Vulva & Vaginal Profile

This questionnaire is made for you to get a better picture of your pain. Share your answers with your general practitioner and together you can find an explanation for your symptoms. 

Please use the numbers 0-5 to mark your answers to each question relevant to you.  

0 = Not at all    ||  1 = Barely  ||  2 = Somewhat  ||  3 = Moderately  ||  4 = Strongly ||  5 = Unendurably

In a few cases, you might need to underline words or write a remark. 

Pain:

  • How annoying has your pain been during the past week?

Location:

  • Is your pain located in a specific place?
    • Is it in the vulva
      • More specifically: Is it located at the entrance to the vagina, urethra, clitoris, labia, or at the perineum towards rectum? 
    • In your vagina
      • Is it on the inside or at the entrance?
      • Is it inside the vagina towards your bladder or opposite?
      • Is it deep on the inside of the vagina?
      • Is it in the top, superficial surface of your vaginal tissues?
      • Is your pain located more in-depth in the vaginal tissue?
    • Do you have other pain concerns or issues in your pelvic area?
    • Do you experience pain elsewhere in the body?
      • Joint pain in the pelvis?
      • Lower back pain?
      • Abdominal pain?
      • Pain in the groin?
      • Buttock pain?
      • Leg pain?

Activities:

You need to login to view the rest of the content. Please . Not a Member? Join Us