SEXUAL SELF OUTPUT

Name:
GENDER IDENTITY: How do you describe yourself? Choose only one.
Male
Female
Trans Male/Trans Man
Trans Female/Trans Woman
Gender Queer/Nonconforming
SEX
What sex were you assigned at birth, such as on an original birth certificate?
Male
Female
SEXUAL ORIENTATION: Do you consider yourself to be:
Heterosexual/Straight
Gay
Lesbian
Bisexual
Something else
I don’t know the answer
I refuse to answer
What is your preferred name? (Example: Anton)
What is your preferred pronoun? (Example: He)
SEXUAL SELF-AWARENESS-5 points each
1. Who taught you about sex when you were young?
2. How was sex talked about in your family growing up?
3. What do you think about sex? Is it a behavior? Is it an identity? Explain.
4. What is the relationship between you and your sexual self? Explain.
5. How well integrated is your sexual self into your real sense of who you are
as a person? Explain.
6. How free are you to open up about your sexual self? Explain.
7. Is shame, fear, or pain an issue in exploring your sexual self? Explain.

‘When we cannot talk about sex, shame will fill the void left by our silence.”