• Date Format: MM slash DD slash YYYY

    Sexual health is an important part of an individual's overall physical and emotional well-being. Erectile dysfunction, also known as impotence, is one type of very common medical condition affecting sexual health. Fortunately, there are many different treatment options for erectile dysfunction. This questionnaire is designed to help you and your doctor identify if you may be experiencing erectile dysfunction. If you are, you may choose to discuss treatment options with your doctor.

    Each question has several possible responses. Circle the number of the response that best describes your own situation. Please be sure that you select one and only one response for each question.


  • The Sexual Health Inventory for Men further classifies ED severity with the following breakpoints:

    1-7 Severe ED 8-11 Moderate ED 12-16 Mild to
    Moderate ED 17-21 Mild ED
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