Physical Pain Questionnaire v1.0
Name:__________________
Age: ____
Do you derive pleasure from pain?
[ ] Yes
[ ] No
[ ] I am curious about experimenting with pain as a means of pleasure
Does the prospect of pain arouse you sexually?
[ ] Yes
[ ] No
[ ] I am curious
Do you derive sexual pleasure from pain?
[ ] Yes
[ ] No
[ ] I would like to try
At what point does/ do you think pain becomes pleasant for you?
[ ] Always
[ ] After being aroused mentally
[ ] During foreplay
[ ] During sexual relations
[ ] When my body is at maximum sensitivity/ after climax
What kinds of stimulation do you find pleasurable/ appealing?
[ ] Blunt
[ ] Sharp
[ ] Hot
[ ] Cold
[ ] Chemical
[ ] Electric shock
[ ] Other
What kind of pain play do you enjoy/ want to try?
[ ] Bunt trauma e.g. Slapping or light beating
[ ] Sharp cutting e.g. Lightly cutting with a scalpel
[ ] Perforation e.g. Needles, staples, tattoo machine
[ ] Burning e.g. Hot wax, fire cupping
[ ] Freezing e.g. Fresh ice cubes, cold burn
[ ] Friction and abrasion e.g. Glass/ sand paper
[ ] Chemical e.g. Stinging nettles, figging
[ ] Epilation e.g. Tweezers, wax or epilator
[ ] Whips, canes or floggers
[ ] Electric shock
[ ] Other
Upon which parts of the body do you find the infliction of pain most appealing?
[ ] Feet
[ ] Calves
[ ] Back of the knees
[ ] Thighs
[ ] Back of the thighs and buttocks
[ ] Genitals
[ ] Anus
[ ] Abdomen
[ ] Lower back
[ ] Upper back
[ ] Nipples
[ ] Neck
[ ] Arms
[ ] Ears
[ ] Cheeks
[ ] Lips
[ ] Mouth
[ ] Tongue
[ ] Shoulders
[ ] Collar bone
[ ] Other
