Appendix 4 62

Women's Health Questionnaire

(optional) Name:
Age:

Instructions: Check the space that corresponds to your answer.

Kindly answer the succeeding
ceedingquestions
questionshonestly.
honestly.

Female Reproductive Health

1. Have you ever consulted an ob-gyne? 9. Have you tried it with:

No the opposite sex
Yes same sex
when ________________________
10. Have you experienced pains in your
2. Do you have a regular monthly period? vaginal area in the past?
No No
Yes Yes

3. How do you keep your reproductive organ 11. Have you experienced any of the
clean? following in vaginal cavity:
cleaning with water only? unusual discharge
w/ soap itchiness
w/ feminine wash foul odor
others (please specify) unusual bleeding

12. Who are most likely to influence you

4. Do you shave your pubic hair? with your hygiene?
No family member
Yes advertisements
others (please specify)
5. How often do you take a bath when you
have a period?
Interpersonal Relationship

6. Do you regularly use pantyliners? 13. Do you live both with your parents?
No No
Yes Yes

7. Have you been involved with someone 14. Do you have an active lifestyle?
intimate? No
No Yes
Yes sports
community services
8. Have you engage in sexual inercourse? others (please specify)
No
Yes