Medical Exam

12. Uterus and Ovaries *

Complete Hysteroscopy (Uterus and Ovaries) Partial Hysteroscopy (Uterus only) Right Ovary Removed Left Ovary Removed None of the above

4. Do you or have you experienced: *

7. In general do you: *

Orgasm easily Take what you think is an average amount of time to orgasm Have a difficult time reaching orgasm / often don't Have never orgasmed

8. When you do orgasm can you? *

Orgasm multiple times one after another Orgasm more then once but it takes a little longer in between each Orgasm once and then you are super sensitive afterward and done Have never orgasmed

Please rate the following question on a scale of 0 - 10. 0 is an absolute boundary. 1 no sexual arousal and no desire to do or try. 2- 3 will do but receive little pleasure or desire. 4 - 5 Some arousal or if in the mood can be enjoyable. 6 - 7 Is a turn on and you enjoy it and like to experience it some to most of the time. 8 - 9 Very aroused and greatly enjoy it every time or at least most of the time. 10 You receive the most pleasure and sexual arousal. If it is something you have not done please say "have not done" But please STILL rate it on how much or little you would like to explore it.

Medical Procedures

3. Breast touched, massaged or squeezed? Light - medium or Firm? 0 - 1 0 & L, M or F *

4. Nipples, touched, played with or pinched? Light - medium - firm? 0 - 1 0 and L, M or F *

20. Please list any fetishes you may have or desire to explore: (example: foot, breast, yoni worship, BDSM (being Dominate or submissive), medical play, role play, anal, cock worship, cum worship, enemas, double penetration (vaginal and anal), double penetration vaginal, gang bang, etc. *

Patient Form