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Bill of Rights
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Miami
Madrid
London
Physicians
Fernando J. Bianco, MD
Mark Emberton, MD
Edward L. Gheiler
Juan I. Martinez-Salamanca, MD
Ariel M. Kaufman, MD
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Urological Research Network
URN
home
Bill of Rights
Centers
Miami
Madrid
London
Physicians
Fernando J. Bianco, MD
Mark Emberton, MD
Edward L. Gheiler
Juan I. Martinez-Salamanca, MD
Ariel M. Kaufman, MD
Inventories
Health Inventories
QOL
SHIM
IPSS
IIEF-15
EQ5
WPAI
BAPS
RSES
COPS-P
Clinical Trials
Publications
Contact Us
Inventories
Health Inventories
QOL
SHIM
IPSS
IIEF-15
EQ5
WPAI
BAPS
RSES
COPS-P
Español
Beliefs About Penis Size Scale - BAPS
Survey Date
*
MM
DD
YYYY
Center
*
Perito Urology
CIPSSV
Urology Specialists
Lyx Miami
Lyx Spain
Lyx Mexico
Name
*
First Name
Last Name
Birthdate
*
Date of Birth
MM
DD
YYYY
Email Address
*
1- I will be alone and without a partner
*
0- Strongly Disagree 1- Disagree 2- Neither Agree or Disagree 3- Agree 4- Strongly Agree
0
1
2
3
4
2- I will be laughed at by a partner in a sexual situation
*
0- Strongly Disagree 1- Disagree 2- Neither Agree or Disagree 3- Agree 4- Strongly Agree
0
1
2
3
4
3- I will not be able to have children
*
0- Strongly Disagree 1- Disagree 2- Neither Agree or Disagree 3- Agree 4- Strongly Agree
0
1
2
3
4
4- I will never feel just “right”
*
0- Strongly Disagree 1- Disagree 2- Neither Agree or Disagree 3- Agree 4- Strongly Agree
0
1
2
3
4
5- I will not be able to be naked in front of other men (e.g. changing rooms or in bedroom)
*
0- Strongly Disagree 1- Disagree 2- Neither Agree or Disagree 3- Agree 4- Strongly Agree
0
1
2
3
4
6- I will not be able to be naked in front of women
*
0- Strongly Disagree 1- Disagree 2- Neither Agree or Disagree 3- Agree 4- Strongly Agree
0
1
2
3
4
7- Others will talk or laugh about my penis
*
0- Strongly Disagree 1- Disagree 2- Neither Agree or Disagree 3- Agree 4- Strongly Agree
0
1
2
3
4
8- Others will be able to see the size or shape of my penis even when I have my trousers on
*
0- Strongly Disagree 1- Disagree 2- Neither Agree or Disagree 3- Agree 4- Strongly Agree
0
1
2
3
4
9- I will feel self-conscious in sexual situations
*
0- Strongly Disagree 1- Disagree 2- Neither Agree or Disagree 3- Agree 4- Strongly Agree
0
1
2
3
4
10- I will feel abnormal
*
0- Strongly Disagree 1- Disagree 2- Neither Agree or Disagree 3- Agree 4- Strongly Agree
0
1
2
3
4
Thank you!