Please complete all the questions that apply to you. All responses are anonymous.
1) How old are you?
(Enter a two digit number, for example "35")
2) At what age where you circumcised? ('not circumcised' is also one of the choices)
(Please Choose One) Infant ( less than 1 year old) Child ( 1-10 years old ) Adolescent ( 11-17 years old ) Adult ( 18 or older ) In am not circumcised
3) Are you happy that you are circumcised?
Yes No Neutral - Don't care one way or the other
4) How do you feel that being circumcised has affected your sex life?
Positive effect on sex, has improved sex, more sensation Neutral, no effect on my sex life Negative effect on sex and/or loss of sensation
Positive effect on sex, has improved sex, more sensation
Neutral, no effect on my sex life
Negative effect on sex and/or loss of sensation
5) Has being circumcised made you feel: (make one choice for each line)
Superior Inferior Neither Superior or Inferior More Masculine Less Masculine Neither More or Less Masculine More Attractive Less Attractive Neither More or Less Attractive Admired Object of Ridicule Neither Ridiculed or Admired More Confident Less Confident No Effect on Confidence Proud Embarrassed Neither Proud or Embarrassed
6) When you discovered that there where males who were not circumcised, what feelings arose?
Check all that apply:
7) Are you envious or jealous of men who are intact (not circumcised)?
8) What year did you find out about foreskin restoration?
Please Choose a Time Period 2005 or later 2000-2004 1995-1999 1990-1994 Before 1989
9) Where did you first hear about foreskin restoration?
Please Choose Where You Heard About Foreskin Restoration TV Show Radio Foreskin Restoration Website (Other than NORM, NOCIRC, or NOHARM) Book ( Such as The Joy of Uncircumcising) Web, Newspaper or Magazine Article Friend or Relative NORM (Web site, phone, e-mail) NOHARMM or NOCIRC website or litature Information Booth ( At a fair or conference for example ) Other Source
10) What did you do when you found out about foreskin restoration?
Please Choose One Choice No Action, Did Nothing Looked on the Internet for Information Contacted NORM or other group Talked to a Doctor Talked to a Counselor (Psychologist, Minister, ect.) Looked for More Print Information (Books, leaflets, ect.) Started restoring with my own improvised technique
If you have started restoring your foreskin please answer the following questions:
11) How long have you been restoring your foreskin?
Please Choose a Time Period Less Than 6 months 6 months to 1 year 1-2 years 2-3 years More than 3 years
12) What results have you had so far? (Skin growth and/or increased sensitivity)
Please Choose One Choice No results yet Poor or minimal results Good results, average progress Great results, better than average Exceptional results, better than ever imagined
13) How do you feel after regaining your foreskin ( or attempting to) ? (check one on each line)
Natural/Whole Freakish Neither Satisfied Dissatisfied Neither More Attractive Less Attractive Neither More or Less Attractive Object of Envy Object of Ridicule Neither Ridiculed or Admired Self Assured Self Conscious Neither
14) Have you consulted a physician, doctor, psychologist, or regarding your restoration?
If "Yes" then answer 14b, 14c, and 14d
14a) What type of health professional did you consult?
Please Choose One... M.D - General Practice M.D. - Urologist D.O. Psychologist or Counselor Psychiatrist Sexologist Plastic Surgeon Alternative Medicine (N.D. for example) Other health professional
14b) How did the doctor respond?
14c) Was the doctor aware of foreskin restoration before you mentioned it?
15) If you have a spouse or partner, what are their feelings/reactions about your interest/participation in a restoration regimen/program? (Check one)
The following questions are optional and are for demographic and background information
What race or geographic region do you most identify with:
(Choose a race or geographic region) White (American or Non-European Born) Black (Non-African Born) African European (Western) European (Eastern and former Soviet countries) Asian Pacific Islands (Including New Zealand and Australia) Hispanic South or Central American Middle Eastern Native American (North or South America)
What State (or Country if born outside the U.S.) where you circumcised in?
OR if a country other than the U.S. please type your answer into the box
Of the major world religions which of the following most closely matches your family's religious background or affiliation?
(Choose a religion) Atheist Christian Protestant Catholic Jewish Islam Muslum Buddhist Hindu Sik Confusian Baha Jain Shinto Humanist Christian Scientist The Church of Jesus Christ of Latter-day Saints Unitarian Universalist None of the above
Did your family's religion play a role in your being circumcised?
Yes No Not sure or doesn't apply
Finally, you may enter any further information, comments, or clarifications to the questions in this survey, that you would like to provide, in the box below.
If you would have specific questions you want answered or want more information please e-mail questions@norm.org OR include your e-mail in the box below.
E-Mail address: (optional)
Comments:
If you would like to tell your story regarding circumcision and/or restoration either for posting on the NORM website or for an upcoming book on men's (and their partner's) experiences of foreskin restoration please send it to story@norm.org
Please click the submit button only one time. It may take a few moments for the survey to be submitted.
