NIH-Chronic Prostatitis Symptom Index (NIH-CPSI)

Pain or Discomfort

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

a. Area between rectum and testicles (perineum)

YesNo

b. Testicles

YesNo

c. Tip of the penis (not related to urination)

YesNo

d. Below your waist, in your pubic or bladder area

YesNo

2. In the last week, have you experienced:

a. Pain or burning during urination?

YesNo

b. Pain or discomfort during or after sexual climax (ejaculation)?

YesNo

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

NeverRarelySometimesOftenUsuallyAlways

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

NO PAIN
012345678910
PAIN AS PAIN 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?

Not at allLess than 1 time in 5Less than half the timeAbout half the timeMore than half the timeAlmost always

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

Not at allLess than 1 time in 5Less than half the timeAbout half the timeMore than half the timeAlmost 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?

NoneOnly a littleSomeA lot

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

NoneOnly a littleSomeA 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?

DelightedPleasedMostly satisfiedMixed (about equally satisfied and dissatisfied)Mostly dissatisfiedUnhappyTerrible

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