Name (Optional):____________________ Age:___

Grade and Section:__________________ Sex Assigned at Birth:___

1. What is menstruation? 6. Have you ever seen anyone making

Blood that comes out of the vagina fun of someone else for
People menstruate every 3 weeks menstruating?
It is common to menstruate over 10 days
Yes
Women menstruate all their lives
No
It is related to the menstrual cycle
I don’t know
I don’t know

2. What is the Menstrual Cycle? 7. Have you ever menstruated? (If no,
It has 3 phases
or I don’t know, please stop here)
Yes
It has something to do with hormones
There are no changes in the body during the No
menstrual cycle I don’t know
It has something to do with ovulation
I don’t know 8. Did you have information on
Menstruating for the first time?
Yes
3. Where have you learnt about
No
menstruation?
Family I don’t know
School
Friends 9. How do you usually feel when you
Internet
menstruate?
Happy
Social networks (e.g. Facebook)
TV Sad
Magazines or books Dirty
Other _________ Sensitive
I don’t know I don’t know
Angry
Embarrassed
4. Would you like to have more
information on menstruation? Relaxed
Yes, on what the menstruation is Tired
Yes, on menstruation duration Other: ______________________
Yes, on how menstruation can have an impact
on my daily life 10. Are you scared of staining your
Yes, on menstruation delays clothes with blood when you
Yes, on menstrual products menstruate?
Yes, on something else: ________ Yes
No, I have enough No
No, I am not interested I don’t know
I don’t know

11. Has anyone ever made fun of you for

5. Are you embarrassed to talk about menstruating?
menstruation?
Yes
Yes
No
No
I don’t know
I don’t know
Pangalan (Opsyunal):____________________ Edad:___
Baitang at Pangkat:__________________ Kasariang Naitalaga sa Kapanganakan:___

1. Ano ang menstruation? 6. Nakakita ka na ba ng ibang tao na

Dugo na lumalabas sa female genitalia pinagtatawanan ang mga kababaihan
Nangyayari ito tuwing 3 linggo dahil sa kanilang menstruation?
Karaniwang tumatagal nang 10 araw Oo
Nararanasan ng mga kababaihan sa kabuuan ng Hindi
kanilang buhay
Hindi ko alam
May kaugnayan sa menstrual cycle
Hindi ko alam
7. Nakaranas ka na ba ng menstruation?
(Kung hindi, mangyaring itigil na ang
2. Ano ang Menstrual Cycle? pagsasagot)
Mayroon itong tatlong yugto Oo
May kinalaman ito sa hormones ng katawan
Hindi
Walang pagbabago sa katawan habang nararanasan ito
Hindi ko alam
May kinalaman ito sa ovulation
Hindi ko alam
8. May kaalaman ka na ba sa menstruation
noong una mo itong naranasan?
Oo
3. Saan mo natutunan ang iyong mga
kaalaman tungkol sa menstruation? Hindi
Pamilya Hindi ko alam
Paaralan
Mga Kaibigan 9. Ano ang madalas na nararamdaman mo
Internet kapag ikaw ay nagkakaroon ng
Social networks (e.g. Facebook) menstruation?
TV Masaya

Mga Magasin o Aklat Malungkot

Iba pa: _________ Madumi
Hindi ko alam Maramdamin
Galit

4. Nais mo bang magkaroon ng Hiya

karagdagang impormasyon tungkol sa Maluwag na Pakiramdam
menstruation? Pagod
Oo, tungkol sa kahulugan nito
Hindi ko alam
Oo, tungkol sa tagal nito
Iba pa: ______________________
Oo, tungkol sa kung paano ito maaaring makaapekto sa
aking pang-araw-araw na buhay
Oo, tungkol sa menstruation delays o pagkaantala nito 10. Natatakot ka bang mamantsahan ang
Oo, tungkol sa menstrual products
iyong damit ng dugo sa tuwing ikaw ay
nagkakaroon ng menstruation?
Oo, tungkol sa iba pa: ________
Oo
Hindi, sapat na ang alam ko
Hindi
Hindi, wala akong interes
Hindi ko alam
Hindi ko alam

11. Nakaranas ka na ba na mapagtawanan

5. Nahihiya ka bang pag-usapan ang usapin
dahil sa pagkakaroon ng menstruation?
ng menstruation?
Oo
Oo
Hindi
Hindi
Hindi ko alam
Hindi ko alam