This questionnaire has been designed to help us understand your problems and to find the most appropriate treatments.  It may also help you to formulate your thoughts on your symptoms and the way in which they can affect your quality of life.  It is important that you answer as many of the questions as you are able.  If you find any of them awkward to answer, please leave them blank and we may discuss them at your consultation should you wish.

Please be assured that the information you provide will be kept confidential, in accordance with Data Protection legislation and entered onto a central database together with the results of clinical examination and any tests that you may have. The findings and results of any surgical intervention that you may have will be recorded and assessed, as will your responses from follow up questionnaires.

The anonymous information collected on all patients will be used for research and study into the treatment of endometriosis, and may be published in medical journals or presented at medical scientific meetings.

If you do not understand any of the questions, particularly about previous treatment, please leave these blank and raise the questions when you are seen in the clinic.

BSGE Pelvic Pain Questionnaire


Background Details

General Questions About Your Pain

Over the course of your current normal menstrual cycle, which of the following symptoms do you experience?  Please tick yes or no to show whether you experience symptom during a normal cycle, and then if you have experienced the symptom, circle a score from 1 to 10 to indicate how slight or severe it usually is.

Information about Bowel Function

NOTE: (N/A is to be used if you have a stoma)


Questions about your health in general

The following questions refer to how you feel about your health in general TODAY. They form part of a standard set of questions relating to quality of life and therefore some may not seem particularly relevant to you. However, please try to answer ALL questions.

Please indicate which statements best describe your health state TODAY

Thank you very much for completing this questionnaire.

We would like to reassure you again that all the answers will be treated in the strictest confidence.