SEXUAL HEALTH INVENTORY FOR MEN |
PATIENT INSTRUCTIONS
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 affecting 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. 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.
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1. How do you rate your confidence that you could get and keep an erection?
Very low | Low | Moderate | High | Very high |
1 | 2 | 3 | 4 | 5 |
No sexual activity |
Almost never or none |
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 |
Did not attempt intercourse |
Almost never or none |
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 |
Did not attempt intercourse |
Extremely difficult |
Very difficult |
Difficult |
Slightly difficult |
Not difficult |
0 | 1 | 2 | 3 | 4 | 5 |
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 |