Pelvic Bowl Steam Intake Form

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Steaming is a safe practice with ancient origins from around the world. Let's make sure we create the best steam set-up for you.

Email *

Full name *

Age *

Date of Last Menstrual Period (if applicable) *

YYYY

What is your intention for doing a Pelvic Bowl Steam? *

Hard & Soft Contraindications *

There are times when it is not beneficial for someone to steam. As a first step, let's check and make sure that it is safe for you to do a steam session. Please check any of the following, if applicable

I am pregnant

I am possibly pregnant

I am trying to conceive

I have an infection characterized by a burning itch

I have had tubal coagulation (burning of the fallopian tubes through laparoscopic surgery)

I have a birth control arm implant

I have had a uterine ablation procedure (where the uterine walls are burned so they scar over)

I have an Essure insert

None of the above

Required

IMPORTANT

If you are using the above birth control methods it may be possible that vaginal steaming could cause a birth control failure. Steaming is not recommended unless you are okay with using a backup form of birth control or you are not concerned about your birth control failing.

If you have a burning itch the warmth from the steam could be uncomfortable since there is already so much heat in your body. In this case you could try doing a sitz bath with cooling herbs. It is also recommended to seek treatment from an acupuncturist to address the underlying imbalances causing the burning itch. Once the burning itch subsides you may proceed with a vaginal steam.

If you have had a uterine ablation procedure (to scar over the uterine walls) it may be possible that vaginal steaming will clear the scar tissue which would reverse the surgery. If you are okay with reversing the surgery then feel free to proceed with a vaginal steam.

Determining Mild vs Advanced Set-up *

Please check any of the following, if applicable.

First time doing a steam session

I have an IUD

Menstrual cycles are currently 27 days or shorter

Currently or have historically been prone to yeast infections

Currently or have historically been prone to bacterial vaginosis

Currently or have historically been prone to urinary tract infections (UTIs)?

Herpes Diagnosis

Use the Nuva Ring (please remove before steam session)

None of the above

Required

Please describe how menstruation has been lately (or if you do not have periods, why not)? *

You can describe cramps, blood colour, blood volume (heavy/light), existence of clots, spotting, etc.

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