1. Over the past 4 weeks‚ how often were you able to get an erection during sexual activity?
· No sexual activity
· Almost always or always
· Most times (much more than half the time)
· Sometimes (about half the time)
· A few times (much less than half the time)
· Almost never or never
2. Over the past 4 weeks‚ when you had erections with sexual stimulation‚ how often were your erections hard enough for penetration?
· No sexual stimulation
· Almost always or always
· Most times (much more than half the time)
· Sometimes (about half the time)
· A few times (much less than half the time)
· Almost never or never
Questions 3‚ 4 and 5 will ask about erections you may have had during sexual intercourse.
3. Over the past 4 weeks‚ when you attempted sexual intercourse‚ how often were you able to penetrate (enter) your partner?
· Did not attempt intercourse
· Almost always or always
· Most times (much more than half the time)
· Sometimes (about half the time)
· A few times (much less than half the time)
· Almost never or never
4. Over the past 4 weeks‚ during sexual intercourse‚ how often were you able to maintain your erection after you had penetrated (entered) your partner?
· Did not attempt intercourse
· Almost always or always
· Most times (much more than half the time)
· Sometimes (about half the time)
· A few times (much less than half the time)
· Almost never or never
5. Over the past 4 weeks‚ during sexual intercourse‚ how difficult was it to maintain your erection to completion of intercourse?
· Did not attempt intercourse
· Almost always or always
· Most times (much more than half the time)
· Sometimes (about half the time) 0 A few times (much less than half the time)
· Almost never or never
6. Over the past 4 weeks‚ how many times have you attempted sexual intercourse?
· No attempts
· 1-2 attempts
· 3-4 attempts
· 5-6 attempts
· 7-10 attempts
· 11 or more attempts
7. Over the past 4 weeks‚ when you attempted sexual intercourse how often was it satisfactory for you?
· Did not attempt intercourse
· Almost always or always
· Most times (much more than half the time)
· Sometimes (about half the time)
· A few times (much less than half the time)
· Almost never or never
8. Over the past 4 weeks‚ how much have you enjoyed sexual intercourse?
· No intercourse
· Very highly enjoyable
· Highly enjoyable
· Fairly enjoyable
· Not very enjoyable
· Not enjoyable
9. Over the past 4 weeks‚ when you had sexual stimulation or intercourse how often did you ejaculate?
· Did not attempt intercourse
· Almost always or always
· Most times (more than half the time)
· Sometimes (about half the time)
· A few times (much less than half the time)
· Almost never or never
10. Over the past 4 weeks‚ when you had sexual stimulation or intercourse how often did you have the feeling of orgasm or climax (with or without ejaculation)?
· No sexual stimulation or intercourse
· Almost always or always
· Most times (much more than half the time)
· Sometimes (about half the time)
· A few times (much less than half the time)
· Almost never or never
Questions 11 and 12 ask about sexual desire. Let’s define sexual desire as a feeling that may include wanting to have a sexual experience (for example‚masturbation or intercourse)‚ thinking about having sex or feeling frustrated dueto a lack of sex.
11. Over the past 4 weeks‚ how often have you felt sexual desire?
· Almost always or always
· Most times (much more than half the time)
· Sometimes (about half the time)
· A few times (much less than half the time)
· Almost never or never
12. Over the past 4 weeks‚ how would you rate your level of sexual desire?
· Very high
· High
· Moderate
· Low
· Very low or none at all
13. Over the past 4 weeks‚ how satisfied
· Very satisfied
· Moderately satisfied
· About equally satisfied and dissatisfied
· Very dissatisfied
14. Over the past 4 weeks‚ how satisfied have you been with your sexual relationship with your partner?
· Very satisfied
· Moderately satisfied
· About equally satisfied and dissatisfied
· Moderately dissatisfied
· Very dissatisfied
15. Over the past 4 weeks‚ how do you rate your confidence that you can get and keep your erection?
· Very high
· High
· Moderate
· Low
· Very low
Erectile Function (items: 1‚ 2‚ 3‚ 4‚ 5‚ 15)‚ Orgasmic Function (items: 9‚ 10)‚ Sexual Desire (items: 11‚ 12)‚ Intercourse Satisfaction (items: 6‚ 7‚ 8)‚ and Overall Satisfaction (items13‚ 14)
This instrument can be found at: http://www.seekwellness.com/mens_sexuality/questionnaire.htm & https://www.researchgate.net/file.PostFileLoader.html?id=55926ccd6225ff5de48b4682&assetKey=AS%3A273804520034308%401442291492243 & http://dro.deakin.edu.au/eserv/DU:30067449/stefanou-theassociations-2014A.pdf
Rosen‚ R. C.‚ Riley‚ A.‚ Wagner‚ G.‚ Osterloh‚ I. H.‚ Kirkpatrick‚ J.‚ & Mishra‚ A. (1997). The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology‚ 49‚ 822-830.