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Dr. Glazer's Vulvodynia.com website sponsors surveys conducted by experts in the field of vulvovaginal pain disorders. We are hopeful that this means of data collection can lead to high quality research that will give professionals and sufferers greater insight into this class of disorders. All information provided by you in completing a survey is anonymous and by completing and submitting a survey on this website you are automatically giving your authorization for us to use this data.

    

Vulvovaginal Pain Survey

PART A - DEMOGRAPHICS

1. AgeRange

How old are you?

1. Under 16
2. 16 - 17
3. 18 - 20
4. 21 - 24
5. 25 - 34
6. 35 - 44
7. 45 - 54
8. 55 - 64
9. 65+

2. Ethnicity

What is your ethnic origin

1. caucasian
2. african
3. oriental
4. East Indian
5. Native American/Australian
6. other

3. Personal Education

What is your current highest level of education?

1. Post-Graduate Degree
2. Graduated Four-Year College
3. Graduated Two-Year College
4. Attended Some College
5. Graduated High School Or Earned G.E.D.
6. Attended Some High School

4. Occupation

Which of the following best describes your occupation?

1. Student
2. Homemaker
3. Retired
4. Self Employed
5. Administrative
6. Sales/Marketing
7. Trade/Labor
8. Education
9. Manager
10. Medical
11. Professional
12. Other

5. Marital status

What is your marital status?

1. Married
2. Living together
3. Single, never married
4. Widowed
5. Separated or divorced

6. Household Income

Please estimate your annual household income.

1. Less than $20,000
2. $20,000 - $39,999
3. $40,000 - $59,999
4. $60,000 - $79,999
5. $80,000 - $99,999
6. $100,000 or more

7. Children

How many children do you have?

1. 0
2. 1
3. 2
4. 3
5. 4
6. more than 4

8. Geographical location

Where do you reside?

1. United States/Canada
2. Central/South America/Mexico
3. Africa
4. Europe
5. Far East
6. Middle East
7. Indian subcontinent
8. Australia/New Zealand

PART B - OBSTETRICAL/GYNECOLOGICAL HISTORY

9. Pregnancies

How many pregnancies have you experienced?

1. none
2. 1
3. 2
4. 3
5. 4 or more

10. Miscarriages

How many miscarriages have you experienced?

1. none
2. 1
3. 2
4. 3
5. 4 or more

11. Abortions

How many abortions have you experienced?

1. none
2. 1
3. 2
4. 3
5. 4 or more

12. Deliveries

How many vaginal deliveries have you experienced?

1. none
2. 1
3. 2
4. 3
5. 4 or more

13. Forceps

Have you ever experienced a delivery in which forceps were used?

1. yes
2. no

14. Episiotomies

How many episiotomies have you experienced?

1. none
2. 1
3. 2
4. 3
5. 4 or more

15. Tearing

Have you ever been told you "tore" during a vaginal delivery?

1. yes
2. no

16. Epidural

Did you have have an epidural block during a delivery

1. yes
2. no

17. C-Sections

How many C-sections have your experienced?

1. none
2. 1
3. 2
4. 3
5. 4 or more

18. Infertility

Have you ever had any problem in becoming pregnant (infertility)?

1. yes
2. no

19. Menstruation

At what age did you start your menstrual periods?

10 or earlier
11
12
13
14
15
16 or later

20. Periods

Are you having menstrual periods?

1. yes
2. no

21. Regularity

Are your menstrual periods regular?

1. yes
2. no

22. Period times

Your periods usually come about every?

25 days or less
26-30 days
31 days or more

23. Tampons/Pads

Do you Use?

1. Tampons
2. Pads

24. Number of Tampons

If you use tampons how many do you use per day during your heaviest flow?

1
2
3
4
5
6 or more

25. Number of Pads

If you use pads how many do you use per day during your heaviest flow?

1
2
3
4
5
6 or more

26. Menstrual Pain

Do you experience pain/severe cramps during your periods?

1. never
2. rarely
3. sometimes
4. often
5. alway

27. Premenstrual Symptoms

Do you suffer any of the following premenstrual sundrome symptoms?

breast tenderness
generalized swelling
mood changes
abdominal pain and or bloating
muscle tension
tiredness
changes in sexual desire (increase or decrease)
cramps and pain
other

28. Midcycle bleeding

Do you have bleeding between periods?

1. yes
2. no

29. Birth Control

Specify which type of birth control you use, if any

1. none
2. condoms
3. Intrauterine device (IUD)
4. birth control pill
5. rhythm or timing method
6. withdrawl
7. other

30. First Intercourse

What was your age at the time of first sexual intercourse?

1. 13 or under
2. 14 to 16
3. 17-19
4. 20-22
5. 23-25
6. over 25
7. never experienced intercourse

31. Childhood abuse

Have you ever experienced sexual abuse as a child?

1. yes
2. no

32. Adult abuse

Have you ever experienced sexual abuse as an adult?

1. yes
2. no

33. Partners

How many sexual partners have you had to date?

1. none
2. 1
3. 2-4
4. 5-9
5. 10-15
6. 16-20
7. more than 20

34. Sexually Transmitted Diseases

Have you ever been diagnosed with a sexually transmitted disease (STD)?

1. yes
2. no

35. STD's

If you have been diagnosed with an STD specify which one(s)?

herpes
chlamydial infections
genital warts (HPV)
gonococcal infections
syphilis
trichomoniaisis

36. Yeast Infections

Have you experienced frequent or recurrent vaginal yeast infections?

1. yes
2. no

37. Urinary Infections

Have you experienced frequent or recurrent Uriniary Tract Infections (UTI's)?

1. yes
2. no

38. Bacterial Infections

Have you experienced frequent or recurrent bacterial vaginosis?

1. yes
2. no

Part C - General Medical History and Systems Review

39. Head and Neck

Do you experience Headaches and/or neck pain

1. never/rarely
2. ocassionally
3. frequently

40. Mouth

Do you experience teeth, gums, jaw, mouth or tongue/taste problems

1. never/rarely
2. ocassionally
3. frequently

41. Eyes

Check off each of the following that apply

wear glasses/contact
eye pressure problems
double or blurred vision
watery or itchy eyes

42. Ears

Check off each of the following that apply

hearing problems
wax in ears
discharge from ears
loss of balance
dizziness/motion sickness
ringing in ears

43. Nose/Throad

Check off each of the following that apply

head colds
runny nose
head congestion
sore/hoarse throat
sneezing spells
nose bleeds

44. Respiratory

Check off each of the following that apply

chest colds
coughing spells
trouble breathing
coughing blood
chronic cough
wheezing/asthma/bronchitis
chest pain
hyperventilation
fainting

45. Cardiovascular

Check off each of the following that apply

heart trouble
hypertension
out of breath quickly when exercising
breathing problems during sleep
leg cramps at night
swollen ankles/feet
rapid or irregular heartbeat
dizziness/fainting spells
pain in thighs or legs when walking

46. Musculoskeletal

Check off each of the following that apply

shoulder pain
back pain
muscle or joint pain with exercise
muscle or joint pain without exercise

47. Digestive

Check off each of the following that apply

stomach nausea
stomach pain
burps after eating
heartburn
trouble swallowing
vomiting blood
constipation
diarrhea
painful bowel movements
bloody bowel movement
dark bowel movements

48. Urinary

Check off each of the following that apply

Hard to start urine flow
pain on urination
urinary urgency and frequencynumbness
Choice
waking at night to urinate
dark color or blood in urine
Involuntary loss of urine with laugh, cough, sneeze, stand or lift
Involuntary loss of urine with urge to urinate

49. Skin

Check off each of the following that apply

dry skin/brittle fingernails
bruise easily
scratch/cuts hard to heal
mole changes
herpes simplex

50. Neruological

Check off each of the following that apply

faintness
numbness
convulsions
tremors
coordination problems
weakness/paralysis

51. Psychiatric

Check off each of the following that apply

substance/alcohol problems
depression
anxiety/panic disorder
obsessive/compulsive disororder
manic/depressive illness
schizophrenia
eating disorder
taking psychiatric medicines

52. Nutrition and diet

Check off each of the following that apply

do not usually eat three meals a day
frequently miss breakfast
frequently diet
frequently snack
frequently add salt to food at the table
see myself as underweight
see myself as overweight
take dietary supplements/vitamins

53. Associated Diseases

Check off any of the following conditions from which you suffer

Interstitial cystitis (IC)
Irritable bowel syndrome (IBS)
Fibromyalgia (FM)
Hashimoto's Disease (subclinical hypothyroidism)
Inflammatory Diseases
Autoimmune Diseases

Part D - Sexual Functioning and Pain

54. Intercourse

Have you ever had or attempted sexual intercourse with a man?

1. yes
2. no

55. Recent Intercourse

Have you had or attempted sexual intercourse in the past 6 months?

1. yes
2. no

56. Sexual Pain

In the past 6 months have you regularly experienced pain in your genital area in any of the following situations?

Friction with tight clothing
Prolonged sitting
Urinating
Inserting a tampon
Masturbating with your hand
Masturbating with a vibrator or other object
Partner stimulating you manually
Inserting one of your fingers
Inserting one of your partners fingers
Inserting two of your own fingers
Inserting two of your partners fingers
Standard gynecological examination
Penile insertion

57. Sexual Pain

Do you expect or think that if you were to have intercourse in the near future that it would be a painful experience or one causing physical discomfort? Please check off one of the choices below on a scale of no pain (0) to 10 (severe pain)

1. not painful (0)
2. a little painful pain (1-2)
3. somewhat painful (3-4)
4. moderately painful (5-6)
5. significantly painful (7-8)
6. extremely painful (9-10)

Proceed with the next question, number 58 if you have had at least one episode of intercourse in the past six months. If you have not experienced intercourse in the past six months proceed to question number 88.

58. Intercourse Frequency

Over the past six months approximately how many times did you have intercourse per month?

1
2
3
4
5
6
7
8
9. more than 8 times per month

59. Penile Penetration

In the past six months what percentage of time has your partner's erect penis been able to enter your vagina?

1. 0%
2. less than 25%
3. between 25% and 50%
4. between 50% and 75%
5. over 75%
6. 100%

60. Thrusting

Once inside the vagina, what percentage of time your partner has successfully entered have you been able to tolerate the in-and-out movement of the penis over the past six months?

1. 0%
2. less than 25%
3. between 25% and 50%
4. between 50% and 75%
5. over 75%
6. 100%

61. Penetration time

Over the past 6 months what is the average length of time that your partner's erect penisis in your vagina?

1. less than 1 minute
2. 1 to 3 minutes
3. 4 to 6 minutes
4. 6 to 8 minutes
5. 8 to 10 minutes
6. 10 to 12 minutes
7. 12 to 15 minutes
8. more than 15 minutes

62. Intercourse pain frequency

In the last 6 months what percentage of the time do you experience pain due to intercourse?

1. 0%
2. less than 25%
3. between 25% and 50%
4. between 50% and 75%
5. over 75%
6. 100%

63. Pain Intensity

Check any of the following which cause variations in degree of pain asociated with intercourse.

How tired I am
How lubricated I am
Intercourse position we use
How nervous or anxious I am
The partner I am having sex with
Whether we are alone in the house
The time of day
How aroused I am
How long foreplay lasts
The place where we have intercourse
The time of my menstrual cycle
Whether I am angry with my partner
Whether I have taken any drugs
Whether I have had an alcholic beverage

64. Years of intercourse

How many years ago did you first have intercourse?

1. within the last year
2. 1 to 3 years ago
3. 4 to 7 years ago
4. 8 to 11 years ago
5. 12 to 15 years ago
6. more than 15 years ago

65. Intercourse pain

Have you always had pain with intercourse since your first time and all subsequent attempts at intercourse?

1. yes
2. no

66. Years of Intercourse Pain

When did you start having pain with intercourse regularly?

1. within the last year
2. 1 to 3 years ago
3. 4 to 7 years ago
4. 8 to 11 years ago
5. 12 to 15 years ago
6. more than 15 years ago

67. Years of Intercourse without Pain

How many years of pain free intercourse did you experience before the pain started

1. less than one year
2. 1 to 3 years
3. 4 to 7 years
4. 8 to 11 years
5. 12 to 15 years
6. more than 15 years

68. Pain Onset

When does the pain typically start?

1. before the penis touches the vaginal opening
2. when penis starts to enter vagina
3. when penis has fully entered and is thrusting
4. immediately after intercourse
5. more than 1/2 hour after intercourse

69. Onset time

Does the pain typically start suddenly or gradually?

1. suddenly
2. gradually

70. Painful activity

Check each of the activities below during which you experience pain

before penile entry
during penile entry
during penile thrusting
after penile thrusting
pain starts more than 1/2 hour after intercourse complete

71. Pain Location

Where do you typically feel the pain associated with intercourse? (check all that apply)

at the vaginal opening
inside the vagina
in the pelvic or abdominal region

72. Pain Localization

Is the pain limited to a particular spot or spots you can point to or is it a general area?

1. localized
2. generalized

73. Lubricants

Have you ever tried lubricants to relieve the pain during intercourse?

1. yes
2. no

74. Pain and lubricants

Does it still hurt significantly when you use lubricants?

1. yes
2. no

75. Pain reduction

What else have you tried, besides lubricants, to ease the pain associated with intercourse? (check all the apply)

topical anesthetics (e.g. lidocaine)
changing intercourse positions
more foreplay to increase arousal
Avoiding use of condoms

76. Sexual Desire

Over the past 6 months approximately how many times have you felt sexual desire per month?

1
2
3
4
5
6
7
8
9
10 or more

77. Desire Level

Rate the average level of arousal (excitement) during sex in the past 6 months

1
2
3
4
5
6
7
8
9
10

78. Change in Arousal level

Compare your level of arousal in the past 6 months to what you consider your normal level of arousal during sex

1. much less
2. somewhat less
3. about the same
4. somewhat more
5. much more

79. Partner

Have you ever discussed the pain with your partner?

1. yes
2. no

80. Masturbation

During the Past 6 months how many times did you masturbate per month?

1. 0
2. 1
3. 2
4. 3
5. 4
6. 5
7. 6
8. 7
9. 8
10. more than 8

81. Orgasm

If you have masturbated into he past six months on what percentage of masturbation did you achieve orgasm?

1. less than 25%
2. between 25% and 50%
3. between 50% and 75%
4. over 75%

82. Aversion

Rate any negative feelings you have experienced about sex over the past six months

1. no negative feelings at all
2. mild negative feelings
3. moderate negative feelings
4. strong negative feelings
5. total disgust

83. Partner manual stimulation

In the past six months what percentage of time that your partner manually stimulated you did you achive orgasm?

1. My partner rarely/never stimulates me manually
2. less than 25%
3. between 25% and 50%
4. between 50% an 75%
5. over 75%

84. Oral stimulation

In the past six months what percentage of the time that your partner stimulates you orally do you achieve orgasm?

1. My partner rearely/never stimulates me orally
2. less than 25%
3. between 25% and 50%
4. between 50% and 75%
5. over 75%

85. Partner interest

How would you rate your partner's average level of sexual desire or interest in the past six months compared to his "normal" level?

1. a lot more than normal
2. womewhat more than normal
3. about the same as always
4. somewhat less than normal
5. a lot less than normal

86. Erections

What percentage of time that sex has been initiated in the past six months has your partner had difficulties achieving or maintaining an erection?

1. no sexual initiatives in the past 6 months
2. no problems
3. problems less than 25% of the time
4. problems 25% to 50% of the time
5. problems 50% to 75% of the time
6. problems more than 75% of the time

87. Partner Ejaculation

What percentage of time that you had sex in the past six months does your partner achieve ejaculation?

1. my partner rarely/never achieves ejaculation
2. less than 25%
3. between 25% and 50%
4. between 50% and 75%
5. over 75%

If you have not had an episode of intercourse in the past six months start with question number 88.

88. Intercourse

When did you last have intercourse?

1. never had successful intercourse
2. between six months and one year ago
3. between one and two years ago
4. between two and three years ago
5. between three and four years ago
6. between four and five years ago
7. over five years ago

89. Past intercourse pain

When you had intercourse in the past did you ever experience significant discomfort before during or after?

1. yes
2. no

90. Penile Penetration

In the past what percentage of time has your partner's erect penis been able to enter your vagina?

1. 0%
2. less than 25%
3. between 25% and 50%
4. between 50% and 75%
5. over 75%
6. 100%

91. Thrusting

In the past, once inside the vagina, what percentage of time have you been able to tolerate the in-and-out movement of the penis?

1. 0%
2. less than 25%
3. between 25% and 50%
4. between 50% and 75%
5. over 75%
6. 100%

92. Penetration time

In the past what is the average length of time that your partner's erect penisis in your vagina?

1. no penetration
2. less than 1 minute
3. 1 to 3 minutes
4 to 6 minutes
5. 6 to 8 minutes
6. 8 to 10 minutes
7. 10 to 12 minutes
8. 12 to 15 minutes
9. more than 15 minutes

93. Intercourse pain frequency

In the past what percentage of the time did you experience pain due to intercourse?

1. 0%
2. less than 25%
3. between 25% and 50%
4. between 50% and 75%
5. over 75%
6. 100%

94. Pain Intensity

Check any of the following which caused variations in degree of pain asociated with intercourse in the past.

How tired I am
How lubricated I am
Intercourse position we use
How nervous or anxious I am
The partner I am having sex with
Whether we are alone in the house
The time of day
How aroused I am
How long foreplay lasts
The place where we have intercourse
The time of my menstrual cycle
Whether I am angry with my partner
Whether I have taken any drugs
Whether I have had an alcholic beverage

95. Years of intercourse

How many years ago did you first have intercourse?

1. within the last year
2. 1 to 3 years ago
3. 4 to 7 years ago
4. 8 to 11 years ago
5. 12 to 15 years ago
6. more than 15 years ago

96. Intercourse pain

Have you always had pain with intercourse since your first time and all subsequent attempts at intercourse?

1. yes
2. no

97. Years of Intercourse Pain

When did you start having pain with intercourse regularly?

1. within the last year
2. 1 to 3 years ago
3. 4 to 7 years ago
4. 8 to 11 years ago
5. 12 to 15 years ago
6. more than 15 years ago

98. Years of Intercourse without Pain

How many years of pain free intercourse did you experience before the pain started

1. less than one year
2. 1 to 3 years
3. 4 to 7 years
4. 8 to 11 years
5. 12 to 15 years
6. more than 15 years

99. Pain Onset

In the past when having or attempting intercourse, when did the pain typically start?

1. before the penis touches the vaginal opening
2. when penis starts to enter vagina
3. when penis has fully entered and is thrusting
4. immediately after intercourse
5. more than 1/2 hour after intercourse

100. Onset time

Did the pain typically start suddenly or gradually?

1. suddenly
2. gradually

101. Painful activity

Check each of the activities below during which you experienced pain in the past

before penile entry
during penile entry
during penile thrusting
after penile thrusting
pain starts more than 1/2 hour after intercourse complete

102. Pain Location

Where did you typically feel the pain associated with intercourse? (check all that apply)

at the vaginal opening
inside the vagina
in the pelvic or abdominal region

103. Pain Localization

Was the pain limited to a particular spot or spots you could point to or was it a general area?

1. localized
2. generalized

104. Lubricants

Did you ever tried lubricants to relieve the pain during intercourse?

1. yes
2. no

105. Pain and lubricants

Did it still hurt significantly when you use lubricants?

1. yes
2. no

106. Pain reduction

What else did you try, besides lubricants, to ease the pain associated with intercourse? (check all the apply)

topical anesthetics (e.g. lidocaine)
changing intercourse positions
more foreplay to increase arousal
Avoiding use of condoms

107. Sexual Desire

Over the past 6 months approximately how many times have you felt sexual desire per month?

1
2
3
4
5
6
7
8
9
10 or more

108. Desire Level

Rate the average level of arousal (excitement) during sexual activity in the past 6 months.

1. no sexual activity of any kind experienced
2. 0
3. 1
4. 2
5. 3
6. 4
7. 5
8. 6
9. 7
10. 8
11. 9
12. 10

109. Change in Arousal level

Compare your level of arousal in the past 6 months to what you consider your normal level of arousal during sex

1. much less
2. somewhat less
3. about the same
4. somewhat more
5. much more

110. Partner

Have you ever discussed the pain with your partner?

1. yes
2. no

111. Masturbation

During the Past 6 months how many times did you masturbate per month?

1. 0
2. 1
3. 2
4. 3
5. 4
6. 5
7. 6
8. 7
9. 8
10. more than 8

112. Orgasm

If you have masturbated into he past six months on what percentage of masturbation did you achieve orgasm?

1. 0%
2. less than 25%
3. between 25% and 50%
4. between 50% and 75%
5. over 75%
6. 100%

113. Aversion

Rate any negative feelings you have experienced about sex over the past six months

1. no negative feelings at all
2. mild negative feelings
3. moderate negative feelings
4. strong negative feelings
5. total disgust

114. Partner manual stimulation

In the past six months what percentage of the time that your partner manually stimulated you did you achieve orgasm?

1. My partner rarely/never stimulates me manually
2. 0%
3. less than 25%
4. between 25% and 50%
5. between 50% an 75%
6. over 75%
7. 100%

115. Oral stimulation

In the past six months what percentage of the time that your partner stimulates you orally do you achieve orgasm?

1. My partner rearely/never stimulates me orally
2. 0%
3. less than 25%
4. between 25% and 50%
5. between 50% and 75%
6. over 75%
7. 100%

116. Partner interest

How would you rate your partner's average level of sexual desire or interest in the past six months compared to his "normal" level?

1. a lot more than normal
2. womewhat more than normal
3. about the same as always
4. somewhat less than normal
5. a lot less than normal

117. Erections

What percentage of time that sex has been initiated in the past six months has your partner had difficulties achieving or maintaining an erection?

1. no sexual initiatives in the past 6 months
2. no problems
3. problems less than 25% of the time
4. problems 25% to 50% of the time
5. problems 50% to 75% of the time
6. problems more than 75% of the time

118. Partner Ejaculation

What percentage of time that you had sex in the past six months does your partner achieve ejaculation?

1. my partner rarely/never achieves ejaculation
2. less than 25%
3. between 25% and 50%
4. between 50% and 75%
5. over 75%

Part E - Relationship/Marriage Scale

119. Relationship hapiness

Check which of the below best described the degree of hapiness of your present marriage/relationship.

1. totally unhappy
2. somewhat unhappy
3. neutral
4. somewhat happy
5. totally happy

Relationship agreement/disagreement

State the approximate extent of agreement or disagreement between you and your partner on the following items.

120. Family Finances

1. Agree Strongly
2. Agree Somewhat
3. Disagree Somewhat
4. Disagree Strongly

121. Recreation

1. Agree Strongly
2. Agree Somewhat
3. Disagree Somewhat
4. Disagree Strongly

122. Showing Affection

1. Agree Strongly
2. Agree Somewhat
3. Disagree Somewhat
4. Disagree Strongly

123. Friends

1. Agree Strongly
2. Agree Somewhat
3. Disagree Somewhat
4. Disagree Strongly

124. Sexual Relations

1. Agree Strongly
2. Agree Somewhat
3. Disagree Somewhat
4. Disagree Strongly

125. Correct conduct (conventionality)

1. Agree Strongly
2. Agree Somewhat
3. Disagree Somewhat
4. Disagree Strongly

126. Philosophy of Life

1. Agree Strongly
2. Agree Somewhat
3. Disagree Somewhat
4. Disagree Strongly

127. Dealing with partners parents

1. Agree Strongly
2. Agree Somewhat
3. Disagree Somewhat
4. Disagree Strongly

128. Disagreement resolution

When disagreements arise, they usually result in:

1. Man giving in
2. woman giving in
3. agreement by mutual give and take

129. Outside Interests

Do you and your partner engage in outside interests together?

1. All of them
2. some of them
3. few of them
4. none of them

130. Regrets

Do you ever wish you had not married/moved in with with your partner?

1. frequently
2. occasionally
3. rarely
4. never

131. Confiding

Do you confide in your partner?

1. almost never
2. rarely
3. in most things
4. in all things

Part F - Vulvovaginal Pain History, Symptoms and Treatments

132. Onset age

Vulvovaginal pain onset at what age?

1. as long as I can remember even as a child I had discomfort
2. between ages 12-17
3. between ages 18-23
4. between ages 24-29
5. between ages 54-58
6. age 59 or over

133. Onset time

check which of the below best describes onset time.

1. pain started quicky within a 24 hour period
2. pain started slowly over one or more weeks

134. Onset intensity

check which of the below best describes the start of your pain.

1. started with the worst pain it has ever been
2. started with significant but not the worst pain
3. started with moderate pain compared to the worst
4. started with mild pain compared to the worst

135. Onset Associations

Was the onset of your pain associated with?

1. nothing I can identify
2. vaginal infection
3. sexual activity
4. accident
5. surgery

136. Pain duration

How long have you suffered from significant vulvovaginal pain?

1. less than six months
2. 6 months to a year
3. 1 to 2 years
4. 2 to 3 years
5. 3 to 4 years
6. 4 to 5 years
7. 5 to 7 years
8 to 10 years
9. 11 or more years

137. Pain level

How consistent is your pain level?

1. always about the same
2. some symptom variability
3. moderate symptom variability
4. high symptom variability

138. Pain constancy

Is your pain present?

1. all the time, constantly
2. pain present more often than not every day
3. pain at least some time every day
4. some pain free days
5. up to several pain free days

139. Provoked/Unprovoked

Is your pain present?

1. only on provocation such as direct pressure (tight clothes, prolonged sitting, etc), direct touch or with attempted intercourse
2. unprovoked occuring spontaneously without provocation

140. Localization

Is your pain?

1. localized to a specific spot(s) you can point to
2. diffuse covering an area of tissue rather than a spot(s)

141. Location

Is your pain located ? (choose all that apply)

around the entire opening of the vagina
at the bottom of the vaginal opening
in the clitoril area
in the urethral area
in the mons (area of pubic hair above vagina)
in the perineum between the vagina and the anus
in the anal area
inner thighs

142. Laterality

Is your pain located entirely or mostly on one side or on both sides?

1. one side
2. both sides

143. Description

check off those sensations below that best describe your pain

burning
stinging
stabbing
aching
itching
drawing or pulling

144. Associated factors

check off those factors associated with your pain

menstrual cycle
diet
sexual activity
direct pressure to the area (tight clothing, sitting, etc)
urination
bowel movement
orgasms

145. Diagnosis

How long from the onset of your pain until you received a vulvar pain diagnosis?

1. within 3 months
2. within 6 months
3. within 1 year
4. within 2 years
5. within 3 years
6. within 4 years
7. 5 or more years

146. Doctors seen

How many different doctors did you see before receiving the diagnosis of a vulvar pain disorder?

1
2
3
4
5
6 or more

Indicate the outcome for each of the following treatments which you have tried.

If you have not tried a treatment just leave it blank and go on.

147Antifungalsforyeast.

1. Excellent
2. Good
3. Fair
4. Poor

148. Antibiotics (for bacterial infection)

1. Excellent
2. Good
3. Fair
4. Poor

149. Antivirals (for viral infection)

1. Excellent
2. Good
3. Fair
4. Poor

150. Tricyclic Antidepressants (e.g. elavil)

1. Excellent
2. Good
3. Fair
4. Poor

151. SSRI's (e.g. prozac, zoloft, paxil)

1. Excellent
2. Good
3. Fair
4. Poor

152. Anticonvulsants (e.g. neurontin)

1. Excellent
2. Good
3. Fair
4. Poor

153. Antihistamines (over the counter or prescription, e.g. claritin)

1. Excellent
2. Good
3. Fair
4. Poor

154. Hormonal treatments (e.g. estrogen, progesterone, testosterone)

1. Excellent
2. Good
3. Fair
4. Poor

155. Accupunture

1. Excellent
2. Good
3. Fair
4. Poor

156. Biofeedback (pelvic floor muscle rehabilitation)

1. Excellent
2. Good
3. Fair
4. Poor

157. Low oxalate diet (with or without calcium citrate supplements)

1. Excellent
2. Good
3. Fair
4. Poor

158. Guaifenasin

1. Excellent
2. Good
3. Fair
4. Poor

159. Nutritional supplements

1. Excellent
2. Good
3. Fair
4. Poor

160. Pain medication (by prescription)

1. Excellent
2. Good
3. Fair
4. Poor

161. Pain medication (over the counter)

1. Excellent
2. Good
3. Fair
4. Poor

162. Alpha interferon injections

1. Excellent
2. Good
3. Fair
4. Poor

163. Vestibulectomy (surgery to remove affected vulvar tissue)

1. Excellent
2. Good
3. Fair
4. Poor

164. Baking soda douche

1. Excellent
2. Good
3. Fair
4. Poor

165. Topical anesthetic (e.g. lidocaine)

1. Excellent
2. Good
3. Fair
4. Poor

166. Avoidance of irritants (e.g. soaps, shampoos, perfumes, toilet paper, detergent,s etc)

1. Excellent
2. Good
3. Fair
4. Poor

167. Chiropractic manipulations

1. Excellent
2. Good
3. Fair
4. Poor

168. Physical Therapy without biofeedback (e.g. myofascial release, massage, etc)

1. Excellent
2. Good
3. Fair
4. Poor

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