Reproductive Health History Questionnaire (continued) Men Check any condition that you have or have had: Testes infection Testes injury Testes tumor Prostatitis Prostate cancer X-rays to pelvic area for diagnosis or therapy Syphilis Date of last prostate examination: _______________ Results?__________________________ Frequency of testicular self-examination: ______________________________ 337 Pelvic surgery Herpes Gonorrhea Chlamydia Venereal warts HIV/AIDS
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