Reproductive Health Assessment

Reproductive Health Screening – Instructions

This assessment evaluates hormonal, menstrual, sexual, and reproductive symptoms.

It supports early identification of reproductive health concerns in both males and females.

How to Take

  • Respond based on symptoms over the last 3 months.
  • All responses are confidential.

Using the Result

  • Results guide gynecologic or urologic evaluation.
  • Full reports may be shared with specialists.
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| 1 | Do you experience pelvic or lower abdominal pain?
| 2 | Menstrual cycle regularity (if applicable)
| 3 | Menstrual pain severity |
4 | Heavy or prolonged bleeding
5 | Abnormal vaginal/penile discharge
6 | Pain during intercourse
7 | Bleeding after intercourse
8 | History of sexually transmitted infection (STI) |
9 | Current genital itching, sores, or rash
10. Difficulty conceiving (if applicable)
11. Erectile or arousal difficulties (if applicable)
12. Pain or burning during urination
13. Testicular or ovarian pain or swelling
14. Use of contraception
15. History of reproductive surgery
16. Hormonal symptoms (hot flashes, mood swings)
17. Unexplained weight or hair changes
18. History of pregnancy complications (if applicable)
19. Family history of reproductive disorders
20. Impact of symptoms on daily life
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