Peyronie’s Disease Questionnaire

Questionnaire Instructions

Questionnaire about Peyronie's disease Please complete these three Peyronie’s disease questionnaires and score them, based on the instructions provided with each.

Simply answer each question “yes” or “no”, keeping your own score. Follow the instructions for each section.

Peyronie’s Disease Evaluation:

1. Do you have a lump(s) or nodule(s) located along the shaft of your penis?

2. Is your penis painful at or near the location of this lump(s) or nodule(s)?

3. Do you have a bend or curve in your penis that you did not have before this lump developed?

4. Do you have pain when you have an erection that you did not have before this lump or curvature developed?

5. Do you have difficulty with sexual intercourse due to poor quality erections or pain that you did not have before this lump or curvature developed?

6. Has your sexual activity been reduced because of pain, deformity of the penis, or inability to achieve an adequate erection?

7. Do you recall any trauma or injury to your penis that occurred shortly before the start of this problem?

8. Do you have a history Dupuytren’s contracture (shortening and thickening of the tendon) in the palm of the hand, diabetes, or high blood pressure in yourself or your family?

Scoring the above “Peyronie’s Disease Evaluation” is rather simple. The more “Yes” answers you have the greater the possibility of PD, with five “Yes” answers being about average for a case of PD. You do not need to answer “Yes” to all of the above questions, nor do you necessarily need a certain number of “Yes” answers to have PD. Questions 1-5 are perhaps the most important to suggest you might have PD.

The only sure way to know if you have PD is to get yourself checked by a doctor. This questionnaire will only give you an idea of what is happening to you, but does not take the place of an actual physical examination.

Current Stage of Peyronie’s Disease Questionnaire:

1. Does the lump(s) or nodule(s) change frequently in any way – softer, harder, smaller, larger ? from time to time?

2. Does the quality or location of pain change from time to time?

3. Does the bend or curvature in your penis continue to change from time to time?

4. Do you have painful erections that you did not have before this lump or curvature developed?

5. Has the problem with your penis been present less than 18 months?

6. Has the problem with your penis been present more than 18 months?

7. Has most or all of the pain in your penis stopped?

8. Has the curvature or angulation of your penis been unchanged for a few months?

9. Are you having problems with the quality or strength of your erection?

Scoring of the above “Current Stage of Peyronie’s Disease Questionnaire” is rather simple.

Questions 1-5. The first five questions (1-5) relate to the symptoms and signs found in the early, acute or inflammatory phase of PD. If you have a few or all “Yes” answers to questions 1-5 you are more likely to be in the acute inflammatory stage of PD.

Questions 6-9. The last four questions (6-9) relate to symptoms and signs found in the later, chronic or stable phase of PD. If you have a few or all “Yes” answers to questions 6-9 you are more likely to be in the chronic stable stage of PD.

Questions 1-9. It is possible to answer “Yes” to some questions in both the acute and chronic phases of PD, because the condition changes so much and because as a man goes from the first to the second phase he can have symptoms of both.

The only sure way to know what stage of PD you might be in is to get yourself checked by a doctor. This questionnaire will only give you an idea of what is happening to you, but does not take the place of an actual physical examination.

Other Consideration Questionnaire:

1. Do you have an open sore or lesion anywhere on your penis or genital region, or in other parts of your lower abdomen, pelvis, or groin?

2. Do you have any discoloration or abnormality in the area of your penis or groin that you did not have before this lump developed?

3. Do you have a discharge of pus, blood or other unusual fluid from your genital area?

4. Do you have pain or discomfort in other parts of your lower abdomen, pelvis, or groin region that started at or about the time as the pain in your penis?

5. Do you have pain or discomfort in other parts of the lower abdomen, pelvis, or groin region that is more intense or more frequent than the pain in your penis?

6. Have you experienced any recent or unusual weight loss that cannot be explained by dieting or exercise?

7. Have you noticed a recent loss of appetite that is unusual for you?

8. Have you noticed a recent decline of energy, or more fatigue, that is unusual for you?

9. Have you engaged in any activity in the past that would expose you to a sexually transmitted disease?

10. Have you previously been diagnosed with a sexually transmitted disease?

11. Have you ever been diagnosed with cancer of any type?

12. Is there a history of cancer in your family?

Scoring of the above “Other Consideration Questionnaire” is also rather simple. If you answer “Yes” to any of these 12 questions, it opens up the possibility that other things may be going on in addition to, or instead of, PD. These questions are only a very general look at other possible issues that might be related to, or causing, some of the problems you are having with your penis – or maybe there is no connection at all. All that a “Yes” answer means at this point is that you should talk to your doctor about it, and find out what he/she thinks of it. Even if have only one “Yes” answer in this last questionnaire, you should talk to the doctor who is taking care of you for your PD, so he/she is fully informed. Please make your treating doctor aware of any “Yes” answer.

This effort will help you to understand your situation better, and guide you in the right direction for Peyronie’s disease treatment.

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