Over the past 4 weeks when you had erections with sexual stimulation how often were your erections hard enough for penetration Please check one box only

□ No sexual activity

□ Almost always/always

□ Most times (much more than half the time)

□ Sometimes (about half the time)

□ Almost never/never

The next three questions will ask about the 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? Please check one box only.

□ Did not attempt intercourse

□ Almost always/always

□ Most times (much more than half the time)

□ Sometimes (about half the time)

□ Almost never/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? Please check one box only.

□ Did not attempt intercourse

□ Almost always/always

□ Most times (much more than half the time)

□ Sometimes (about half the time)

□ Almost never/never

5. Over the past 4 weeks, during sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? Please check one box only.

□ Did not attempt intercourse

□ Extremely difficult

□ Very difficult

□ Slightly difficult

□ Not difficult

6. Over the past 4 weeks, how many times have you attempted sexual intercourse? Please check one box only.

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Dealing With Erectile Dysfunction

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