PAIN OR DISCOMFORT

1. In the last week, have you experienced any pain or discomfort in the following areas?

YES NO
a. Area between rectum and testicles (perineum) 1 0
b. Testicles 1 0
c. Tip of the penis (not related to urination) 1 0
d. Below your waist, in your bladder or pubic area 1 0



2. In the last week, have you experienced:

YES NO
a. Pain or burning during urination? 1 0
b. Pain or discomfort during or after sexual climax (ejaculation)? 1 0



3. How often have you had pain or discomfort in any of these areas over the last week?

0 Never
1 Rarely
2 Sometimes
3 Often
4 Usually
5 Always



4. Which number best describes your AVERAGE pain or discomfort on the days that you had it, over the last week?

0 1 2 3 4 5 6 7 8 9 10
No pain Pain as bad as you can imagine.



URINATION

5. How often have you had a sensation of not emptying your bladder completely after you finished urinating, over the last week?

0 Not at all
1 Less than 1 time in 5
2 Less than half the time
3 About half the time
4 More than half the time
5 Almost always



6. How often have you had to urinate again less than two hours after you finished urinating, over the last week?

0 Not at all
1 Less than 1 time in 5
2 Less than half the time
3 About half the time
4 More than half the time
5 Almost always



IMPACT OF SYMPTOMS

7. How much have your symptoms kept you from doing the kinds of things you would usually do, over the last week?

0 None
1 Only a little
2 Some
3 A lot



8. How much did you think about your symptoms, over the last week?

0 None
1 Only a little
2 Some
3 A lot



QUALITY OF LIFE

9. If you were to spend the rest of your life with your symptoms just the way they have been during the last week, how would you feel about that?

0 Delighted
1 Pleased
2 Mostly satisfied
3 Mixed (about equally satisfied and dissatisfied
4 Mostly dissatisfied
5 Unhappy
6 Terrible



SCORING THE NIH-CHRONIC PROSTATITIS SYMPTOM INDEX DOMAINS

Pain: Total of items 1a, 1b, 1c, 1d, 2a, 2b, 3, and 4 =
Urinary Symptoms: Total of items 5 and 6 =
Quality of Life Impact: Total of items 7, 8, and 9 =
TOTAL =

Higher scores represent worse outcomes

Mild 0 - 14
Moderate 15 - 29
Severe 30 - 43

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