How often were you able to get an erection during sexual activity?
- No sexual activity
- Almost never or never
- A few times (less than half the time)
- Sometimes (about half the time)
- Most times (more than half the time)
- Almost always or always
When you had erections from sexual stimulation, how often were your erections hard enough for penetration?
- No sexual activity
- Almost never or never
- A few times (less than half the time)
- Sometimes (about half the time)
- Most times (more than half the time)
- Almost always or always
When you attempted intercourse, how often were you able to penetrate (enter) your partner?
- Did not attempt intercourse
- Almost never or never
- A few times (less than half the time)
- Sometimes (about half the time)
- Most times (more than half the time)
- Almost always or always
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 (less than half the time)
- Sometimes (about half the time)
- Most times (more than half the time)
- Almost always or always
During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?
- Did not attempt intercourse
- Almost never or never
- A few times (less than half the time)
- Sometimes (about half the time)
- Most times (more than half the time)
- Almost always or always
How many times have you attempted sexual intercourse?
- No attempts
- Almost never or never
- A few times (less than half the time)
- Sometimes (about half the time)
- Most times (more than half the time)
- Almost always or always
When you attempted sexual intercourse, how often was it satisfactory for you?
- Did not attempt intercourse
- Almost never or never
- A few times (less than half the time)
- Sometimes (about half the time)
- Most times (more than half the time)
- Almost always or always
How much have you enjoyed sexual intercourse?
- No intercourse
- No enjoyment at all
- Not very enjoyable
- Fairly enjoyable
- Highly enjoyable
- Very highly enjoyable
When you had sexual stimulation or intercourse, how often did you ejaculate?
- No sexual stimulation or intercourse
- Almost never or never
- A few times (less than half the time)
- Sometimes (about half the time)
- Most times (more than half the time)
- Almost always or always
When you had sexual stimulation or intercourse, how often did you have the feeling of orgasm or climax?
- Almost never or never
- A few times (less than half the time)
- Sometimes (about half the time)
- Most times (more than half the time)
- Almost always or always
How often have you felt sexual desire?
- Almost never or never
- A few times (less than half the time)
- Sometimes (about half the time)
- Most times (more than half the time)
- Almost always or always
How would you rate your level of sexual desire?
- Very low or none at all
- Low
- Moderate
- High
- Very high
How satisfied have you been with your overall sex life?
- Very dissatisfied
- Moderately dissatisfied
- Equally satisfied & dissatisfied
- Moderately satisfied
- Very satisfied
How satisfied have you been with your sexual relationship with your partner?
- Very dissatisfied
- Moderately dissatisfied
- Equally satisfied & dissatisfied
- Moderately satisfied
- Very satisfied
How do you rate your confidence that you could get and keep an erection?
- Very low
- Low
- Moderate
- High
- Very high
All items are scored in 5 domains as follows:
Domain | Items | Range | Score Max Score |
---|---|---|---|
Erectile Function | 1, 2, 3, 4, 5, 15 | 0-5 | 30 |
Orgasmic Function | 9, 10 | 0-5 | 10 |
Sexual Desire | 11, 12 | 0-5 | 10 |
Intercourse Satisfaction | 6, 7, 8 | 0-5 | 15 |
Overall Satisfaction | 13, 14 | 0-5 | 10 |
I.Erectile function total scores can be interpreted as follows:
Score | Interpretation |
---|---|
0-6 | Severe dysfunction |
7-12 | Moderate dysfunction |
13-18 | Mild to moderate dysfunction |
19-24 | Mild dysfunction |
25-30 | No dysfunction |
II.Orgasmic function total scores can be interpreted as follows:
Score | Interpretation |
---|---|
0-2 | Severe dysfunction |
3-4 | Moderate dysfunction |
5-6 | Mild to moderate dysfunction |
7-8 | Mild dysfunction |
9-10 | No dysfunction |
III.Sexual desire total scores can be interpreted as follows:
Score | Interpretation |
---|---|
0-2 | Severe dysfunction |
3-4 | Moderate dysfunction |
5-6 | Mild to moderate dysfunction |
7-8 | Mild dysfunction |
9-10 | No dysfunction |
IV.Intercourse satisfaction total scores can be interpreted as follows:
Score | Interpretation |
---|---|
0-2 | Severe dysfunction |
3-4 | Moderate dysfunction |
5-6 | Mild to moderate dysfunction |
7-8 | Mild dysfunction |
9-10 | No dysfunction |
V.Overall satisfaction total scores can be interpreted as follows:
Score | Interpretation |
---|---|
0-2 | Severe dysfunction |
3-4 | Moderate dysfunction |
5-6 | Mild to moderate dysfunction |
7-8 | Mild dysfunction |
9-10 | No dysfunction |