Name *
Name
Be as detailed as possible.
Including corn, soy, dairy, grasses, etc.
Are you currently under age 13? *
Are your menstrual cycles 28 days or longer? *
Do you ever have menstrual cycles 27 days or less? *
Is your menstrual cycle absent or missing for an unknown reason or because of birth control? *
If you don't currently have periods, what is the reason?
Are you currently taking birth control pills? *
Do you have tubal coagulation (burning of the fallopian tubes through laparoscopic surgery through the belly button)? *
Do you have a birth control arm implant (i.e. nexplanon)? *
Have you had a uterine ablation procedure (where the uterine walls are burned so they scar over)? *
Do you have an Essure insert? *
Do you have fresh spotting between periods? *
Have you had spontaneous heavy bleeding within the past 3 months? *
Have you had two periods per month (i.e. a period every 2 weeks) in the past 3 months? *
Do you have green or yellow vaginal discharge? *
Do you have an infection characterized with a burning itch? *
Do you have malodorous vaginal discharge? *
Do you have herpes? *
Are you currently or historically prone to yeast infections? *
Are you currently or historically prone to bacterial vaginosis? *
Do you have any type of dry infection (without vaginal discharge)? *
Do you have vaginal dryness? *
Have you experienced hot flashes recently? *
Have you experienced nightsweats recently? *
Do you have an aversion to heat? *
Do you radiate heat? *
Are you actively trying to conceive? *
Do you have Uterine Fibroids? *
Do you have cystic ovaries? *
Characterized as one large cyst.
Do you have polycystic ovaries? *
Characterized as multiple small cysts on the ovary.
Do you have blocked tubes? *
What is your general energy level? *
You may select more than one.
What is your general disposition like? *
You may select more than one.
Do you experience cramps with your period? *
Do you experience PMS with your period? *
What is a typical period like for you? *
Select as many as apply to accurately describe a typical period.
Would you like to receive weekly emails from me about nutrition, menstrual cycle health, and fertility? *
You will be able to unsubscribe any time.
Are you interested in being a case study for yoni steaming? *
As a case study I will follow along with your progress as you use the herbs over the next three months and write an article about how yoni steaming and herbal medicine have impacted your menstrual cycle health and fertility.
Disclaimer *
Disclaimer
Most of the side-effects reported while steaming are positive. Users have reported better sleep and lucid dreams, relaxation, decreased swelling in legs and feet, decreased abdominal bloating, slimmer waistline, increased libido and sexual sensation; increased vaginal nectar and fertility, decrease in breast soreness, fewer headaches, fewer PMS symptoms and improved emotional balance, increased circulation and energy, tingling feet, glowing skin, reduction in incidence of hormonal acne and increased lubrication and vaginal nectar, scar softening, tighter vaginal canal and harmonization with the moon cycle. WHAT TO EXPECT Steaming is a cleanse. Some of the possible signs the vaginal steaming is working is if you experience -- the urge to urinate while steaming, brown discharge after steaming, increased clots or cramps during the period, increased dry cramps, increased irregular vaginal discharge (white, green, thick, clumpy), emotional release, periods that come earlier or later than expected. All of these signs are a normal part of the cleansing process and these signs will go away once the cleanse is complete. Please note these changes and let Mollie know of these positive changes. BEST PRACTICES 1) Go to the bathroom directly prior to vaginal steaming. 2) Learn proper period care. Avoid tampon use and instead use cotton pads or period panties. The period is a uterine cleanse and if you support it the clots can easily clear out. Plugging up with tampons, on the other hand, prevents the old residue from clearing out and that is often the cause of cramping. CAUTION SIGNS If steaming causes a rash, bumps, headaches itchiness, diarrhea or the onset of fresh spotting or inter-period bleeding, this could be a sign that your steam protocol or herbs might need to be adjusted or that there is an allergic reaction. If these signs occur please let Mollie know so I can adjust the steam session as necessary or make a referral. **** In 99% of all cases using a mild steam session and mild herbs will prevent any of the above signs from happening so it's very important that you give honest answers in this intake form so that Mollie can provide you with the best herbal blend for your needs. I understand that vaginal steaming may have positive or negative side effects as a result of doing a vaginal steam session. I accept legal responsibility for my choice to do a vaginal steam session and waive the responsibility of Mollie Williams and Parsley and Pumpkins Nutrition in the case that any of the named side effects (or others) may occur. I agree that this is a legally binding document. My printed name and date below represent my signature.