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Romantic Relationships, Sexual Satisfaction, and Perceived QOL in Individuals with SCI
Please complete our survey if you are currently in or have previously been involved in a romantic relationship while living with a SCI. The purpose of this study is to examine the perceived quality of life of individuals with SCI through the perspective of sexual satisfaction and quality of romantic relationships. If at any time you feel uncomfortable you may stop the survey.
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* Indicates required question
What is your date of birth?
*
MM
/
DD
/
YYYY
By clicking on the "Yes" button below indicates that:
*
1.) You have read the above information and have had a chance to ask any questions you may have about the study 2.) You agree to be in the study and have been told that you can change your mind and withdraw your consent at any time 3.) You meet the inclusion criteria for the study
Yes
No
What is the highest education you received?
None at all
Elementary
High School
College
Clear selection
What is your gender?
*
Male
Female
Are you currently ill?
Yes
No
Clear selection
If something is wrong with your health what do you think it is?
Your answer
What is your marital status?
*
Single
Married
In a non-marital relationship
Separated
Divorced
Widowed
Do you get the kind of support from others that you need?
*
For the following questions, please select the response that best fits how much support you've received from others within the LAST 2 WEEKS.
Not at all
1
2
3
4
5
Completely
How would you rate your quality of life?
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Very poor
1
2
3
4
5
Very good
How satisfied are you with your health?
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Very dissatisfied
1
2
3
4
5
Very satisfied
To what extent do you feel that physical pain prevents you from doing what you need to do?
*
Not at all
1
2
3
4
5
An extreme amount
How much do you need any medical treatment to function in your daily life?
*
Not at all
1
2
3
4
5
An extreme amount
How much do you enjoy life?
*
Not at all
1
2
3
4
5
An extreme amount
To what extent do you feel your life to be meaningful?
*
Not at all
1
2
3
4
5
An extreme amount
How well are you able to concentrate?
*
Not at all
1
2
3
4
5
Extremely
How safe do you feel in your daily life?
*
Not at all
1
2
3
4
5
Extremely
How healthy is your physical environment?
*
Not at all
1
2
3
4
5
Extremely
Do you have enough energy for everyday life?
*
Not at all
1
2
3
4
5
Completely
Are you able to accept your bodily appearance?
*
Not at all
1
2
3
4
5
Completely
Have you enough money to meet your needs?
*
Not at all
1
2
3
4
5
Completely
How available to you is the information that you need in your day to day life?
*
Not at all
1
2
3
4
5
Completely
To what extent do you have the opportunity for leisure activities?
*
Not at all
1
2
3
4
5
Completely
How well are you able to get around?
Very poor
1
2
3
4
5
Very good
Clear selection
How satisfied are you with your sleep?
*
Very dissatisfied
1
2
3
4
5
Very satisfied
How satisfied are you with your ability to perform your daily living activities?
*
Very dissatisfied
1
2
3
4
5
Very satisfied
How satisfied are you with your capacity for work?
*
Very dissatisfied
1
2
3
4
5
Very satisfied
How satisfied are you with yourself?
*
Very dissatisfied
1
2
3
4
5
Very satisfied
How satisfied are you with your personal relationships?
*
Very dissatisfied
1
2
3
4
5
Very satisfied
How satisfied are you with your sex life?
*
Very dissatisfied
1
2
3
4
5
Very satisfied
How satisfied are you with the support you get from your friends?
*
Very dissatisfied
1
2
3
4
5
Very satisfied
How satisfied are you with the conditions of your living place?
*
Very dissatisfied
1
2
3
4
5
Very satisfied
How satisfied are you with your access to health services?
*
Very dissatisfied
1
2
3
4
5
Very satisfied
How satisfied are you with your transport?
*
Very dissatisfied
1
2
3
4
5
Very satisfied
How often do you have negative feelings such as blue mood, despair, anxiety, depression?
*
The following question refers to HOW OFTEN you have felt or experienced certain things in the last two weeks.
Never
1
2
3
4
5
Always
How is your sexual desire now compared to before injury?
*
**For the remaining survey questions, please answer according to your current OR previous relationship**
non-existant
decreased
unchanged
increased
How important is sexuality to you now compared to before injury?
*
non-existant
decreased
unchanged
increased
How is your relationship, most of the time, with your sexual partner after injury?
*
Please rate question on a scale of 1-7.
Very dissatisfying
1
2
3
4
5
6
7
Very satisfying
How was your relationship, most of the time, with your sexual partner before injury?
*
Please rate question on a scale of 1-7.
Very dissatisfying
1
2
3
4
5
6
7
Very satisfying
How are your possibilities and your ability to enjoy sexuality yourself?
*
very dissatisfying
rather dissatisfying
rather satisfying
very satisfying
How are your possibilities and your ability to give your partner sexual fulfillment?
*
very dissatisfying
rather dissatisfying
rather satisfying
very satisfying
Please indicate the degree of happiness, all things considered, of your relationship.
*
Extremely unhappy
0
1
2
3
4
5
6
Perfect
Amount of time spent together.
*
Please indicate the approximate extent of agreement or disagreement between you and your partner.
Always disagree
0
1
2
3
4
5
Always agree
Making major decisions.
*
Please indicate the approximate extent of agreement or disagreement between you and your partner.
Always disagree
0
1
2
3
4
5
Always agree
Demonstrations of affection.
*
Please indicate the approximate extent of agreement or disagreement between you and your partner.
Always disagree
0
1
2
3
4
5
Always agree
In general, how often do you think that things between you and your partner are going well?
*
Never
0
1
2
3
4
5
All the time
How often do you wish you hadn't gotten into this relationship?
*
All the time
0
1
2
3
4
5
Never
I still feel a strong connection with my partner.
*
Not at all true
0
1
2
3
4
5
Completely true
If I had my life to live over, I would marry (or live with/date) the same person.
*
Not at all true
0
1
2
3
4
5
Completely true
Our relationship is strong.
*
Not at all true
0
1
2
3
4
5
Completely true
I sometimes wonder if there is someone else out there for me.
*
Not at all true
0
1
2
3
4
5
Completely true
My relationship with my partner makes me happy.
*
Not at all true
0
1
2
3
4
5
Completely true
I have a warm and comfortable relationship with my partner.
*
Not at all true
0
1
2
3
4
5
Completely true
I can't imagine ending my relationship with my partner.
*
Not at all true
0
1
2
3
4
5
Completely true
I feel that I can confide in my partner about virtually anything.
*
Not at all true
0
1
2
3
4
5
Completely true
I have second thoughts about this relationship recently.
*
Completely true
0
1
2
3
4
5
Not at all true
For me, my partner is the perfect romantic partner.
*
Not at all true
0
1
2
3
4
5
Completely true
I really feel like part of a team with my partner.
*
Not at all true
0
1
2
3
4
5
Completely true
I cannot imagine another person making me as happy as my partner does.
*
Not at all true
0
1
2
3
4
5
Completely true
How rewarding is your relationship with your partner?
*
Not at all
0
1
2
3
4
5
Completely
How well does your partner meet your needs?
*
Not at all
0
1
2
3
4
5
Completely
To what extent has your relationship met your original expectations?
*
Not at all
0
1
2
3
4
5
Completely
In general, how satisfied are you with your relationship?
*
Not at all
0
1
2
3
4
5
Completely
How good is your relationship compared to most?
*
Worse than others (extremely bad)
0
1
2
3
4
5
Better than all others (extremely good)
Do you enjoy your partner's company?
*
Choose
Never
Less than once a month
Once or twice a month
Once or twice a week
Once a day
More often
How often do you and your partner have fun together?
*
Choose
Never
Less than once a month
Once or twice a month
Once or twice a week
Once a day
More often
Select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.
*
Boring
0
1
2
3
4
5
Interesting
Select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.
*
Bad
0
1
2
3
4
5
Good
Select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.
*
Empty
0
1
2
3
4
5
Full
Select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.
*
Lonely
0
1
2
3
4
5
Friendly
Select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.
*
Fragile
0
1
2
3
4
5
Sturdy
Select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.
*
Discouraging
0
1
2
3
4
5
Hopeful
Select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.
*
Miserable
0
1
2
3
4
5
Enjoyable
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