Anonymous Research Survey for Men's Health
1. Age
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2. Occupation
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3. Are you circumcised? (If No, then please submit this survey)
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4. Would you restore this part of your body if the option were available? (Yes or No)
5. Have you experienced any negative feelings as a result of being circumcised? (Anxiety and panic attacks, fear, anger, irritability, obsessions and compulsions, shock and disbelief, emotional numbing and detachment, physical pain, erectile dysfunction, depression, nightmares, trauma, shame, guilt, suicidal ideation, or any other negative experiences)
6. Is it difficult for you to feel confident around women (or any romantic partners) as a result of negative feelings related to circumcision? (Yes or No)
7. Have you ever viewed pornography to cope with any negative feelings related to circumcision? (Yes or No)
8. If the option were available, would you be interested in counseling that specialized in circumcision trauma recovery? (Yes or No)
9. On a scale of 1 - 10, how important is this issue to you? (10 = most important; 1 = least important)
10. On a scale of 1 - 10, how comfortable do you feel to discuss this topic with friends and family members? (10 = Very Comfortable, 1 = Not Comfortable at all)
11. Do you know someone in your life who would benefit from circumcision trauma recovery? (Yes or No)
12. Please include any additional comments that you have about this survey
13. Email
Submit