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Sexual Health Inventory for Men

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 effecting 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.  The next five questions are to be indicated as to your medical history over the past six months.

1.         How do you rate your confidence that you can get and keep an erection? 

1.                 Very Low

2.                 Low

3.                 Moderate

4.                 High

5.                 Very High

2.                  When you had erections with sexual stimulation how often were your erections hard enough for penetration (entering your partner)? 

0.                 No sexual activity

1.                 Almost never or never.

2.                 A few times, meaning less than half the time.

3.                 Sometimes or about half the time.

4.                 Most times, much more than half the time.

5.                 Almost or always.

3.                  During sexual intercourse, how often were you able to maintain your erection after you had penetrated or entered your partner?

0.                 Did not attempt intercourse.

1.                 Almost never.

2.                 A few times, much less than half the time.

3.                 Sometimes, about half the time.

4.                 Most times, much more than half the time.

5.                 Almost always, or always.

4.                  During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

0.                 Did not attempt intercourse.

1.                 Extremely difficult.

2.                 Very difficult.

3.                 Difficult.

4.                 Slightly difficult.

5.                 Not difficult.

5.         When you attempted sexual intercourse, how often was it satisfactory for you?

0.                 Did not attempt intercourse.

1.                 Almost never or never.

2.                 A few times, much less than half the time.

3.                 Sometimes, about half the time.

4.                 Most times, much more than half the time.

5.                 Almost always, or always.

Add up the total number of points and enter here:

If your score is 21 or less, you have definite indications for erectile dysfunction and need to speak with your physician. 

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