Please indicate your age range.

	25 - 35 years
	36 - 45 years
	46 - 55 years
	55+ years

Are you experiencing any changes in your sexual health as you age? For example, vaginal/genital dryness, painful intercourse.

	Yes
	No - Thank you for completing the survey! Please scroll to the bottom to submit.

What changes are you experiencing in your sexual health? Check all that apply.

	Vaginal or genital dryness
	Vaginal or genital irritation
	Vaginal or genital discharge
	Painful intercourse
	Changes in sexual desire
	Vaginal or genital burning
	Other (please specify)

Have you discussed your symptoms with a healthcare provider?

	Yes
	No

If yes, which types of healthcare provider? Check all that apply.

Have any healthcare providers given you recommendations to relieve your symptoms?

	Yes
	No

If yes, please indicate which type(s) of healthcare provider and the type(s) of recommendation(s). Check all that apply.

	Prescription Medication	Over-the-Counter Medication	Supplements	Visit to Specialist
Internist/Primary Care
Ob-Gyn
Nurse Practitioner
Physician Assistant
Other

Please indicate your level of satisfaction with the information you receive from any healthcare provider(s) regarding your changes in sexual health.

1. Are you aware of treatment options for vaginal/genital dryness and painful intercourse?

	Yes
	No

2. Are you currently treating your symptoms?

	Yes
	No

3. If yes, what treatment(s) are you using? Check all that apply.

	Prescription vaginal estrogen (creams, tablets, rings)
	Lubricant or moisturizer (such as Replens, K-Y Jelly)
	Prescription oral estrogen
	Other (please specify)

Please provide any comments on the quality or availability of educational information available to mid-life women on this topic.

THANK YOU!
We appreciate your time, your honesty, and your input.

	Very Satisfied
	Satisfied
	Not Very Satisfied
	Unsatisfied
	No Opinion