Appendix 4 Women's Health Questionnaire

(optional) Name: Age:

62

Instructions: Check the space that corresponds to your answer. Kindly answer the succeeding questions honestly. ceeding questions honestly.

Female Reproductive Health 1. Have you ever consulted an ob-gyne? No Yes when ________________________ 2. Do you have a regular monthly period? No Yes 3. How do you keep your reproductive organ clean? cleaning with water only? w/ soap w/ feminine wash others (please specify) 9. Have you tried it with: the opposite sex same sex 10. Have you experienced pains in your vaginal area in the past? No Yes 11. Have you experienced any of the following in vaginal cavity: unusual discharge itchiness foul odor unusual bleeding 12. Who are most likely to influence you with your hygiene? family member advertisements others (please specify)

4. Do you shave your pubic hair? No Yes 5. How often do you take a bath when you have a period?

Interpersonal Relationship 6. Do you regularly use pantyliners? No Yes 7. Have you been involved with someone intimate? No Yes 8. Have you engage in sexual inercourse? No 13. Do you live both with your parents? No Yes 14. Do you have an active lifestyle? No Yes sports community services others (please specify)

Yes

Sign up to vote on this title
UsefulNot useful