Sad Nipple Syndrome Research
Hey, you are here! Just tell us about your SNS experience.
We need your voice, your courage is the strongest support to us!

We believe SNS has a profound biological and psychological influence on people and further research on such topic is a necessity. We hope as more research and investigation being done, the information and the knowledge base about SNS will expand more widely.

You are invited to participate in this research project voluntarily. The procedure involves filling an online survey that will take approximately 30 minutes. Your responses will be confidential and we do not collect identifying information such as your name, email address or IP address.

We will do our best to keep your information confidential. The surveys will not contain information that will personally identify you. The results of this study will be used for scholarly purposes only and may be shared with other SNS researchers .

 If you have any questions about the research study, please contact        pauline_xuexiaofan@163.com.

Sign in to Google to save your progress. Learn more
ELECTRONIC CONSENT: *
Required
What is your gender? *
Age *
Ethnic origin: Please specify your ethnicity. *
What's your highest educational attainment?
What's your Occupation?
What is your current relation status?
Clear selection
Have you given birth?
Clear selection
If yes, did you experience the Dysphoric Milk Ejection Reflex (D-MER) when breastfeeding?
Clear selection
Do you remember what age your first SNS happened? *
If you are a girl, did it happen before your first period or after? *
What triggers SNS ? *
Do the feelings come on suddenly and for no apparent reason? *
How long does your experience last every time? *
Does the feeling disappear immediately after the stimulation stopped? *
Please describe your SNS feelings? *
Does it happen on both of your nipples? *
Rate your feelings on a 10-point intensity scale *
happy/normal
suicidal ideation
Have you found anything that makes your symptoms better? *
Have you found anything that makes your symptoms worse? *
How would you rate your overall stress from SNS *
no stress
unable to cope
Did you ask for help or consult your doctor? *
Do you feel the experience getting better with the age? *
Medical health history *
Required
Mental health history *
Required
Have you ever been suffered from insomnia? *
Medication History *
Required
Would you like to have any medical examination in the coming days on SNS research? *
If you want to join any medical examination or track the progress of our research, please leave your contact information here. We are glad to talk with you!
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms