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Pelvic Questionnaires

Pelvic Floor Disability Index 

  • Appropriate for females
  • 20 questions
  • Assesses levels of disability and distress – how much it bothers you
  • Subsections assess pelvic organ prolapse (POP) distress, colorectal-anal distress, and urinary distress
Pelvic Function PFDI 20Download

Pelvic Floor Impact Questionnaire

  • Appropriate for females
  • 7 questions
  • Assesses impact of pelvic symptoms on activities, relationships, and feelings
  • Categories include bladder or urine, bowel or rectum, and vagina or pelvis
Pelvic Function PFIQ 7Download

Female Sexual Function Index

  • Appropriate for females
  • 19 questions
  • Assesses sexual feelings and responses during the past 4 weeks
  • Subsections include sexual desire or interest, sexual arousal and satisfaction, and pain or discomfort
Pelvic Function FSFIDownload

Queensland Female Pelvic Floor Questionnaire 

  • Appropriate for females
  • 42 questions
  • Assesses visceral (bladder, bowel, and sexual) pelvic function
  • Subsections include bladder function, bowel function, prolapse symptoms and sexual function
Pelvic Function QFPFQDownload

Constipation Questionnaire

  • Appropriate for males and females
  • 29 questions
  • Assess the impact of constipation
  • Subsection include symptoms, effect on daily life, feelings, satisfaction and quality of life
Pelvic Function CQDownload

NIH Chronic Prostatitis Symptom Index Female

  • Appropriate for females
  • 9 questions
  • Assesses urologic and pelvic pain and function
  • Subsections include pain or discomfort, urination, impact of symptoms, and quality of life
Pelvic Function NIHCPSI FemaleDownload

NIH Chronic Prostatitis Symptom Index Male

  • Appropriate for males
  • 9 questions
  • Assesses urologic and pelvic pain and function
  • Subsections include pain or discomfort, urination, impact of symptoms, and quality of life
Pelvic Function NIHCPSI MaleDownload

Pelvic Pain and Urgency Frequency (Interstitial Cystitis) 

  • Appropriate for males and females
  • 8 questions
  • Assesses urinary and sexual function, and pain response
Pelvic Function PUF ICDownload

Pelvic Pain Impact Questionnaire 

  • Appropriate for males and females
  • 10 questions
  • Assesses the impact of pelvic pain on your life
Pelvic Function PPIQDownload

Persistent Pelvic Pain Screening Questionnaire

  • Appropriate for males and females
  • 15 questions
  • Assesses the impact of persistent pelvic pain on your life
Pelvic Function 3PSQDownload

Bladder Chart

  • Appropriate for males and females
  • DIY chart for at least 48 consecutive hours (2 days), option for 96 hours (4 days)
  • Assesses fluid intake, bladder frequency and volume, urinary urgency and incontinence
Pelvic Function Bladder ChartDownload

Bristol Stool Chart for Adults

  • Appropriate for males and females
  • Assesses stool consistency / type
Pelvic Function BSCDownload

Choose Your Poo for Kids

  • Appropriate for children (and the child in you!!)
  • Assesses stool consistency / type
Pelvic Function BSC kidsDownload

Pain and Psychosocial Questionnaires

Pain Stages of Change Questionnaire

  • Appropriate for males and females
  • 30 questions
  • Assesses readiness for change
  • Stages include precontemplation, contemplation, preparation, action, and maintenance
Pelvic Function PSOCQDownload

Central Sensitization Inventory

  • Appropriate for males and females
  • 2 parts – part A 25 questions, part B 10 questions
  • Assesses the symptoms of central sensitization and co-morbid pathology
Pelvic Function CSIDownload

Depression Anxiety and Stress Scale

  • Appropriate for males and females
  • 21 questions
  • Assesses depression, anxiety and stress
Pelvic Function DASS 21Download

Adverse Childhood Experiences Questionnaire

  • Appropriate for males and females
  • 28 questions
  • Assesses trauma in childhood
  • Subsections include abuse, neglect, and household challenges
Pelvic Function ACE QDownload

Adverse Childhood Experiences International Questionnaire

  • Appropriate for males and females
  • 10 questions
  • Assesses trauma in childhood
  • Subsections include abuse, neglect, and household challenges
Pelvic Function ACE IQDownload

Trauma Screening Questionnaire

  • Appropriate for men and women
  • 10 questions
  • Assesses personal reactions to traumatic event(s)
Pelvic Function TSQDownload

Composite Autonomic Score

  • Appropriate for males and females
  • 31 questions
  • Assesses background bodily functions
  • Subsections include orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor function
Pelvic Function COMPASS 31Download

Insomnia Severity Index

  • Appropriate for males and females
  • 7 questions
  • Assesses sleep quality
Pelvic Function ISIDownload

Fremantle (Anywhere) Awareness Questionnaire

  • Appropriate for males and females
  • 9 questions
  • Assesses how people with persistent pain are aware of how different their body or movement might feel
Pelvic Function FreAQDownload

Short-from McGill Pain Questionnaire

  • Appropriate for males and females
  • 24 questions
  • Assesses pain for a range of multiple pain descriptors
Pelvic Function SF MPQ 2Download

Pain Catastrophization Scale

  • Appropriate for males and females
  • 13 questions
  • Assesses unhelpful thoughts and beliefs about pain
  • Subsections include helplessness, rumination, and magnification
Pelvic Function PCSDownload

Injustice Experience Questionnaire

  • Appropriate for males and females
  • 12 questions
  • Assesses thoughts and feelings you may experience when thinking about your injury
Pelvic Function IEQDownload