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How often were you able to get an erection during sexual activity?

No sexual activity Almost never or never A few times (less than half the time) Sometimes (about half the time) Most times (more than half the time) Almost always or always

When you had erections with sexual stimulation, how often were your erections hard enough for penetration?

No sexual activity Almost never or never A few times (less than half the time) Sometimes (about half the time) Most times (more than half the time) Almost always or always

When you attempted intercourse, how often were you able to penetrate (enter) your partner?

Did not attempt intercourse Almost never or never A few times (less than half the time) Sometimes (about half the time) Most times (more than half the time) Almost always or always

During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

Did not attempt intercourse Almost never or never A few times (less than half the time) Sometimes (about half the time) Most times (more than half the time) Almost always or always

During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

Did not attempt intercourse Extremely difficult Very difficult Difficult Slightly difficult Not difficult

How do you rate your confidence that you could get and keep an erection?

Very low Low Moderate High Very high

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Would you like our pharmacist to call and review your results with you?

Yes – please enter your phone number No – I’m good for now

Which time is usually most convenient for your consultation?

Morning (9:00am – 12:00pm) Afternoon (12:00pm – 4:00pm) Evening (4:00pm – 9:00pm)

Here’s what we mean in a few of the terms used:

Sexual activity: Includes intercourse, foreplay, caressing, or masturbation
Sexual intercourse: Penetration of your partner
Sexual stimulation: Things like foreplay, touch, or even erotic visuals
Ejaculation: The release or sensation of semen
Orgasm: The climax or peak sensation during sexual activity

This assessment is for informational purposes only. It does not diagnose or replace medical advice.

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Erectile Dysfunction
Premature Ejaculation

Erectile Dysfunction
Premature Ejaculation