RATE YOUR SEXUAL HEALTH
You may be wondering if erectile dysfunction (ED) if affecting your sexual performance. Chances are, it may very well be! Take this quick survey and print it out to bring it with you to your next appointment with us.
The Sexual Health Quiz
1. How do you rate your confidence that you could get and keep an
erection?
O Very low
O Low
O Moderate
O High
O Very high
2. When you had erections with sexual stimulation, how often were
your erections hard enough for penetration (entering your
partner)?
O No sexual activity
O Almost never or never
O A few times (much less than half the time)
O Sometimes (half the time)
O Most times (much more than half the time)
O Almost always or never
3. During sexual intercourse, how often were you able to maintin
your erection after you had penetrated (entered your partner)?
O Did not attempt intercourse
O Almost never or never
O A few times (much less than half the time)
O Sometimes (half the time)
O Most times (much more than half the time)
O Almost always or never
4. During sexual intercourse, how difficult was it to maintain your
erection before the completion of intercourse?
O Did not attempt intercourse
O Extremely difficult
O Very difficult
O Difficult
O Slightly difficult
O Not difficult
5. When you attempted sexual intercourse, how often was it
satisfactory for your partner?
O Did not attempt intercourse
O Almost never or never
O A few times (much less than half the time)
O Sometimes (half the time)
O Most times (much more than half the time)
O Almost always or never
Sexual Health questionnaire.doc
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