Erectile Function Questionnaire

Sexual health is an important part of an individual's overall physical and emotional well-being. Erectile dysfunction, also known as impotence, is one type of very common medical condition affecting sexual health. Fortunately, there are many different treatment options for erectile dysfunction. This questionnaire is designed to help you and your doctor identify if you may be experiencing erectile dysfunction. If you are, you may choose to discuss treatment options with your doctor.

Each question has several possible responses. Select the number of the response that best describes your own situation.

i.    How do you rate your confidence that you could get and keep an erection?
1 Very low
2 Low
3 Moderate
4 High
5 Very high

ii.    When you had erections with sexual stimulation, how often were your erections hard enough for penetration (entering your partner)?
0 No sexual activity
1 Almost never or never
2 A few times (much less than half the the time)
3 Sometimes (about half the time)
4 Most times (much more than half the time)
5 Almost always or always

iii.    During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?
0 Did not attempt intercourse
1 Almost never or never
2 A few times (much less than half the the time)
3 Sometimes (about half the time)
4 Most times (much more than half the time)
5 Almost always or always

iv.    During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?
0 Did not attempt intercourse
1 Extremely difficult
2 Very difficult
3 Difficult
4 Slightly difficult
5 Not difficult


v.    When you attempted sexual intercourse, how often was it satisfactory for you?
0 Did not attempt intercourse
1 Almost never or never
2 A few times (much less than half the the time)
3 Sometimes (about half the time)
4 Most times (much more than half the time)
5 Almost always or always

Then, add all the number selected from the above 5 questions, the total will be your score of erectile function.

Score Guide:
A score of 1 to 7 indicates severe ED. If your score is 1 - 7, consider making an appointment with a provider for diagnosis and, if necessary, treatment.
A score of 8-11 indicates moderate ED. If your score is 8 - 11, consider making an appointment with a provider for diagnosis and, if necessary, treatment.
A score of 12-16 indicates mild to moderate ED. If your score is 12 - 16, you may want to consider making an appointment with a provider for diagnosis and, if necessary, treatment.
A score of 17-21 indicates mild ED. If your score is 17 - 21 and you are concerned about possibly having ED, you may want to consider making an appointment with a provider for diagnosis and, if necessary, treatment.
A score of 22 or more suggests you do not have ED.