Filling out this form is not a substitute for having a conversation about sex. It is designed to make it easier to have a conversation about the things you might forget to talk about and to learn about the things you might disagree about. (Feel free to use this for your personal use - but if you copy it for a class, newsletter, hand-out, etc. please email me about getting permission and giving me credit.)

Some of these questions are only for couples who are male and female, or have decided to have vaginal sex. Some questions will be questions for people who have never has sex before, and others for people who have had sex for many years.

If a question doesn't apply to you - just don't answer it or cross it out. If you don't want to answer a question - just don't answer it. This is just a tool to help you - it is not a test. If you have suggestions for changes, please email me.. Susan

These are the sex acts I am willing to do or have you do.

Nothing at all - I am not interested in you in that way at all.
I'm not sure I am ready for anything! You asked me to fill this out:
Kissing on the lips :
Kissing with open mouth and tongue/ French kissing : 
Touching bare or exposed skin only: 
Touching over clothes only:
Touching under clothes above the waist:
Touching under clothes anywhere:
Inserting finger into vagina:
Inserting finger into anus:
Oral sex on me:
Oral sex on you:
Vaginal sex:
Anal sex:
Ejaculation/ orgasm:
Spanking as part of sex:
Other, please specify: __________________________

Do I have any sexually transmitted infections ?

No:
Not sure : 
Yes:  What? _______________________

I know I don't (or do) because?

I was tested : When?________________
I have never had sex: 
I have never had sex without condoms/ dental dams : 
I have only had sex with a virgin:
I just know:
Other, please specify:  ______________________________

What do I plan to use for pregnancy and/or disease protection ?
If you want to be absolutely sure you will not get pregnant , use two forms of birth control as none are 100% efffective/guaranteed. Withdrawal or pulling out is not a good method and is impossible to do do right every time.

Condoms:
Dental dams:

The following are for pregnancy prevention only

Birth control pill. patch, implant, or injection: 
Diaphragn, IUD, cervical cap: 
Vasectomy, sterilization:
Infertile, post-menopausal:
Other, please specify:  ________________________________

If I am using a birth control pill or patch  - I have been using it for at least 4 months.
If you have been using birth control for less than 4 months, or you forget to take a pill, or you don't take your pill everyday at the same time, you should absolutely use another method in addition to the pill or patch.

Yes:
No: 

Who will pay for over-the-counter pregnancy detection kits, or medical care that might be needed as a result off our having sex?
If you have a lot of pregnancy scares, or one of you has sex with other people - this could be a lot of money to some people, especially to teenagers. Pregnancy kits were originally designed to help people who wanted to be pregnant. If you use a pregnancy detection kit be sure to follow the directions very carefully.

Me:
You:
We split it:

What do I want to do in the event of accidental pregnancy?
This needs to be discussed before you have vaginal sex. If one of you is absolutely against abortion and the other one absolutely refuses to have a baby - you need to know this before you have sex, not when one of you gets pregnant.

Adoption:
Abortion: 
Marriage: 
Single parenting:
Other, please specify:  _________________________________________

These are the following ground rules I agree to:
Ground rules might need to change. If this is your first serious relationship, you might not know what rules are important to you. As your relationship changes and grows, the rules might need to change, too.

No means no :
Stop means stop : 
Yes means yes : 
I have the right to change my mind:
Just because we do it once, doesn't mean I will do it again:
We will have sex with each other and no one else:
My commitment to you is for this one time only:
If we have sex with others, it will be sex with condoms and /or dental dams only:
If we have sex with others it is OK, but we have to talk about it first :
If we have sex with others, it is OK, but I don't want to know about it:
Other, please specify:  _______________________________

Other, please specify:   _______________________________

These are the people I want to tell we are having sex:
It is important that you agree on this. Many relationship end because a person tells someone the other person did not want to know.

No one, it is our secret:
My best friend, ________: 
My mom, dad, or both:
I want to tell everybody!
I really don't care who knows:
Other, please specify:  _______________________________

The thing that scares me most about sex is:
Being scared about sex is not unusual. Lots of people are scared, especially the first time with a new person, or the first time doing something new.
Nothing:
Getting pregnant : 
Getting a disease: 
That you won't like me:
That I won't do it OK:
Losing control, feeling vulnerable:
People (my Mom or Dad or friends) will find out:
Other, please specify:  _____________________________________

________________________________________________________

________________________________________________________

After we have Sex Question Suggestions

What thing did you like best about the sex we had together?

What thing did you like least about the sex we had together?

If you could change one thing about the sex we had it would be?