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Important: Be honest with your answer and select the answer that most closely applies to you on average over the last 6 months
1. How do you rate your confidence that you could get and keep an erection?

Very Low

Low

Moderate

High

Very High

Important: Be honest with your answer and select the answer that most closely applies to you on average over the last 6 months
2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration?

Almost never/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/always

Important: Be honest with your answer and select the answer that most closely applies to you on average over the last 6 months
3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

Almost never/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/always

Important: Be honest with your answer and select the answer that most closely applies to you on average over the last 6 months
4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

Extremely difficult

Very difficult

Difficult

Slightly difficult

Not difficult

Important: Be honest with your answer and select the answer that most closely applies to you on average over the last 6 months
5. When you attempted sexual intercourse, how often was it satisfactory for you?

Almost never/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/always