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  • Patient Instructions

  • 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 affection 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 response that best describes your own situation. Please be sure that you select a response for each questions.
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    Score 1-7 Severe ED, 8-11 Moderate ED, 12-16 Mild to Moderate ED, 17-21 Mild ED
  • This information, including the questions, structure and completeness of the sample survey, is based on forms and/or scoring systems developed by independent organizations of relevance to the diagnosis and treatment of benign prostatic hyperplasia (BPH). This material is not a substitute for a consultation or physical examination by a physician.

  • This field is for validation purposes and should be left unchanged.