SPECIFIC PAIN QUESTIONS

Do you have pain during or after sexual intercourse? When talking with your doctor about pain with intercourse, be open and honest about the type of pain you have, whether it’s with deep penetration or all the time, whether orgasm makes the pain worse, and what methods alleviate the pain. Yes  No  Sometimes  Pain is worse with deep penetration

 I have pain during orgasm

 I have pain after orgasm

 I have pain with certain sexual positions

Do you have painful bowel movements? Many women with endometriosis report significant bowel pain, including painful bowel movements, rectal pain, constipation, or diarrhoea. The doctor will also want to know if you’ve ever experienced blood in your stool and if any of these symptoms occur during menstruation. Yes  No  Sometimes

 I have painful bowel movements

 I have rectal pain

 I have constipation and/or diarrhoea or alternating courses of both

 I have had blood in my stool

 My bowel symptoms are worse during menstruation

Do you have pelvic pain with physical exercise? Some women with endometriosis report feeling more pain when they engage in strenuous physical exercise. The pain may be more severe during menstruation.  Yes  No  Sometimes

 Pain with exercise is worse during menstruation

When did your pain start?  Pain started _____ years ago

 Pain started recently. When? _______________________

Where is the pain? As you answer this question, point to or describe the area of your body that’s affected.Some physicians will provide a printed diagram of the body so you can mark the areas where you have pain.

Type of pain? When describing pain, consider which adjectives best describe what you experience. Women often describe endometriosis pain as burning, stabbing, gnawing, cramping, jabbing, throbbing, cold, sharp, aching, or pressure.Severity of pain? There are several ways you can describe the pain’s severity. For example, you may choose to use an adjective, such as excruciating, severe, moderate, or mild. Or you may choose to use a pain scale, rating it on a scale of one (no pain) to ten (pain so severe, it makes you pass out). If it’s helpful, you may want to refer to the Andrea Mankoski’s Pain Scale (see follwing pages)

Adjective(s) that describe my pain:

Pain on a scale of 1-10: _____

SPECIFIC PAIN QUESTIONS YOUR RESPONSES

How bad is your pain right now?

Be honest! How many days each month are you in pain? If you have a really good memory, you may be able to estimate the number of days you’re in pain each month. However, most of us tend to put pain out of our minds after it’s come and gone, so our estimates aren’t always accurate. That’s why a Daily Pain Journal (see following pages) is a better way of determining exactly how many days each month you have pain.

Number of days I’m in pain per month: _____ Is the pain getting worse?

From the time the pain started until now, has it gotten worse? If so, by what degree?

 Pain is getting much worse

 Pain is getting somewhat worse

 Pain is about the same as usual

 Pain is getting somewhat better

How does the pain impact your life? Tell your physician if you’re missing work or school or declining invitations due to your symptoms. The doctor will also ask if the pain is preventing you from engaging in sports or exercise.

List the medications you have taken to try to alleviate your pain. Were these medications effective? Most women with endometriosis have tried some type of analgesic or anti-inflammatory pain reliever. Tell your doctor of any over-the-counter or prescription medications you have taken or are taking for pain, and whether they reduce your pain levels.

List any alternative methods you are currently using (or have used) to relieve your pain: When traditional methods don’t work, many women incorporate alternative approaches (such as acupuncture, chiropractic medicine, or biofeedback) to help alleviate their pain. Tell your doctor if you are taking any herbs or seeing alternative practitioners for your pain and whether these methods are effective.

OTHER SYMPTOMS: YOUR RESPONSES: Do you routinely experience nausea with menstruation?

 Yes  No

Do you vomit during menstruation?  Yes  No

Do you have unusual vaginal bleeding at any time during your cycle?

 Yes  No

Do you experience painful urination or blood in urine at any time during your cycle?  Yes  No

Do you experience bloating during menstruation or at other times?

  Yes  No

Do you have difficulty gaining or losing weight?  Yes  No

Do you experience fatigue?  Yes  No