A questionnaire for ED
Each question has several possible responses. Circle the number of the response that best describes your own
situation. Please be sure that you select only one response for each question. Over the past six months:
- How do you rate your confidence that you could get and keep an erection?
- Very low = 1
- Low = 2
- Moderate = 3
- High = 4
- Very high = 5
- When you had erections with sexual stimulation, how
often were your erections hard enough for penetration
(entering your partner)?
- No sexual activity = 0
- Almost never or never = 1
- A few times (much less than half the time) = 2
- Sometimes (about half the time) = 3
- Most times (much more than half the time) = 4
- Almost always or always = 5
- During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?
- Did not attempt intercourse = 0
- Almost never or never = 1
- A few times (much less than half the time) = 2
- Sometimes (about half the time) = 3
- Most times (much more than half the time) = 4
- Almost always or always = 5
- During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?
- Did not attempt intercourse = 0
- Extremely difficult = 1
- Very difficult = 2
- Difficult = 3
- Slightly difficult = 4
- Not difficult = 5
- When you attempted sexual intercourse, how often was it satisfactory for you?
- Did not attempt intercourse = 0
- Almost never or never = 1
- A few times (much less than half the time) = 2
- Sometimes (about half the time) = 3
- Most times (much more than half the time) = 4
- Almost always or always = 5
To score the quiz:
Add the numbers corresponding to your answers. If your score is 21 or lower, you may be showing signs of ED and you may benefit from medical evaluation and therapy.
Source: International Index of Erectile Dysfunction.