Name* First Last Email* Review each question and select the response that best describes your own situation OVER THE PAST 6 MONTHS:1. How do you rate your confidence that you could get and keep an erection?*Very lowLowModerateHighVery high2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration?*Almost never/neverA few times (much less than half the time)Sometimes (about half the time)Most times (much more than half the time)Almost always/always3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?*Almost never/neverA few times (much less than half the time)Sometimes (about half the time)Most times (much more than half the time)Almost always/always4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?*Extremely difficultVery difficultDifficultSlightly difficultNot difficult5. When you attempted sexual intercourse, how often was it satisfactory for you?*Almost never/neverA few times (much less than half the time)Sometimes (about half the time)Most times (much more than half the time)Almost always/alwaysCAPTCHAEmailThis field is for validation purposes and should be left unchanged.
