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.

Erectile Dysfunction Diagnosis

The list of diagnostic tests mentioned in various sources as used in the diagnosis of Impotence includes:

• Physical examination
• Blood pressure
• Palpate peripheral pulses (to determine if there are abnormalities to the blood supply)
• Test nerve function by testing reflexes and sensation
• Genital examination looking for evidence Peyronie's disease and checking size, shape and consistency of the testicles and penis
• Digital rectal examination to assess prostate size, consistency and tenderness
• Examine for the loss of secondary sexual characteristics - may suggest Klinefelter's syndrome.

• Mental state examination (to help detect depression, anxiety and other psychiatric diagnoses) - including appearance, behavior, rate and continuity of speech, mood, affect, thought content, evidence of any hallucinations or abnormal beliefs, orientation to time, place and person, attention and concentration, short-term memory, insight and judgement. 

• Blood tests
• Blood lipid levels including cholesterol and triglycerides (looking for vascular disease)
• Fasting blood sugar (looking for diabetes)
• Liver function (looking for drug or alcohol problem)
• Iron studies (looking for hemochromatosis)
• Electrolytes and renal function
• Thyroid function tests
• Total testosterone and DHEA-S levels (for libido)
• If testosterone is low, test FSH, LH and prolactin levels
• Prostate specific antigen (PSA) levels
• Urine tests

• Urine microscopy and culture
• Urine drug screen, if indicated
• Radiological investigations
• Transrectal ultrasound, if suspect prostate cancer
• MRI spine, if suspect multiple sclerosis and other spinal cord lesions
• Nocturnal tumescent study - an electronic computerized test to detect and measure penile erections during sleep. It acts as a guide to differentiate between psychological cause (normal studies) and organic physical cause (poor function).
• Nerve conduction studies may be required to rule out diabetic neuropathy as a cause of sexual dysfunction
• Electrophysiological tests such as visual-evoked response (VER) - may be required to diagnose Multiple sclerosis.
• Physical exam
• Blood counts 
• Urinalysis

• Lipid profile
• Creatinine test
• Liver enzymes test
• Testosterone level
• Monitoring nocturnal penile tumescence
• Psychosocial examination 

Erectile Dysfunction Statistic

“More than 18 million men in the United States over age 20 are affected by erectile dysfunction, according to a study from the Johns Hopkins Bloomberg School of Public Health. The prevalence of erectile dysfunction was strongly linked with age, cardiovascular disease, diabetes and a lack of physical activity. The findings also indicate that lifestyle changes, such as increased physical activity and measures to prevent cardiovascular disease and diabetes, may also prevent decreased erectile function. The study is published in the February 1, 2007, issue of the American Journal of Medicine.”

Erectile Dysfunction Statistics:

• One in 10 men in the world has erectile dysfunction.
• 30 million men in the United States have erectile dysfunction.
• 50% of men with diabetes have erectile dysfunction, frequently within 10 years of diagnosis.
• The likelihood of erectile dysfunction increases with age: 39% at age 40, 65% over the age of 65.
• Smokers have a higher likelihood of erectile dysfunction. Men who smoke more than 1 pack per day have a 50% higher chance of impotency than non-smokers the same age.

Erectile Dysfunction appears to be on the rise:

• More men are experiencing impotency because the baby boomer generation is getting older. According to same reports, every 7 seconds a baby boomer turns 50 years old.
• Awareness of the problem is increasing, which increases the number of men who are treated.
• Because, in the past, men have generally been unwilling to talk about their problem or seek treatment, erectile dysfunction has been under reported.
• Many physicians are not aware of the treatment options, so patients have been either under treated or not treated at all.
• According to a report in Newsweek, 11/17/97, "Each new drug, with its attendant publicity, brings more men into the game. Some urologists expect the number of men seeking treatment to double in the coming years."