SHIM - Sexual Health Inventory for Men

Answer based on your activity over the last 4 weeks ....

Name *
Name
Date of Birth *
Date of Birth
The following responses apply
1- On my Own 2- When I use - Viagra, Cialis, Levitra, Stendra, Staxyn 3- When I use Penile Injections
1 Very low 2 Low 3 Moderate 4 High 5 Very high
0. No sexual activity 1. Almost always or always 2. Most times (much more than half the time) 3. Sometimes (about half the time) 4. A few times (much less than half the time) 5. Almost never or never
0. Did not attempt intercourse 1. Almost always or always 2. Most times (much more than half the time) 3. Sometimes (about half the time) 4. A few times (much less than half the time) 5. Almost never or never
0 Did not attempt intercourse 1 Extremely difficult 2 Very difficult 3 Difficult 4 Slightly difficult 5 Not difficult
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 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