The sexual health inventory for men is an ED questionnaire for men to fill out on their own about the quality of their erections and how they feel about them. It is up to you whether to bring this to your doctor as part of your physical exam for erectile dysfunction.
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 for each question.
OVER THE PAST 6 MONTHS:
1. How do you rate your confidence that you could get and keep an erection?
|
None
|
Very Low
|
Low
|
Low
Moderate |
High
|
Very
High |
|
|
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|
0
|
1
|
2
|
3
|
4
|
5
|
2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration (entering your partner)?
|
No sexual
activity |
Almost
never or never |
A few times (much less than 1/2 the time)
|
Sometimes (about ½ the time)
|
Most times (much more than ½ the time)
|
Almost always or always
|
|
|
|||||
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0
|
1
|
2
|
3
|
4
|
5
|
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 1/2 the time)
|
Sometimes (about ½ the time)
|
Most times (much more than ½ the time)
|
Almost always or always
|
|
|
|||||
|
0
|
1
|
2
|
3
|
4
|
5
|
4. 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 (much less than 1/2 the time)
|
Sometimes (about ½ the time)
|
Most times (much more than ½ the time)
|
Almost always or always
|
|
|
|||||
|
0
|
1
|
2
|
3
|
4
|
5
|
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 1/2 the time)
|
Sometimes (about ½ the time)
|
Most times (much more than ½ the time)
|
Almost always or always
|
|
|
|||||
|
0
|
1
|
2
|
3
|
4
|
5
|
KEY
| 22-25 | Normal erectile function |
| 17-21 | Mild ED |
| 12-16 | Mild to moderate ED |
| 8-11 | Moderate ED |
| < 7 | Severe ED |
Name: ___________________
Score: ___________________
Posted August 2008
Last Updated September 2009
