Each question has 5 possible responses, select the option that best
describes your own situation.

1. How do you rate your confidence that you could keep an erection?

Choose answerVery lowLowModerateHighVery high


2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration (entering your partner)?
Choose answerAlmost never or neverA 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


3. During sexual intercourse, how often were you able to maintain your erection
after you had penetrated (entered) your partner?
Choose answerAlmost never or neverA 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


4. When you attempted sexual intercourse, how often was it satisfactory for you?
Choose answerAlmost never or neverA 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


5. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?
Choose answerExtremely difficultVery difficultDifficultSlightly difficultNot difficult


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