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Vaginal Pain. Breast Lumps. Pain During Sex. Infertility. Miscarriage. Men. Prostate Pain. Impotence. Infertility The statements made on this form are accurate to the best of my knowledge. _____ _____ Signature Date. 3 Place an “X” on the drawing to the left wherever you have pain. Beside the “X” indicate the type of pain you are ... ................
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