check

Your Pelvic Health Profile - Sexual Function

The questions in this assessment relate to sexual function and are taken from the Australian Pelvic Floor Questionnaire.

Click the button below to start.

Start

Question 1 of 11

Are you sexually active?

A

No

B

Less than once per week

C

Once or more per week

D

Daily or most days

Question 2 of 11

If you are not sexually active, please tell us why.

(Select all that apply)
A

Do not have a partner

B

I am not interested

C

My partner is unable

D

Vaginal dryness

E

Too painful

F

Embarrassment or fear due to the prolapse or incontinence

G

Other reasons (no need to specify)

Question 3 of 11

Do you have sufficient vaginal lubrication during intercourse?

A

Yes

B

No

Question 4 of 11

During intercourse, vaginal sensation is...

A

Normal / pleasant

B

Minimal

C

Painful

D

No sensation at all

Question 5 of 11

Do you feel that your vagina is too loose or too lax?

A

Never

B

Occasionally

C

Frequently

D

Always

Question 6 of 11

Do you feel that your vagina is too tight?

A

Never

B

Occasionally

C

Frequently

D

Always

Question 7 of 11

Do you experience pain with sexual intercourse?

A

Never

B

Occasionally

C

Frequently

D

Always

Question 8 of 11

Where does the pain during intercourse occur?

(Select all that apply)
A

Not applicable (I do not experience pain)

B

At the entrance to the vagina

C

Deep inside, in the pelvis

Question 9 of 11

Do you leak urine during sexual intercourse?

A

Never

B

Occasionally

C

Frequently

D

Always

Question 10 of 11

How much do these problems with sexual function bother you?

A

Not applicable

B

Not at all

C

Slightly

D

Moderately

E

Greatly

Question 11 of 11

Do you have any other symptoms relating to your sexual function that have not been covered in the previous questions?

Confirm and Submit