| All the Time | Often (at Least Once a Week) | Rarely (a Few Times) | Never | |
| Vaginal dryness | ||||
| Vaginal discharge | ||||
| Vaginal bleeding | ||||
| Vaginal itchiness | ||||
| Urinary tract infections (UTIs) (please write the number of UTIs you’ve had in the past year) | ||||
| Yeast infections/vaginitis (please write the number of yeast infections/vaginitis you’ve had in the past year) | ||||
| Hot flashes/insomnia | ||||
| Decreased sex drive | ||||
| Feel depressed |
Official websites use .gov
A
.gov website belongs to an official
government organization in the United States.
Secure .gov websites use HTTPS
A lock (
) or https:// means you've safely
connected to the .gov website. Share sensitive
information only on official, secure websites.