|
Questions regarding the time before and during pregnancy | Possible answers |
(1) I lost urine involuntary/against my will | Never ☐ Sometimes ☐ Daily ☐ |
(2) I lost stool involuntary/against my will | Never ☐ Sometimes ☐ Daily ☐ |
(3) I lost gas involuntary/against my will | Never ☐ Sometimes ☐ Daily ☐ |
(4) I had burning/painful sensations during defecation | Never ☐ Sometimes ☐ Always ☐ |
(5) I had burning/painful sensations during sexual intercourse | Never ☐ Sometimes ☐ Always ☐ |
(6) I had a feeling of discomfort/foreign body in the vagina | Never ☐ Sometimes ☐ Daily ☐ |
(7) I had the feeling of something squeezing downwards into the vagina | Never ☐ Sometimes ☐ Daily ☐ |
|
Questions regarding the time after birth | Possible answers |
(8) I lost urine involuntary/against my will | Yes ☐ No ☐ |
(9) Compared to the time before childbirth, I lost urine involuntary/against my will | Less often 1 2 3 4 5 6 7 more often |
(10) I lost stool involuntary/against my will | Yes ☐ No ☐ |
(11) Compared to the time before childbirth, I lost stool involuntary/against my will | Less often 1 2 3 4 5 6 7 more often |
(12) I lost gas involuntary/against my will | Yes ☐ No ☐ |
(13) Compared to the time before childbirth, I lost bowel gas involuntary/against my will | Less often 1 2 3 4 5 6 7 more often |
(14) I have a feeling of discomfort/foreign body in the vagina | Yes ☐ No ☐ |
(15) Compared to the time before childbirth, I have a feeling of discomfort/foreign body in the vagina | Less often 1 2 3 4 5 6 7 more often |
(16) I have the feeling of something squeezing downwards into the vagina | Yes ☐ No ☐ |
(17) Compared to the time before childbirth, I have the feeling of something squeezing downwards into the vagina | Less often 1 2 3 4 5 6 7 more often |
(18) Compared to the time before childbirth, I have the feeling that my vaginal opening is | Tighter/closer 1 2 3 4 5 6 7 wider |
(19) Compared to the time before childbirth, I have the feeling that my pelvic floor is | Weaker 1 2 3 4 5 6 7 stronger |
(20) I do pelvic floor exercise | Yes ☐ No ☐ |
(21) Compared to the time before delivery, I do pelvic floor exercise | Less frequently 1 2 3 4 5 6 7 more frequently |
(22) I already had sexual intercourse after delivery | Yes ☐ No ☐ |
(23) Compared to the time before delivery, my vagina is | Drier 1 2 3 4 5 6 7 wetter |
(24) Sexual intercourse is painful | Yes ☐ No ☐ |
(25) Compared to the time before delivery, sexual intercourse is painful | Less frequently 1 2 3 4 5 6 7 more frequently |
(26) Compared to the time before delivery, my orgasm capability is | Worse 1 2 3 4 5 6 7 better |
(27) Compared to the time before delivery, my sensation in the vagina during sexual intercourse is | Reduced 1 2 3 4 5 6 7 increased |
(28) Compared to the time before delivery, my satisfaction with sexual intercourse is | Reduced 1 2 3 4 5 6 7 increased |
|