Describe your situation over the past 4 weeks.
1. How often were you able to get an erection during sexual activity? Choose answerNo sexual activityAlmost never or neverA few times (less than half the time)Sometimes (about half the time)Most times (more than half the time)Almost always or always
2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration? Choose answerNo sexual activityAlmost never or neverA few times (less than half the time)Sometimes (about half the time)Most times (more than half the time)Almost always or always
3. When you attempted intercourse, how often were you able to penetrate (enter) your partner? Choose answerDid not attempt intercourseAlmost never or neverA few times (less than half the time)Sometimes (about half the time)Most times (more than half the time)Almost always or always
4. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner? Choose answerDid not attempt intercourseAlmost never or neverA few times (less than half the time)Sometimes (about half the time)Most times (more than half the time)Almost always or always
5. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? Choose answerDid not attempt intercourseExtremely difficultVery difficultDifficultSlightly difficultNot difficult
6. How many times have you attempted sexual intercourse? Choose answerNo attemptsOne to two attemptsThree to four attemptsFive to six attemptsSeven to ten attemptsEleven or more attempts
7. When you attempted sexual intercourse, how often was it satisfactory for you? Choose answerDid not attempt intercourseAlmost never or neverA few times (less than half the time)Sometimes (about half the time)Most times (more than half the time)Almost always or always
8.How much have you enjoyed sexual intercourse? Choose answerNo intercourseNo enjoyment at allNot very enjoyableFairly enjoyableHighly enjoyableVery highly enjoyable
9.When you had sexual stimulation or intercourse, how often did you ejaculate? Choose answerNo sexual stimulation or intercourseAlmost never or neverA few times (less than half the time)Sometimes (about half the time)Most times (more than half the time)Almost always or always
10.When you had sexual stimulation or intercourse, how often did you have the feeling of orgasm or climax? Choose answerAlmost never or neverA few times (less than half the time)Sometimes (about half the time)Most times (more than half the time)Almost always or always
11.How often have you felt sexual desire? Choose answerAlmost never or neverA few times (less than half the time)Sometimes (about half the time)Most times (more than half the time)Almost always or always
12.How would you rate your level of sexual desire? Choose answerVery low or none at allLowModerateHighVery high
13.How satisfied have you been with your overall sex life? Choose answerVery dissatisfiedModerately dissatisfiedEqually satisfied & dissatisfiedModerately satisfiedVery satisfied
14.How satisfied have you been with your sexual relationship with your partner? Choose answerVery dissatisfiedModerately dissatisfiedEqually satisfied & dissatisfiedModerately satisfiedVery satisfied
15.How do you rate your confidence that you could get and keep an erection? Choose answerVery low or none at allLowModerateHighVery high
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