Patient Questionnaires

Bowel, Bladder or Pelvic Symptoms

These two questionnaires will ask you if you have certain bowel, bladder, or pelvic symptoms and, if you do, how much they bother you. Please fill out both tests if you have abdominal, vulvar, pelvic and/or rectal pain with intercourse, with use of a tampon, with getting a pelvic exam at your gynecologist’s office; with urinating or having a bowel movement or with sitting.

Impact to Activities, Relationships and Feelings

Some women find that bladder, bowel, or vaginal symptoms affect their activities, relationships, and feelings. For each question place an “X” in the response that best describes how much your activities, relationships, or feelings have been affected by your bladder, bowel, or vaginal symptoms or conditions over the last 3 months.

Low Back, Sacral or Coccyx Pain

There have been many cases of dyspareunia, vaginismus and stress urinary incontinence that I have referred to Marci with amazing results over the years. One in particular, is a woman who was unable to have intercourse with her husband for many years prior to working with Marci. She eventually became…

Joanne SweeneyM.D.