Birth Control Side Effects Questionnaire
PLEASE TAKE A FEW MOMENTS TO READ THIS INTRO BEFORE COMPLETING THIS SURVEY ON YOUR EXPERIENCES AFTER STARTING/WHILE USING BIRTH CONTROL.

The data that the scientific and medical community has is dated and I don't believe it to be very complete as the questionnaires you typically receive at the doctors office for birth control prescriptions are not very thorough-this does not provide clinicians, pharmaceutical companies, or society the needed info in order for those Assigned Female at Birth (AFAB) to make the best decisions for their reproductive health and it perpetuates the belief that birth control doesn't affect vulvovaginal health or sexual response.

By you completing this survey, and encouraging others to do so as well, you will be providing much needed info so that we may have a better picture as to how birth control is affecting those who use the various types listed below in this survey.

I do not ask for any identifying information and you clicked on an anonymous link to access this survey, so please do not feel afraid or reluctant to answer honestly, there is no way to personally identify you.

No question is required to be answered and can be left blank to continue on.  However, the more information you provide, the more it will help fellow vagina owners get any treatment they need and help the medical community to provide that help! If you prefer not to answer a question, you can simply type N/A or leave it blank and move on.

When considering your answers to the questions below, your answer can include whether something was experienced right away after starting birth control, didn't start happening until years later, or any time in between, as long as it was experienced AFTER beginning, or WHILE USING, birth control. There will be a section asking if symptoms or concerns continued after stopping birth control.

There will be sections at the end of the survey for you to answer whether a symptom or issue was experienced before starting birth control and if you continued to experience symptoms or issues after stopping, and a section where you can type any comments or additional information you feel is relevant.

The survey will be active for 1 year and I will provide the results afterwards!

If you have any questions or concerns please email me at healthyhoohainfo@gmail.com


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Age
Race (Check all that apply)
Was first vaginal penetration (self or partnered) before or after starting birth control?
Clear selection
Age of first period
Check all birth control method you are CURRENTLY using
Approximately what year did you start using your CURRENT birth control?
List brand name of CURRENT birth control(s)
Check all birth control methods used in the PAST
Approximately what age did you first start using ANY of the birth controls listed? (Not including condoms)
As best as you can, list brand names of PAST birth controls
Was there a reason you chose to switch birth control method or brand? (Check all that apply)
What is your Estrogen status? (Check all that apply)
Have you EVER had any of the following surgeries/biopsies regardless of birth control use? (Check all that apply)
Do you currently have or have you ever in the past had any of the following diagnoses regardless of birth control use? (check all that apply)
Did you start using a birth control to help improve any of the health conditions listed above?
Clear selection
If you started a birth control to help improve a condition listed above, did the condition:
Clear selection
Please answer the following questions: (Leave blank any that don't apply)
Before starting birth control
After starting birth control
Both
My face was dryer
I had more acne
My hail/scalp was dryer
My hair was thicker
My breasts were tender, painful, swollen feeling
Sexually related vaginal penetration caused pain/burning
Tampon insertion caused pain/burning
Tampon removal caused pain/burning
I feel/felt easily frustrated
I feel/felt more depressed
I feel/felt more angry or quick to blow up
I feel/felt more overwhelmed or stressed out
My periods were heavier
Since starting, or while using, birth control has your desire to have sex:
Clear selection
If your desire to have sex increased was it due to having LESS fear or concern of getting pregnant?
Clear selection
Since starting, or while using, birth control has your ability to tolerate skin/beauty/scented products changed?
Clear selection
Since starting, or while using, birth control has your weight around your abdomen:
Clear selection
Since starting, or while using, birth control do you experience pain, burning, stinging, rawness, tenderness or itching after sexually related vaginal penetration including vaginal masturbation?
Clear selection
Since starting, or while using, birth control do you experience what feel like tears/cuts/splits/fissures on your vulva, vestibule, or in your vagina NOT related to sexual activity?
Clear selection
Since starting, or while using, birth control does your daily vaginal discharge cause you stinging, burning, rawness, tenderness, irritation, itching?
Clear selection
If you answered YES or SOMETIMES to the previous question, please indicate what point in your cycle you notice it happening: (Check all that apply)
Since starting, or while using, birth control do you experience pain, rawness, stinging, burning, itching, tenderness when:
Yes
No
Urination with NO recent sexual penetration
Urination ONLY after sexual penetration
Tampon insertion
Tampon removal
Menstrual cup insertion
Menstrual cup removal
Gently touching the location of pain/burning such as wiping after using bathroom or showering
Riding a bicycle or wearing tight pants
Sitting
Standing
Lying down
Generally just constantly no matter what I am doing
Exercise
Since starting, or while using, birth control do you experience pain, itching, burning, rawness, tenderness only during certain points in your menstrual cycle? (Check all that apply)
Since starting, or while using, birth control does the speculum insertion during a gynecological exam, or shortly after, cause what you would describe as: (Check all that apply)
Since starting, or while using, birth control do you find yourself avoiding a sexual advances or masturbation because of sexual pain, low sex drive, or other sexually related health issues?
Clear selection
Since starting, or while using, birth control do you feel like you enjoy the physical sensations of sexual activity:
Clear selection
Since starting, or while using, birth control do your orgasms feel:
Clear selection
Since starting, or while using, birth control has your ABILITY to orgasm:
Clear selection
Since starting, or while using, birth control has your orgasms:
Clear selection
Since starting, or while using, birth control do you feel like you are more or less lubricated for sexual activity?
Clear selection
Since starting, or while using, birth control do you feel as though you have vaginal dryness?
Clear selection
Since starting, or while using, birth control do you wish you had a higher sex drive than you do or are frustrated by your lack of sex drive?
Clear selection
Since starting, or while using, birth control do you experience the desire to INITIATE sex or masturbation?
Clear selection
Since starting, or while using, birth control do you ONLY feel sexual desire and arousal after someone has initiated a sexual/intimate encounter with you?
Clear selection
Since starting, or while using, birth control do you experience cervical mucus/egg white type discharge at any point throughout your cycle?
Clear selection
Since starting, or while using, birth control do you experience bleeding/spotting during or shortly after vaginally penetrative sex or penetrative masturbation?
Clear selection
Since starting, or while using, birth control do you experience deep pain with vaginal thrusting, (partnered or during masturbation)?
Clear selection
Since starting or while using, birth control do you feel as though you have developed allergies you didn't have before or that your allergies have gotten worse?
Clear selection
Since starting, or while using, birth control do you feel you have had an increase in Bacterial Vaginosis, Yeast infections, or other vaginal infections?
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Since starting, or while using, birth control do you feel you have had an increase in general vulvar itching and discomfort?
Clear selection
Since starting, or while using, birth control do you feel you have had an increase in urinary tract infections or do you get recurrent UTI's after vaginally penetrative sex?
Clear selection
Have you been told you have vulvovaginal atrophy?
Clear selection
Since starting, or while using, birth control do you feel like you always, or chronically, have a vulvovaginal or urinary infection but test results always come back negative?
Clear selection
Since starting, or while using, birth control do you feel as though you have Irritable Bowel Syndrome (IBS) type symptoms or have been diagnosed with IBS?
Clear selection
Since starting, or while using, birth control do you feel as though you have had an increase or decrease in participating in group or independent activities, events, hobbies, interests?
Clear selection
Since starting, or while using, birth control do you feel as though your vulvar scent or vaginal discharge scent has changed?
Clear selection
Since starting, or while using, birth control do you choose to have periods:
Clear selection
Do you CURRENTLY smoke tobacco cigarettes?
Clear selection
Since starting, or while using, birth control do you feel foggy brained or feel as though you have a worse memory than you think you should?
Clear selection
Since starting, or while using, birth control have your cramps:
Clear selection
If you have been on different birth controls were the cramps:
Clear selection
Since starting, or while using, birth control do you experience bleeding or spotting between periods?
Clear selection
Since starting, or while using, birth control do you experience general headaches, tension headaches, or migraines:
Clear selection
Since starting, or while using, birth control do you feel as though you are more bloated feeling or looking?
Clear selection
What side effects were you told about by the doctor or pharmacist when prescribed your PAST or CURRENT birth controls?
Do you feel as though your prescriber/doctor properly made you aware of the potential side effects of birth control?
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If you have experienced any of the symptoms listed in the survey (such as pain, itching, dryness, infections, low desire, spotting, mood changes, others, etc.) how greatly have they affected your life?
Clear selection
Have you sought help for these symptoms?
Clear selection
If you sought help for your symptoms did you feel as though the doctor/clinician/nurse/medical professional had enough knowledge or experience to properly help you resolve your issues?
Clear selection
Since starting, or while using, birth control do you avoid sexual encounters or have to stop sex earlier than you prefer, due to symptoms you experience such as pain, irritation, vaginal dryness, low desire, etc.?
Clear selection
Since starting, or while using, birth control do you avoid, or have to stop early, NON sexual activities such as wearing tight pants or participating in activities due to symptoms you experience such as pain, break through bleeding, low interest, mood, cramps?
Clear selection
Were any symptoms of low sexual desire or low desire to masturbate experienced BEFORE starting birth control?
Clear selection
Were any symptoms of low vaginal arousal or lubrication/wetness experienced BEFORE starting birth control?
Clear selection
Were any symptoms of pain, burning, rawness, itching experienced BEFORE starting birth control that was also NOT related to an infection?
Clear selection
If you answered yes to experiencing low desire, arousal, or pain before starting birth control, did those symptoms or health issues continue AFTER starting birth control?
Clear selection
Did you experience difficulties getting pregnant after stopping birth control?
Clear selection
If you answered yes to having difficulties getting pregnant after STOPPING birth control, how long did it take for you to become pregnant?
If you answered yes to having difficulties getting pregnant after STOPPING birth control, did you require the assistance of a fertility clinic to become pregnant?
Clear selection
If you experienced any of the effects listed in the survey or any other undesired effects from your birth control, did you continue to experience them AFTER STOPPING ALL FORMS of birth control?
Clear selection
Please briefly list the side effects that you continued to experience after stopping all forms of birth control except condom use. If all symptoms persisted, simply reply as such.
Are you CURRENTLY taking a prescribed Selective Serotonin Reuptake Inhibitor (SSRI), Selective Norepinephrine Reuptake Inhibitor (SNRI), benzodiazepines (Valium, Lorazepam, etc.), or other antidepressants?
Clear selection
If you are CURRENTLY taking a prescribed SSRI, SNRI, benzodiazepine, or antidepressant, please list brand name and dose (remember, questions are not mandatory if you are uncomfortable providing information)
Have you taken a prescribed SSRI, SNRI, benzodiazepine, or antidepressant in the PAST but are not longer taking?
Clear selection
If you took an SSRI, SNRI, benzodiazepine, or antidepressant in the PAST please list brand(s) and dose(s) the best you can remember (Remember questions are not mandatory if you are uncomfortable providing this information)
Have you ever used the following acne medications: (Check all that apply)
Before starting birth control
After starting birth control
Currently still using
NOT currently using
Isotretinoin (Accutane, Claravis, Myorisan, etc.)
Spironolactone (CaroSpir, Aldactone, etc.)
Please use this space to provide any additional information you feel may be relevant to any of the questions you answered in the survey.
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