Patients Assessment Guide

Urogenital health

1.     Do you have a history of vaginal infections?

a.     If yes, when was the last episode?

b.     What treatment did you use?

c.      How many episodes have you had in the last 12 months?

2.     Do you have a history of urinary infections?

a.     If yes, when was the last onset?

b.     What therapy did you use and for how long?

c.      How many onsets did you have in the last 12 months?

3.     When was your last menstrual period?

4.     Are you currently pregnant?

5.     Are you currently breastfeeding?

6.     Are you on a birth control pill?

7.     Are you menopausal?

General health

8.     Have you been on antibiotic/antifungal treatment recently?

9.     Do you have any immuno-compromising condition?

10.  Are you on immunosuppressants?

11.  Do you have diabetes?

12.  Do you have any other hormonal issues (adrenal, thyroid)?

13.  How is your general health?

14.  Do you have additional systemic symptoms (e.g., lower abdominal pain, fever, nausea and vomiting)?

Sexual activity and practice

15.  Are you sexually active?

a.     If yes, how many sexual partners have you had in the last 12 months?

b.     Did symptoms begin with a new sexual partner?

c.      Are symptoms exacerbated after sexual intercourse?

d.     Do you use condoms?

e.     Do you use any other sexual protection method?

f.      Do you practice oral sex?

g.     Do you practice anal sex?

h.     Do you have sex with women?

i.       Do you use sex toys?

Vaginal hygiene

16.  Do you practice douching?

j.       If yes, how many times per month?

17.  Do you use vaginal washes and other intimate cosmetic products?

k.     If yes, are they scented or flavoured?

18.  Do you often visit baths, spas or pools?

l.       If yes, how many times per month?

19.  Do you use vaginal lubricants?

m.   If yes, is it water-, silica- or oil- based?

Diet

20.  Do you consume a high quantity of refined and industrially processed food?

21.  Do you consume a high quantity of sweets (e.g., chocolates, cakes, lollies etc.)?

22.  Do you consume a high quantity of oily/ saturated fat food (e.g., butter, full cream cheese, deep fried food)?

23.  How many servings of vegetables and fruits do you have per day? (Healthy intake is 5 servings of vegetables and 2 servings of fruit per day. Serve size is approx. ½ cup.

24.  Do you take any dietary supplements or fermented food (e.g., yogurt, kombucha, kefir)?