Sexual Health Inventory for men - Patient Instructions - Print this page to complete
Sexual health is an important part of an individual's overall physical and emotional well-being. Erectile dysfunction, also known as impotence, is a very common medical condition affecting sexual health. Fortunately there are many different treatment options for erectile dysfunction. This questionnaire is designed to help your doctor identify if you may be experiencing erectile dysfunction.
Each question has several possible responses. Select 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. Please print this page first.
1. How do you rate your confidence that you could get and keep an erection? |
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2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration (entering your partner)? |
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A few times (much less than half the time) |
2 |
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Sometimes (about half the time) |
3 |
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Most Times (much more than half the time) |
4 |
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Almost always
or
always |
5 |
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| 3. During sexual intercourse, how often were you able to maintain your erection after you at penetrated (entered) your partner? |
Did not attempt intercourse |
0 |
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A few times (much less than half the time) |
2 |
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Sometimes (about half the time) |
3 |
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Most Times (much more than half the time) |
4 |
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Almost always
or
always |
5 |
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4.During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? |
Did not attempt intercourse |
0 |
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5. When you attempted sexual intercourse, how often was it satisfactory for you? |
Did not attempt intercourse |
0 |
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A few times (much less than half the time) |
2 |
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Sometimes (about half the time) |
3 |
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Most Times (much more than half the time) |
4 |
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Almost always
or
always |
5 |
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SCORE |
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Add the numbers corresponding to questions 1-5. If your total score is 21 or less, you may be showing signs of erectile dysfunction and may want to speak with your doctor. |