Test Your Sexual Health

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 very common medical condition affection sexual health. Fortunately, there are many different treatment options for erectile dysfunction. This questionnaire is designed to help you and your doctor identify if you may be experiencing erectile dysfunction. If you are, you may choose to discuss treatment options with your doctor.

Each question has several possible responses. Answer each question with a 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:

1. How do you rate your confidence that you can get and keep an erection?

Very Low
Low
Moderate
High
Very High

2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration (entering your partner)?

No sexual activity
Almost never or never
A few times (much less than half)
Sometimes (about half the time)
Almost always or always

3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

Did not attempt intercourse
Almost never or never
A few times (much less than half)
Sometimes (about half the time)
Almost always or always

4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

Did not attempt intercourse
Extremely difficult
Very difficult
Slightly difficult
Not difficult

5. When you attempted sexual intercourse, how often was it satisfactory to you?

Did not attempt intercourse
Almost never or never
A few times (much less than half)
Sometimes (about half the time)
Almost always or always

 

Your total:

If your score is 21 or less, you may want to speak with your doctor.



Advanced Urology Associates of Florida

1986 35TH Avenue, Vero Beach, FL 32960 (772) 562-7220
7945 Bay St. #4, Sebastian, FL 32958 (772) 388-0239