Updated
Original VAYEMA symptom and impact self-check – not a validated scale
Sexual wellbeing concerns
Answer the symptom statements below to see which experiences and areas of daily life you report as most affected. These are original VAYEMA questions, not a validated diagnostic scale. No clinical severity or probability score is calculated.
Answers are processed only in this page by this assessment. They are not submitted, monitored or automatically saved. No name, email or account is required. Use a private device and clear your answers when finished.
For adults aged 18 and over. This self-check cannot diagnose or rule out a condition. Concerns about a child require an age-appropriate professional assessment.
Thinking about the past four weeks, how well does each statement describe your experience?
Additional context – not included in any questionnaire score
These are original VAYEMA questions, not a diagnostic instrument or a validated severity scale. They summarise the experiences you select and do not predict a diagnosis or future harm. Background condition information; this source does not endorse this self-check.
What a psychosexual assessment can clarify
The assessment brings together your description of the difficulty and the context in which it occurs. A clinician may ask about desire, arousal, erections, orgasm, ejaculation or pain, depending on your concern. They should also consider physical and psychological contributors rather than deciding in advance that the problem is purely emotional. Public Health Wales describes psychosexual support as assessment of possible physical, psychological or combined causes. [1]
Before the appointment, choose one opening sentence that feels manageable: for example, that something has changed, that you are experiencing discomfort, or that intimacy has become difficult to discuss. You do not need to provide a complete explanation. You can ask what the clinician needs to know now and what can wait. A useful first outcome is clarity about the next appropriate step, not an immediate label.
Why this is not a sexual dysfunction test
This worksheet has no validated scoring system, threshold or diagnostic interpretation. It cannot distinguish a medical condition from a relationship difficulty, establish the cause of pain, or tell you which treatment will work. Do not add up your answers or use the number of concerns as a measure of severity. One significant concern can be enough to ask for help, while several unanswered prompts may simply reflect a wish for privacy.
A formal questionnaire, when chosen by a qualified clinician, has a different purpose from these preparation notes. Ask what a questionnaire measures, whether it is appropriate for your circumstances and how the result will be interpreted alongside a conversation. An online search for a sexual dysfunction test should not become a requirement to prove that your concern deserves attention. This page is designed to support a discussion, not replace one.
Describe changes without monitoring yourself constantly
You might note approximately when the concern began, whether it is persistent or intermittent, and any relevant change in health, medication or circumstances. Keep the description at a level you are comfortable sharing. A simple timeline is more useful for this worksheet than a detailed record of every intimate experience. There is no need to repeatedly test your response or attempt an activity that is unwanted or uncomfortable.
For example, you could note that the difficulty followed an illness, appeared around a medication change, or has no obvious starting point. These are observations to discuss, not proof of a cause. Add what you would like help understanding and anything you prefer to explain verbally. Stop writing when the notes are sufficient for that purpose; completing the form thoroughly is not a treatment task or a test of motivation.
Physical health may need its own assessment
Some sexual difficulties are associated with medical conditions or medicines. NHS guidance notes that recurring erection problems can be linked with conditions such as diabetes, blood pressure problems or hormonal difficulties, as well as anxiety or depression. Low desire can also have several possible contributors, including health changes and medication. A GP or appropriate sexual health professional can help decide whether further examination or investigation is needed. [2] [3]
Bring a current medication list when relevant, including non-prescribed products, and describe suspected side effects without stopping treatment yourself. Ask who will coordinate any medical and psychological care. A referral for talking therapy should not be treated as evidence that physical symptoms have been ruled out. Equally, the worksheet cannot specify which blood test or specialist is appropriate; that decision needs your history and a qualified assessment.
Consent and comfort throughout the appointment
Before discussing sensitive information, ask the clinician to explain the purpose of the assessment and how it will be conducted. You can request clearer language, a pause or a different way of answering. Consider writing down practical preferences, such as needing an interpreter, additional time or an explanation before a sensitive question. You do not need to place graphic details in an online form to begin asking for care.
A medical appointment and a talking-therapy session have different roles. At a sexual health clinic, staff should explain any proposed tests or examinations, and you can ask about having another member of staff or a support person present. Discuss questions about consent and comfort directly with the clinician rather than assuming an examination is part of every psychosexual appointment. Your preparation notes can simply say that you want to understand the process first. [4]
Individual goals and the choice to involve a partner
Decide what you would like the assessment to help you understand before deciding who should attend. You may want an individual conversation about discomfort, uncertainty, body changes or a difference in expectations. Psychosexual services may work with individuals or couples, depending on the circumstances. Ask about the options and whether there will be an opportunity to speak privately. A partner’s attendance should not be treated as permission to speak on your behalf. [1]
Useful goals might include understanding a symptom, reducing pressure, feeling able to express a boundary, or deciding whether a specialist referral is appropriate. You do not have to adopt sexual frequency, a particular activity or a partner’s satisfaction as your measure of progress. Write goals in your own terms. The worksheet does not decide which relationship arrangement or sexual identity is right for you, and none of its prompts should be used to impose one.
When a joint discussion is not the safe starting point
Fear, threats, sexual pressure or controlling behaviour need a different response from an ordinary disagreement about intimacy. The National Domestic Violence Hotline cautions against joint counselling with an abusive partner because disclosures may be used against the person experiencing abuse. Seek confidential individual support from an appropriate specialist rather than using this worksheet as material for a confrontation or a compulsory shared exercise. [5]
You do not need to document unsafe experiences here. Consider whether someone else can view your screen, accounts or files before using any online tool. For immediate danger or a medical emergency, use local emergency services rather than waiting for an assessment appointment or a website reply. Where there is no immediate emergency, a specialist support service can help you consider safer options in your circumstances; this page does not carry out that assessment.
Choose a suitably qualified professional
Ask about the professional’s training, experience with your concern and arrangements for referral when a problem falls outside their expertise. In the UK, the COSRT public register provides information about practitioners who meet its registration standards. Registration is useful information to check, not a promise that any particular approach will be suitable or successful. A practitioner should be able to explain their role without relying on a guaranteed outcome. [6]
For a first contact, keep the enquiry brief: the general concern, the kind of appointment you are seeking and any accessibility needs. Ask whether a medical review should happen first or alongside therapy. There is no need to send intimate photographs, lengthy personal histories or sensitive records through an ordinary enquiry form. Agree an appropriate clinical route before providing information that is not needed to arrange the initial conversation.
Understand confidentiality before sharing notes
Ask what will be recorded, who can access the record, how information is handled when a partner also attends and what the limits of confidentiality are. The BACP describes the first therapy session as including discussion of how the therapist works, assessment and an agreement about the service. These are useful subjects to raise before disclosing material you are uncertain about sharing. Do not assume that every service uses the same arrangements. [7]
The worksheet is optional local preparation, not a secure message to a care team. Its answers are not automatically sent or saved by this tool. A file you choose to download remains a separate copy on your device and needs your own attention to privacy. Shared devices, browser features or monitoring software may create additional risks beyond the tool’s control. You can attend without notes and explain your preferences directly.
Leave with an agreed next step
Before the appointment ends, ask the clinician to summarise what is understood, what remains uncertain and what they recommend next. The next step might be medical review, a more specialised assessment, individual or relationship-focused therapy, or time to consider options. You can ask why an option is being suggested and what alternatives exist. An initial consultation is not a commitment to a predetermined course of treatment.
Keep a brief record of the plan rather than retaining every sensitive detail from your preparation. Note who is responsible for any referral, what information you need to provide and how to seek help if circumstances change. Use the companion understanding and treatment guides to prepare further questions, not to select a diagnosis yourself. At VAYEMA, the initial enquiry can begin with the type of support you are looking for; specific clinical arrangements need confirmation.
Frequently asked questions
Can this questionnaire diagnose sexual dysfunction?
No. It is an unscored preparation worksheet, not a validated diagnostic questionnaire. It does not test physical function, establish a psychological cause or determine whether treatment is needed. A qualified professional can explore the concern in context and advise whether medical review, psychosexual therapy or another assessment is appropriate. You can seek that discussion without completing this tool.
Do I have to describe intimate experiences in detail?
No. Use only the detail you are comfortable placing on your device. A short description of the concern and the question you want answered is enough for preparation. During an appointment, ask why a sensitive question is relevant and request a pause or clarification when needed. The worksheet is optional and is not an admissions requirement.
Should I book a medical appointment or psychosexual therapy first?
That depends on your symptoms and history. Physical symptoms and persistent changes in sexual function may need assessment by a GP or sexual health professional, sometimes alongside psychological support. Ask a qualified clinician to guide the sequence rather than relying on this page to rule out medical causes. Do not stop prescribed medication to test a suspected explanation. [3]
Must my partner attend the assessment?
Not necessarily. Ask the service whether an individual appointment is available and how partner involvement is agreed. You may prefer to discuss your concern privately before deciding on a shared session. Where there is fear or abuse, seek specialist individual support rather than treating joint counselling as the default starting point. Your own consent and safety matter.
Will VAYEMA receive my worksheet answers?
No answers are sent by this worksheet, and nobody is monitoring them. Completing it does not book an appointment or alert a clinician. A download you choose to create is a file on your device, not a clinical record held by VAYEMA. Share information only through an agreed route and only when you decide it is appropriate.
What should I do when I finish?
Choose one or two questions you would like a professional to address and arrange suitable support. You can clear your notes or keep only what is helpful and safe. Do not wait for a score or a response from the worksheet. Immediate danger or a medical emergency requires local emergency help, whether the worksheet is complete, incomplete or unused.
Resources and references
[1] Public Health Wales: Psychosexual help
[4] NHS: Sexual health clinics and what to expect
[5] National Domestic Violence Hotline: Couples therapy and abuse
[6] COSRT: Register of psychosexual and relationship therapists