. ___only men
2. Are you married to this partner? ___Yes ___No
3. How many years and/or months have you been with this partner? ____Years ____Months
4. On a scale of 1-5 (1 = least & 5 = most), how satisfied are you in your sexual relationship? ______
5. On a scale of 1-5 (1 = least & 5 = most), how happy outside of your sexual relationship are you with your current partner? ______
6. Counting your first partner, how many sexual partners have you had during your lifetime? _____
7. During the last year, how many different partners have you been sexual with? _______
8. What is the longest time you have been with any other partner?
____Years ____Months ____Weeks
9. How old were you when you first petted? _____
10. How old were you when you first had sexual intercourse? ____________ ___N/A
11. When you first had sexual intercourse, you
a. ___did so of your own free will
b. ___were verbally pressured into it
c. ___were physically pressured into it
d. ___were violently pressured into it
12. Since your first intercourse, have you ever been forced into intercourse?
___Yes ___No
If yes, how many times? _____
Please describe:
13. How often do you engage in activities with your partner that
end in your orgasm?
a. _____times a week
b. _____times a month
c. _____times a year
d. _____never
14. How often does your partner have an orgasm with you?
a. _____times a week
b. _____times a month
c. _____times a year
d. _____never
15. Please answer these questions using the following scale.
SCALE: 1 = not at all 2 = almost never 3 = sometimes 4 = usually 5 = almost always
Do you prefer to wear clothing that hides your body? ______
Do you enjoy telling your partner your desires when you are sexual
together? ______
Do you enjoy being sexual with your partner with the light on or in
the daylight? ______
Do you enjoy being caressed on your stomach by your partner? ______
Do you enjoy walking in the nude in front of your partner? ______
If your partner told you he desired you just the way you are, would
you believe him? ______
Do you feel comfortable dressing in a way that expresses your sexuality?
______
16. If your body size were thinner, would your choice of a partner be
different? ___Yes ___No
If yes, why?
If no, why not?
17. Has your weight ever been an issue in your relationship?
____Often ____Sometimes ____Rarely _____Never
18. Has your partner ever verbally abused you about your size?
____Often ____Sometimes ____Rarely _____Never
19. Has your partner ever physically abused you?
____Often ____Sometimes ____Rarely _____Never
20. Does your partner remind you gently to lose weight?
____Often ____Sometimes ____Rarely _____Never
21. Does your partner pressure you to lose weight?
____Often ____Sometimes ____Rarely _____Never
22. Does your partner ask you to gain weight?
____Often ____Sometimes ____Rarely _____Never
23. Does your partner complain about what you are eating?
____Often ____Sometimes ____Rarely _____Never
24. Does your partner complain about how much you are eating?
____Often ____Sometimes ____Rarely _____Never
25. Do you believe that a person who prefers large women must have something
wrong with him/her?
___Yes ___No
26. Do you believe that it is difficult for a large woman to attract a partner? ___Yes ___No
27. Do you believe your partner would find you less desirable if you gained weight? ____Yes ___No
28. Would you be less interested in sex with your partner if you gained weight? ___Yes ___No
29. Would you be more interested in sex with your partner if you lost
weight? ___Yes ___No
If yes, why?
If no, why not?
30. Would your partner find you more sexually desirable if you were thinner? ___Yes ___No
31. In regard to your sexual desirability, who is more concerned about you weight? ___Your partner ___You
32. How would you describe the body size of your partner?
a. ___extremely thin
b. ___somewhat thin
c. ___about average
d. ___somewhat large
e. ___very large
33. Does your partner's body size affect your attraction to him/her?
a. ___very much
b. ___somewhat
c. ___not much
d. ___not at all
34. Would you be more interested in sex with your partner if your partner lost weight? ___Yes ___No
35. Do you believe your partner is sexually attracted to you?
a. ___very much
b. ___somewhat
c. ___quite attracted
d. ___not at all attracted
36. Does your partner's body size affect his/her own sexuality?
a. ___very much
b. ___somewhat
c. ___not much
d. ___not at all
PARTNER BEHAVIOR
Please answer these questions using the following scale.
SCALE: 1= never 2 = rarely 3 = sometimes 4 = always
1. Does your partner take time to assure you that he/she is sexually attracted to you? ______
2. Do you take time to assure your partner that he/she is sexually attractive to you? ______
3. Does your partner tell you what he/she likes about your body? ______
4. Do you tell your partner what you like about his/her body? ______
5. Does your partner express passion for you in words before lovemaking? ______
6. Do you express passion for your partner in words before lovemaking? ______
7. Does your partner express passion for you in actions before lovemaking? ______
8. Do you express passion for your partner before lovemaking in actions? ______
9. Does your partner talk during lovemaking in an exciting manner? ______
10. Do you talk during lovemaking in an exciting manner? ______
11. Does your partner tell you what would be sexually exciting for him/her? ______
12. Do you tell your partner what would be sexually exciting for you? ______
13. Does your partner express attraction for you away from lovemaking? ______
14. Do you express attraction for your partner away from lovemaking? ______
15. Does your partner enjoy your pleasuring him/her? ______
16. Do you enjoy his/her pleasuring you? ______
17. Do you believe your partner enjoys his/her own sexuality in general? ______
18. Do you believe you enjoy your own sexuality in general? ______
19. On a scale of 1-5 (1= not at all & 5 = a great deal), how would you rate your partner's attraction to you in regard to your: face? ____ arms?____ breasts?____ stomach?____ vulva/vagina?____ mouth?____ hips?____ buttocks?____ legs?_____ feet?_____ whole body?____
20. Do you avoid any sexual position due to your or your partner's weight?
____Yes ____No
If yes, please specify:
21. Is your partner faithful as far as your know? ____Yes ____No
22. Have you been faithful to your partner? ____Yes ____No
23. Have there been other partners who gave you more satisfaction? ____Yes
____No
If yes, why?
If no, why not?
24. Do you or your partner have any sexual dysfunction? (Check all that apply)
You Your partner
Difficulty in experiencing orgasm ______ ________
Come to a climax too quickly ______ ________
Physical pain during intercourse ______ ________
Feel anxious about ability to perform ______ ________
Have trouble achieving or maintaining an erection ______ ________
Have trouble lubricating ______ ________
Decreased interest in sex due to medication ______ ________
25. Is your partner attracted to those of a different gender from you?
___Yes ___No ___Sometimes
26. In general, during sexual relations, are you most often
a. ___more active
b. ___less active
c. ___equal to partner
27. If you had a different partner, but were the same weight, do you think you would enjoy your sexual life more? ___Yes ___No
28. If your sexual life with your partner is satisfactory, which of the following do you believe has had the most influence on the feeling of satisfaction in the sexual relationship?
(Number in order of greatest influence…1st, 2nd, 3rd, etc.)
___positive body image
___positive sexual outlook
___your partner
___diets
___counseling, therapies
___other (describe):
___N/A
29. If your sexual life with your partner is not satisfactory, which of the following do you believe has had the most influence on the lack of satisfaction in the sexual relationship?
(Number in order of greatest influence…1st, 2nd, 3rd, etc.)
___negative body image
___negative sexual outlook
___your partner
___diets
___lack of or poor counseling, therapies
___other (describe):
___N/A
30. Using the following scale, how would you rate your and your partner's sexual preferences?
SCALE: 0 = not at all 1 = enjoy somewhat 2 = enjoy quite a bit 3 = enjoy very much 4 = enjoy completely
You Your Partner
Kissing
_____ _______
Cuddling
_____ _______
Stroking
_____ _______
Mutual masturbation
_____ _______
Receiving oral sex
_____ _______
Giving oral sex
_____ _______
Sexual intercourse
_____ _______
Telephone sex
_____ _______
Anal sex
_____ _______
Light S&M (Dominance & Submission) _____
_______
Heavy S&M
_____ _______
other (describe):
_____ _______
31. If you engage in sexual intercourse, what positions do you and your
partner most enjoy?
Mark all that apply.
You Your Partner
Partner on top
_____
_______
You on top
_____
_______
Sitting position
_____
_______
Facing on sides
_____
_______
Sides, rear entry
_____
_______
In X position (scissors)
_____
_______
In a swing
_____
_______
Standing
_____
_______
Rear entry ("doggy style")
_____
_______
Legs over side of bed
_____
_______
other (describe):
_____
_______
List by preference your three favorite positions.
1st: ______________________ 2nd: _________________________
3rd: _____________________
List your partner's three favorite positions.
1st: ______________________ 2nd: _________________________
3rd :_____________________
COUNSELING AND THERAPY
1. Have you ever sought counseling to assist you in your sexualrelationship?
___Yes ___No
If yes, please indicate the kind of therapy by a check mark on the
left.
On the right, using the following scale, indicate how helpful the therapy was.
SCALE: 1 = not at al helpful 2 = a little helpful 3 = somewhat helpful 4 = very helpful 5 = extremely helpful
How helpful?
___Masters and Johnson style ________
___LoPiccolo Therapy ________
___Sex therapist ________
___Psychiatrist ________
___Sexual seminars or workshops ________
___MFCC (Marriage, Family and Child Counselor) ________
___LSW (Licensed Social Worker) ________
___Other (describe): ________
2. Have you ever sought counseling to assist you with your emotional
problems without regard to weight or sexuality?
If yes, please list what type of therapy in the left column.
On the right, using the following scale, indicate how helpful the therapy was.
SCALE: 1 = not at all helpful 2 = a little helpful 3 = somewhat helpful 4 = very helpful 5 = extremely helpful
Type of therapy How helpful?
__________________________________ __________
__________________________________ __________
__________________________________ __________
3. Have you ever sought counseling with your partner to assist
you with all of the following issues at the same time: your body
image, your sexuality, your sexual relationship, and
your emotional issues? ____Yes ____No
If yes, please list what type of therapy in the left column.
On the right, using the following scale, indicate how helpful the therapy was.
SCALE: 1 = not at all helpful 2 = a little helpful 3 = somewhat helpful
4 = very helpful 5 = extremely helpful
Type of therapy
How helpful?
__________________________________ __________
__________________________________ __________
__________________________________ __________
Thank you very much for taking the time to complete this questionnaire!
If you are interested in talking further about these issues, or receiving the results of the dissertation, please add your name, address, and telephone number here. You may send this page in with the questionnaire, or send it to me under separate cover.
_____Talk further _____Receive results
Name: __________________________________________________________
Address: ________________________________________________________
________________________________________________________________
________________________________________________________________
Phone: _________________________________________________________
E-mail: _________________________________________________________
Use enclosed return envelope or send to:
Lilka Areton
20 Forrest Court
San Anselmo, CA 94960
FAX: (415) 453-9445
E-mail: chililka@msn.com