Female Questionnaire
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SYMPTOMS: GLANDULAR

Q374

Do you have Diabetes?
  • Don't know
  • No, it has been ruled out within the past 6 months
  • Yes*
* more questions will be asked later

Q375

Do you suffer from Hypoglycemia (abnormally low blood glucose level)?
  • Never had it / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current significant problem

Q376

  • Never had it / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current significant problem

Q377

  • Never had it / not sure / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem, confirmed
  • Current significant problem, confirmed

Q378

Do you have a swelling at the front of your neck?
  • Don't know
  • Definitely not
  • Possibly - I'm not sure
  • Yes, minor
  • Yes, major / pronounced

Q379

Have you suffered from Adrenal Insufficiency?
  • Uncertain / don't know
  • No, lab tests have confirmed normal function
  • It is a suspected problem
  • Yes, a lab test has confirmed it
  • I have confirmed Addison's Disease

Q380

Have you had any swollen, tender or painful lymph nodes within the past year? They appear as small, smooth lumps under the skin. If in doubt, the link above has more information.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

SYMPTOMS: METABOLIC

Q381

Are you hyperactive? In other words, do you always feel the need to be active?
  • Don't know
  • No
  • Somewhat
  • Yes, very

Q382

How would you rate your physical stamina (ability to undertake prolonged exercise)?
  • I have poor endurance
  • I'm about average / don't know
  • I have strong endurance

Q383

How warm or cold do your hands and feet tend to be? Consider when you shake hands with other people: do their hands usually feel warm (meaning your hands are colder) or cold (your hands are warmer)?
  • Usually or always cold
  • Colder than average
  • Average / don't know
  • Warmer than average
  • Usually or always warm

Q384

How often do you feel cold for no apparent reason? This question refers to your whole body, not just hands and feet.
  • Don't know / hands and feet only
  • Never / less than once a year
  • Occasionally - several times a year
  • Regularly - several times a month
  • Often/always

Q385

Do you experience inappropriate/excessive sweating during the day? Only include sweating that is not explained by a hot/humid climate, physical exertion, or dressing too warmly.
  • It is explained by my environment / don't know
  • Never / rarely / less than once a year
  • Yes, I sweat excessively several times a year
  • Yes, regular/frequent unexplained sweating
  • Yes, regular/frequent unexplained heavy sweating

Q386

Do your feet tend to have a strong odor and/or sweat a lot?
  • No / not particularly / don't know
  • Slight sweating, no significant odor
  • Slight sweating, significant odor
  • Significant sweating, no significant odor
  • Significant sweating and odor

Q387

Do you suffer from edema (swelling/puffiness caused by fluid retention) anywhere on your body? Do not include swelling that is red or painful to the touch: this is due to infection or injury and is covered elsewhere.
  • Don't know
  • No
  • Yes / probably*
* more questions will be asked later

Q388

Compared to other people, how quickly do you tend to recover from a cold or flu? Normally symptoms are at their worst in the first 2-3 days, then start improving during days 3-5, with full recovery taking 7-14 days.
  • Don't know
  • Quickly - full recovery usually within 1 to 5 days
  • I'm about average
  • Colds/flus often hit me harder than other people
  • Recovery usually/always takes over 2 weeks

Q389

In an average year, about how often do you get a cold or flu?
  • Rarely / once or twice / don't know
  • 2-3 times
  • More than 3 times

Q390

Do you currently have a fever? If you do, try to rate your average temperature.
  • Don't know
  • No
  • Mild fever, 99-100°F (37.2-37.8°C)
  • Moderate fever, 100.1-103°F (37.8-39.4°C)
  • High fever, usually over 103°F (39.4°C)

Q391

How often do you get unexplained fevers?
  • Never / rarely / don't know
  • Occasionally - one or two per year
  • Frequently - several/many per year

Q392

If you suffer from unexplained recurring fever, how would you rate its average severity?
  • Not applicable / don't know
  • Very mild, almost nothing
  • Mild - I can function normally with it
  • High - I can function but I would rather be in bed
  • Very high - I'm bedridden

Q393

Do you sometimes experience 'chills' (sensations of cold accompanied by shivering) that can not be explained by your environment?
  • Don't know
  • No
  • Occasionally
  • Often - more than once a month
  • I am experiencing chills due to a current illness

Q394

Have you experienced any unusual headaches within the past month?
  • They are ongoing / don't know
  • No
  • Yes, one/some that have now resolved
  • Yes, I am having mild to moderate headaches
  • Yes, I am having severe headaches

Q395

Are headaches an ongoing / long-term problem for you?
  • Don't know
  • No, headaches are not a problem for me
  • My headaches started less than a month ago
  • In the past only, not any more
  • Yes, I have been having headaches for over a month*
* more questions will be asked later

Q396

Do you feel shaky, headachy, tired, faint or nauseated when meals are delayed?
  • No / don't know
  • Occasionally / moderately
  • Often / severely

Q397

Do you experience inner trembling?
  • No / don't know
  • Occasional / moderate
  • Often / severe

Q398

Have you suffered from Pancreatitis?
  • Never had it / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem

Q399

What is your approximate percentage body fat?
  • Don't know
  • 14-20% / very low
  • 21-24% / low
  • 25-31% / average
  • Over 32% / high

Q400

Do you have any problems with your weight? This includes being under/overweight, difficulty maintaining weight, a history of serious weight gains and losses, recent unexplained weight changes, etc.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

SYMPTOMS: URINARY

Q401

Have you suffered from kidney stones?
  • Never had one / don't know
  • Probably had one/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem

Q402

Do you have any degree of Chronic Renal Insufficiency or Kidney Failure?
  • Don't know
  • No, definitely not (confirmed)
  • Chronic Renal Insufficiency
  • Chronic Renal Failure - not on dialysis yet
  • End-Stage Renal Disease - on dialysis

Q403

Do you have a problem with urine leakage (incontinence)?
  • Don't know
  • No
  • Minor occasional problem
  • Occurs with physical stress only (cough, jumping)
  • A continual problem / use absorptive pads

Q404

Do you have internal pain or discomfort in the inguinal (groin) area?
  • Never / don't know
  • Occasional moderate discomfort
  • Frequent moderate discomfort
  • Occasional severe pain
  • Frequent severe pain

Q405

How difficult or easy is it for you to urinate? In other words, how forceful is your urine stream?
  • Very weak stream / great difficulty urinating
  • Weakened stream / some difficulty
  • Don't know
  • Average / the same as it has always been
  • Strong stream, rapid emptying

Q406

Nighttime urination. On average, about how many times do you get up to urinate during your sleeping hours?
  • Rarely / only if I drink too much / don't know
  • Once
  • Twice
  • Three times
  • Four or more times

Q407

Daytime urination. On average, how many times do you urinate during your waking hours?
  • Under 2 times
  • 2 or 3 times
  • About 4 to 5 times / don't know
  • 6 to 9 times
  • 10 or more times

Q408

Do you feel a frequent need to urinate, even when your bladder is empty?
  • Don't know
  • No, definitely not
  • Yes, sometimes
  • Yes, often

Q409

What is the usual color of your urine, ignoring supplement (B-vitamin) yellowing, medications you are taking or other obvious factors?
  • Don't know
  • Colorless
  • Light Yellow
  • Dark Yellow
  • Very dark or black

Q410

Is your urine cloudy?
  • Don't know
  • No, it is clear
  • Occasionally slightly cloudy
  • Often slightly cloudy / occasionally very cloudy
  • Often very cloudy - as if a little milk was added

Q411

Do you ever see blood in your urine?
  • No / don't know
  • Yes, once or twice recently
  • Yes, occasionally
  • Yes, regularly

Q412

When you urinate, is foam produced in the toilet? This is known as 'foamy urine'.
  • Don't know
  • No / extremely rarely
  • Occasionally foamy
  • Frequently foamy OR occasionally very foamy
  • Always very foamy

Q413

Do you suffer pain or burning while urinating?
  • No / don't know
  • Very slight, barely noticeable
  • Yes, but not too worrying
  • Yes, worrying
  • Yes, severe - excruciating

Q414

Have you had any form of unusual urethral discharge? In other words, do you have a discharge from the same opening that you pee through?
  • No / don't know
  • Minor, in the past only
  • Major, in the past only
  • Current minor problem
  • Current major problem

Q415

Does your urine usually have a strong odor?
  • No / don't know
  • Fairly strong
  • Very strong

SYMPTOMS: FEMALE

Some of the questions below are personal in nature.  If you would prefer not to answer a question, simply skip it by leaving the default "don't know" response.

Q416

Do you have silicone (not saline) breast implants?
  • Never had them / prefer not to say / don't know
  • Removed after being in place for less than 5 years
  • Removed, in place for over 5 years
  • Yes, for under 5 years
  • Yes, for over 5 years

Q417

On an average day, for how long do you wear a bra?
  • Prefer not to say / don't know
  • Never / very rarely
  • Less than 10 hours per day
  • 10 to 16 hours per day
  • Over 16 hours per day (I sleep with it on)

Q418

Have you had any breast cysts?
  • Never had one / don't know
  • Probably had one/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem

Q419

Are you currently experiencing breast tenderness, soreness or swelling that is not associated with your menstrual cycle? If it is related to your cycle, answer the question that comes later.
  • Don't know / it is related to my cycle
  • No
  • Yes, slight, for under 1 month
  • Yes, severe, for under 1 month
  • Yes, for over 1 month

Q420

Do you have a tendency towards male characteristics (build, breast development)?
  • No / don't know
  • Moderately
  • Definitely

SYMPTOMS: REPRODUCTIVE

Some of the questions below are personal in nature.  If you are unwilling to answer a question, skip it by leaving the default "don't know" response.

Q421

At what age did you become sexually active?
  • Not applicable / never active / don't know
  • Before age 15
  • 15 to 19
  • 20 to 25
  • Over 25

Q422

What is the approximate number of sexual partners that you have had during your lifetime?
  • Prefer not to say / don't know
  • One or fewer
  • 2 to 5
  • 6 to 20
  • Over 20

Q423

How strong is your sex drive (libido)? In other words, how strong is your desire for sexual activity?
  • Totally absent - I am not at all interested in sex
  • Reduced
  • About average / prefer not to say / don't know
  • Increased
  • Very strong - I can't live without it!

Q424

Have you had endometriosis?
  • Never had it / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem

Q425

Have you had Pap Smear tests?
  • Don't know
  • Never had one
  • No, not within the last year
  • Yes, within last year, cells normal
  • Yes, within last year, cells abnormal

Q426

Cervical Dysplasia. Have irregular, but non-cancerous, cells been found on a Pap Smear? (Class 1 = Slightly abnormal, Class 2 = Abnormal, Class 3 = Severely abnormal. Class 4 would be cancer.)
  • Not applicable / they were cancerous / don't know
  • Abnormal cells in the past only - class 1 or 2
  • Very abnormal cells in the past only - class 3
  • Current abnormal cells - class 1 or 2
  • Current very abnormal cells - class 3

Q427

Do you have difficulty achieving an orgasm?
  • Prefer not to say / don't know
  • No
  • Occasionally, less than half the time
  • Often, more than half the time
  • Always

Q428

When you have tried, how difficult in general has it been for you to conceive children?
  • Not applicable / I have not tried / don't know
  • It has not been difficult
  • There was some difficulty
  • It was very difficult
  • I am infertile / unable to have children

Q429

Is there a chance of your becoming pregnant within the next six months?
  • Don't know
  • No, definitely not
  • Yes, a fair chance
  • Yes - in fact I think I may be already
  • I am currently pregnant

Q430

Have you ever been pregnant, now or in the past?
  • Don't know
  • No
  • Yes, but not currently pregnant*
  • Currently pregnant with first child*
  • Pregnant now but this is not my first time*
* more questions will be asked later

Q431

Have you had Uterine Fibroids?
  • Never had them / don't know
  • Probably had them/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem

Q432

Have you had Ovarian Cysts?
  • Never had one / don't know
  • Probably had one/minor episode(s) now resolved,
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem

Q433

Do you experience any unusual vaginal symptoms? For example, discharge, dryness, odor, burning sensations, pain, pain during sexual intercourse, itching, or other discomfort. (Do not include bleeding, which is covered elsewhere.)
  • Not applicable / don't know
  • No
  • Yes / probably*
* more questions will be asked later

Q434

Do you have any genital sores or lesions?
  • No / don't know
  • One or two, minor
  • Numerous, minor
  • One or two, worrying
  • Numerous, worrying

Q435

Do you have any wart-like fleshy bumps in or around the vagina or anus, or groin? They may bleed when irritated, and may occur individually or merge to form small cauliflower-like clusters.
  • Don't know
  • No
  • Yes, one or two
  • Yes, a few
  • Yes, many / cluster(s)

Q436

What is your current menstrual status? If unsure, answer Premenopausal if aged under 45 or Perimenopausal if aged 45-52. Only answer Postmenopausal if you have passed through menopause.
  • Not applicable / don't know
  • Premenopausal - I still have regular periods*
  • Perimenopausal - periods are changing*
  • Menopausal - having menopausal symptoms*
  • Postmenopausal, either naturally or surgically*
* more questions will be asked later

Q437

What is your HIV/AIDS risk/status?
  • I am not at risk and have tested negative
  • I am not at risk, but have not been tested
  • Don't know
  • I am at risk
  • I have been diagnosed with it

Q438

Other than AIDS, have you had any form of sexually-transmitted disease (STD)?
  • Don't know
  • No
  • Yes / probably*
* more questions will be asked later