Before you see a doctor

Below are some helpful questions to ask yourself and take with you when you visit your doctor in relation to gynaecological problems. 

Date________________________________

1. Circle words that describe your pain:

aching    throbbing    shooting    stabbing    gnawing    sharp    tender    burning    exhausting    tiring    penetrating    nagging    numb    miserable    unbearable

Other __________________________________________________________________________

2. At what time of day is your pain the worst?

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3. Rate the pain at its WORST in the past month, 0-10
- no pain[0], as bad as you can imagine[10]

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4. Rate the pain at its LEAST in the past month, 0-10
- no pain[0], as bad as you can imagine[10]

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5. Rate the pain at its AVERAGE in the past month 0-10
- no pain[0], as bad as you can imagine[10]

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6. Rate and describe your pain AT THIS MOMENT 0-10
- no pain[0], as bad as you can imagine[10]

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7. What makes your pain better?

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8. What makes your pain worse?

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9. What treatments have you used? - Did they help?
Rate degree to which the treatment helped using 0 -10.
0 = Didn't help at all, 10 = Helped absolutely

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10. What side effects did you have?

itching    burning    stinging    chemical burns    nausea    vomiting    constipation    tired    itching    nightmares    sweating    difficulty thinking    insomnia

11. Describe HOW, in the past week, pain has interfered with your life:

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PLEASE PRINT THIS , FILL IT IN AND TAKE IT WITH YOU WHEN NEXT YOU VISIT YOUR PHYSICIAN