Sexual health is an important part of an individual's overall physical and emotional well-being.
Erectile dysfunction, also known as impotence, is one type of a very common medical condition affectying sexual health.
It affects more men than most people realize. Fortunately, there are many different treatment options for erectile dysfunction.
This questionnaire is designed to help you and your doctor identify if you are experiencing erectile dysfunction.
If you are, you may choose to discuss treatment options with your doctor.
Each question has several possible responses.
Circle the number of the response that best describes your own situation.
Please be sure that you select one and only one response for each question.
OVER THE PAST 6 MONTHS
How do you rate your confidence that you can get and keep an erection?
Very low
Low
Moderate
High
Very High
1
2
3
4
5
When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
No sexual activity
Almost never or never
A few times (much less than half the time)
Sometimes (about half the time)
Most times (much more than half the time)
Almost always or always
0
1
2
3
4
5
During sex, how often were you able to maintain your erection after you had penetrated your partner?
Did not attempt intercourse
Almost never or never
A few times (much less than half the time)
Sometimes (about half the time)
Most times (much more than half the time)
Almost always or always
0
1
2
3
4
5
During sex, how difficult was it to maintain your erection to completion of the intercourse?
Did not attempt intercourse
Extremely difficult
Very difficult
Difficult
Slightly difficult
Not difficult
0
1
2
3
4
5
When you attempted sexual intercourse, how often was it satisfactory for you?
Did not attempt intercourse
Almost never or never
A few times (much less than half the time)
Sometimes (about half the time)
Most times (much more than half the time)
Almost always or always
0
1
2
3
4
5
Add the numbers corresponding to the five questions above. If your score is 21 or less, you may want to speak with your doctor.
The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient.
