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Erectile Function Assessment

The following questionnaire is designed to assess your erectile function over the past four weeks. It is based on the internationally validated International Index of Erectile Function (IIEF) and helps identify whether erectile dysfunction may be affecting you.
Please answer each question as honestly as possible. Your responses will provide an indication of your erectile function and can help inform a discussion with one of our clinicians if you choose to book a consultation.
The questionnaire takes approximately 3–4 minutes to complete.
Definitions:
- sexual activity includes intercourse, caressing, foreplay & masturbation - sexual intercourse is defined as sexual penetration of your partner - sexual stimulation includes situation such as foreplay, erotic pictures etc. - ejaculation is the ejection of semen from the penis (or the feeling of this) - orgasm is the fulfilment or climax following sexual stimulation or intercourse

Full Name

Email Address

Date of Birth

I understand that my responses will be securely stored and may be used by my clinician if I choose to book a consultation.

A