MSM questionnaire

to evaluate:

correlation between the frequency of receptive sex and

anodyspareunia/discomfort/bleeding
correlation between either of the previous factors and HIV status
factors for anodyspareunia have already been investigated in
Belgium (see concept article): only age and the frequency of
intercourse remained significantly correlated with
anodyspareunia on multivariate analysis of ten factors higher
frequency (and age) being protective

1. General Data:

Participant number/ID code: ______

Gender: m f transgender do not wish to specify

Age: ____

Weight: ______ kg Height: ______ cm

Education: primary
secondary
tertiary
university graduation or doctorate

2. Sexual history questions:

2.1 Which of the following do you use or have used on yourself for anal
insertion?

dildos
plugs
other toys or objects (specify:______________________________)
hands/fists, or arms
none of the above (proceed with question 2.3)

2.2 Is the maximum size (diameter/caliber/circumference) of the toys you

normally use...

below the size of this object?

about the size of this object?
above the size of this object?
[The participant is shown a cylindric object with a diameter of 4 cm.]

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2.3 In the last month, how many times did you have receptive anal
intercourse or use sex toys, plugs, dildos, or other objects on yourself
which had at least the diameter just shown?

0 1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30 >30 times

2.4 How long (in days) were the longest time gaps between any instance of
receptive anal intercourse or any anal insertion of toys, plugs, dildos, or
other objects which had at least the diameter just shown...

(a) ...in the last month?

1 day 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30 days
>30 days (or no receptive intercourse/object insertion in last month)

(b) ...in your sexually active life?

1 day 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
>30 days >60 days >90 days
attempted receptive intercourse/object insertion only a few times in life
or never

2.5 Over the past 4 weeks, how often did you experience discomfort or pain
during anal penetration by a partner?

Did not attempt intercourse

Almost always or always
Most times (more than half the time)
Sometimes (about half the time)
A few times (less than half the time)
Almost never or never

2.6 Over the past 4 weeks, how often did you experience discomfort or pain
following anal penetration by a partner?

Did not attempt intercourse

Almost always or always
Most times (more than half the time)
Sometimes (about half the time)
A few times (less than half the time)
Almost never or never

2.7 Over the past 4 weeks, how would you rate your level (degree) of

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 discomfort or pain during or following anal penetration by a partner?

Did not attempt intercourse

Very high
High
Moderate
Low
Very low or none at all

2.8 Have you ever noticed anal itching, burning, or soreness during or after
receptive anal intercourse?

never
rarely (less than half the time)
sometimes (about half the time)
most times (more than half the time)
always

2.9 Have you ever noticed blood that you believe came from your anus
during or after receptive anal intercourse?

never
rarely (less than half the time)
sometimes (about half the time)
most times (more than half the time)
always

2.10 Is there blood on the toilet paper?

never
rarely (less than half the time)
sometimes (about half the time)
most times (more than half the time)
always

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3. Colorectal medical question:

Have you ever been diagnosed with an anal disease? If so, what was it?

Common anal diseases include the following [can also be ticked]:

Anal fissure (acute) [a painful tear in the anus]

Chronic anal fissure [a tear in the anus that did not heal within 4 weeks]
Perianal abscess [a pouch of pus beside the anus]
Perianal thrombosis [a sudden, pea-sized, painful knot beside the anus]
Anal fistula [a tunnel from inside the anus or rectum to the outside skin]
Haemorrhoids/piles [swollen or inflamed veins in the anus or lower rectum]
Pilonidal cyst [a cyst between anus and sacrum]
Anal skin tags
Anal warts