ThermiVa® Questionnaire


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How would you rate your level of sexual desire?



Has your relationship with your partner been adversely affected due to childbirth or the natural aging process?



How would you rate your sexual satisfaction during intercourse?



How confident are you about becoming aroused during sexual activity?



Do you experience discomfort during intercourse due to dryness?



Do you frequently experience urinary leaking or urgency?



How would you rate your vaginal tightness?




If you scored a 1 or 2 on any of the questions above or if you’d like more information, please submit this form and one of our staff will be in touch with you to schedule a consultation

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