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
SHIM - Sexual Health Inventory for Men
Answer based on your activity over the last 4 weeks ....
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
OWN
Oral MEDS
Injections
S1_How do you rate your confidence that you could get and keep an erection? IIEFQ15
*
1 Very low 2 Low 3 Moderate 4 High 5 Very high
0
1
2
3
4
5
S2_When you had erections with sexual stimulation, how often were your erections hard enough for penetration? IIEFQ2
*
0. No sexual activity 1. Almost never or never 2. A few times (much less than half the time) 3. Sometimes (about half the time) 4. Most times (much more than half the time) 5. Almost always or always
0
1
2
3
4
5
S3_During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner? IIEFQ4
*
0. No sexual activity 1. Almost never or never 2. A few times (much less than half the time) 3. Sometimes (about half the time) 4. Most times (much more than half the time) 5. Almost always or always
0
1
2
3
4
5
S4_During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? IIEFQ5
*
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
S5_When you attempted sexual intercourse, how often was it satisfactory for you? IIEFQ7
*
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
OPTIONAL - How many times have you attempted sexual intercourse? IIEFQ6
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
Thank you!