IIEF - International Index of Erectile Function

The responses apply to the last 4 weeks of sexual activity

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Name

First Name

Last Name

Date of Birth

YYYY

The current EMAIL that you use to log in the Focalyx App

The following responses apply

1- On my Own 2- When I use - Viagra, Cialis, Levitra, Stendra, Staxyn 3- When I use Penile Injections

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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