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Have you had children?
 
Yes
 
No
 
Prefer not to answer
 
 
 
As far as you know, are you able to have children?
 
Yes
 
No
 
Don't know
 
Prefer not to answer
 
 
 
How would you rate your current body image?
 
Very poor
 
Poor
 
Neutral
 
Good
 
Very good
 
 
 
How closely do you feel you fit the social 'ideal' in physical appearance?
 
Not at all
 
Very little
 
Neutral
 
Somewhat
 
Very closely
 
 
 
Does your body image change depending on where you are at in your cycle?
 
Yes
 
No
 
Not sure
 
 
 
If yes, in what way?
   
 
 
 
Does your body image change with your pain levels?
 
Yes
 
No
 
Not sure
 
 
 
If yes, in what way?
   
 
 
 
What is your age?
 
18-24
 
25-34
 
35-44
 
45-54
 
55-64
 
65 or over
 
 
 
How long have you had endometriosis?
 
1-5 years
 
5-10 years
 
More than 10 years
 
Don't know
 
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