Disclaimer: The information collected for this survey is confidential. By submitting this form you will remain anonymous. Results will be tallied, analyzed, documented for publication to professional journals, and submitted for presentation at professional organizational conferences. The purpose of this research is to give women a voice in Gynecological Health Care Services. Please only fill out this survey once. Thank You!
Geographical Area: Prefer City and State or Region and Country.
Occupation:
Current Marital Status:
Have you ever had a gynecological exam, an exam of the female genitalia by a doctor or gynecologist or other medical professional?
How many different gynecological exams do you think you have had in your lifetime?
What was the nature of the gynecological exam(s): (Write all that apply. Ex. birth control, pregnancy, pain, disease, infection, rape, fear of STD, fear of pregnancy, or other)
What are or were your fears about having a gynecological exam?
What did you need to know prior to having your first gynecological exam that would have made the process easier?
How often do you have a gynecological exam?
How many different doctors do you suppose have preformed gynecological exams on you?
How often and in what situations do or did you have anyone go with you to the office? If so, who? (Write all that apply and the frequency of the situation.)
How often and in what situations do or did they also go into the examination room? If so, who? (Write all that apply and the frequency of the situation.)
Do you prefer a certain gender of doctor?
If you have a preference of gender of doctor, state your reasons for choice:
How often and in what situations were you asked about sexual activity?
How often and in what situations were you asked about birth control usage?
What did you need to occur or what information or questions do you feel would have made the visit most pleasant?
On average did you have a paper gown, cloth gown or other? (please define if other is selected) And what is your preference?
What atmosphere would you find most pleasant in regard
to gynecological health care?
How often and in what situations did the doctor ask you about hygiene (of the genitalia)?
How often and in what situations were you offered suggestions for vulvar health care (care of the genitalia)?
How often and in what situations were vulvar (female genitalia) self-exams demonstrated or mentioned?
How often and in what situations did the doctor show you with a mirror or camera what she/he was doing during your gynecological exam? If so, which one?
Would either method be preferred? Why or why not?
On average did the examination room have a gynecological table or chair?
What is your preference if you have used both types? Why?
Overall, do you feel like you are allotted the time or the option to ask questions?
How often and in what situations were you given health care literature to read? If so, what types and/or topics? & on what topics would you like to know more about?
How do you value the relationship with the receptionist?
On average, how do or did you find the temperature of the examination room?
In what situations, if any, were you offered paper and pen to take notes or write down instructions?
On average, how often have you been prescribed medication?
Do you always fill your prescriptions? If not, for what reasons do you not fill them?
Describe your current or last doctor's bedside manner:
How is the current or last doctor's response to your questions?
How long was the average wait in the waiting room?
On average, how long did you wait in the examination room?
On average, what types of terminology did the doctor use?
Did your current or last doctor describe the procedure or illnesses by using posters, 3D models, by drawing pictures, by using hand gestures, etc.? List all that apply.
Thank you for your assistance in giving women a voice in gynecological health care. This study is being conducted by an independent research student attending the University of Findlay. Additional comments about this survey may be noted below or email: benavidesa@findlay.edu or to andrea@sexualitytutor.com
Overall, how would you rate your gynecological health care satisfaction?
