Name & Surname
For each statement that applies to you, enter a ' X '.
1.
Weak urinary stream?
2.
Experience start and stop urinations before emptying?
3.
Sensation of sitting on a tennis ball in the perineum area?
4.
Trouble emptying the bladder? Sensation of not emptying the bladder?
5.
Frequent urination? Returning to urinate in less than 2 hours?
6.
Get up during sleep 2 or more times per night?
7.
Urinary urgency. Must hasten to urinate or urine might escape?
8.
Strain to start? Do you have to push hard or wait to get urination started?
9.
Dribbling. Do you experience dribbling after urination?
10.
Twinges of pain after ejaculation?
11.
Unaccountable (non injury) pain in back, hips, thighs, pelvis, rectum?
12.
Avoid the sun, work in doors? (lack of sun-generated Vitamin D)
13.
History of bacterial or fungal prostatitis?
14.
Prostatic fluid appears in urine?
15.
Genetic family history of prostate cancer?
16.
Pain in the perineum area during a bowel movement?
17.
History of STD: gonorrhea, trichomonas, etc.?
