❑1	Pain, pressure, discomfort in your pubic or bladder area
❑2	Pain, pressure, discomfort in the area between: your rectum and testicles (perineum) [MALES only], - OR-the vaginal area [FEMALES only]
❑3	Pain/discomfort during or after sexual activity
❑4	Strong need to urinate with little or no warning
❑5	Frequent urination during the day
❑6	Frequent urination at night
❑7	Sense of not emptying your bladder completely
❑8	Other: _______________________________________________________________________