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Living with Diabetes

Sexual Health Questionnaire for Men

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. There is a range of 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 response that best describes your own situation. Please be sure to select one response for each question.

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

  Very low

  Low

  Moderate

  High

  Very high

2. When you have had erections with sexual stimulation, how often were your erections hard enough for penetration?

  No sexual activity

  Almost never or never

  A 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?

  Did not attempt intercourse

  Almost never or never

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

  Did not attempt intercourse

  Extremely difficult

  Very difficult

  Difficult

  Slightly difficult

  Not difficult

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

  Did not attempt intercourse

  Almost never or never

  A 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

Please click this button to reveal your score

Your score:

What your score means:

If your score is 21 or less, you may be showing signs of erectile dysfunction and may want to speak with your doctor.