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
Publications
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
Publications
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!