| | 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 |
SCORE |
| 0 |
1 |
2 |
3 |
4 |
5 |
| 1. Over the past 4 weeks, how often were you able to get an erection during sexual activity**?; |
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| | NO SEXUAL STIMULATION |
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 |
SCORE |
| 0 |
1 |
2 |
3 |
4 |
5 |
| 2. Over the past 4 weeks, when you had erections with sexual stimulation****, how often were your erections hard enough for penetration? |
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| | 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 |
SCORE |
| 0 |
1 |
2 |
3 |
4 |
5 |
| 3. When you had erections with sexual stimulations, how often were your erections hard enough for penetration (entering your partner)? |
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| 4. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner? |
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| | DID NOT ATTEMPT INTERCOURSE |
EXTREMELY DIFFICULT |
VERY DIFFICULT |
DIFFICULT |
SLIGHTLY DIFFICULT |
NOT DIFFICULT |
SCORE |
| 0 |
1 |
2 |
3 |
4 |
5 |
| 5. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? |
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| | - |
VERY LOW |
LOW |
MODERATE |
HIGH |
VERY HIGH |
SCORE |
| 0 |
1 |
2 |
3 |
4 |
5 |
| 6. How would you rate your confidence in your ability to get and keep an erection? |
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