URN
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Bill of Rights
Centers
Miami
Madrid
London
Physicians
Fernando J. Bianco, MD
Mark Emberton, MD
Edward L. Gheiler
Juan I. Martinez-Salamanca, MD
Ariel M. Kaufman, MD
Inventories
Health Inventories
QOL
SHIM
IPSS
IIEF-15
EQ5
WPAI
BAPS
RSES
COPS-P
Clinical Trials
Contact Us
Urological Research Network
URN
home
Bill of Rights
Centers
Miami
Madrid
London
Physicians
Fernando J. Bianco, MD
Mark Emberton, MD
Edward L. Gheiler
Juan I. Martinez-Salamanca, MD
Ariel M. Kaufman, MD
Inventories
Health Inventories
QOL
SHIM
IPSS
IIEF-15
EQ5
WPAI
BAPS
RSES
COPS-P
Clinical Trials
Contact Us
Inventories
Health Inventories
QOL
SHIM
IPSS
IIEF-15
EQ5
WPAI
BAPS
RSES
COPS-P
IIEF - International Index of Erectile Function
The responses apply to the last 4 weeks of sexual activity
Español
Name
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Email
*
The following responses apply
*
1- On my Own 2- When I use - Viagra, Cialis, Levitra, Stendra, Staxyn 3- When I use Penile Injections
1
2
3
Q1_How often were you able to get an erection during sexual activity?
*
0 No sexual activity 1 Almost never or never 2 A few times (less than half the time) 3 Sometimes (about half the time) 4 Most times (more than half the time) 5 Almost always or always
0
1
2
3
4
5
Q2_When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
*
0 No sexual activity 1 Almost never or never 2 A few times (less than half the time) 3 Sometimes (about half the time) 4 Most times (more than half the time) 5 Almost always or always
0
1
2
3
4
5
Q3_When you attempted intercourse, how often were you able to penetrate (enter) your partner?
*
0 Did not attempt intercourse 1 Almost never or never 2 A few times (less than half the time) 3 Sometimes (about half the time) 4 Most times (more than half the time) 5 Almost always or always
0
1
2
3
4
5
Q4_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 (less than half the time) 3 Sometimes (about half the time) 4 Most times (more than half the time) 5 Almost always or always
0
1
2
3
4
5
Q5_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
0
1
2
3
4
5
Q6_How many times have you attempted sexual intercourse?
*
0 No attempts 1 One to two attempts 2 Three to four attempts 3 Five to six attempts 4 Seven to ten attempts 5 Eleven or more attempts
0
1
2
3
4
5
Q7_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 (less than half the time) 3 Sometimes (about half the time) 4 Most times (more than half the time) 5 Almost always or always
0
1
2
3
4
5
Q8_How much have you enjoyed sexual intercourse?
*
0 No intercourse 1 No enjoyment at all 2 Not very enjoyable 3 Fairly enjoyable 4 Highly enjoyable 5 Very highly enjoyable
0
1
2
3
4
5
Q9_When you had sexual stimulation or intercourse, how often did you ejaculate?
*
0 No sexual stimulation or intercourse 1 Almost never or never 2 A few times (less than half the time) 3 Sometimes (about half the time) 4 Most times (more than half the time) 5 Almost always or always
0
1
2
3
4
5
Q10_When you had sexual stimulation or intercourse, how often did you have the feeling of orgasm or climax?
*
1 Almost never or never 2 A few times (less than half the time) 3 Sometimes (about half the time) 4 Most times (more than half the time) 5 Almost always or always
0
1
2
3
4
5
Q11_How often have you felt sexual desire?
*
1 Almost never or never 2 A few times (less than half the time) 3 Sometimes (about half the time) 4 Most times (more than half the time) 5 Almost always or always
0
1
2
3
4
5
Q12_How would you rate your level of sexual desire?
*
1 Very low or none at all 2 Low 3 Moderate 4 High 5 Very high
0
1
2
3
4
5
Q13_How satisfied have you been with your overall sex life?
*
1 Very dissatisfied 2 Moderately dissatisfied 3 Equally satisfied & dissatisfied 4 Moderately satisfied 5 Very satisfied
0
1
2
3
4
5
Q14_How satisfied have you been with your sexual relationship with your partner?
*
1 Very dissatisfied 2 Moderately dissatisfied 3 Equally satisfied & dissatisfied 4 Moderately satisfied 5 Very satisfied
0
1
2
3
4
5
Q15_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
0
1
2
3
4
5
Thank you!