Weak Erections

Weak Erections, Impotence or Erectile dysfunction

Sexual health is an important part of an individual's overall physical and emotional well-being.  Erectile dysfunction is one type of very common sexual complaint.  There are many different treatment options for erectile dysfunction.  This questionnaire is designed to help you and your physician identify the nature and severity of your erectile dysfunction and to discuss potential treatment options.

Each question has several responses from which you are asked to choose the one that best describes your own situation.  Please be sure that you select only one response per question.

Please ensure all information is completed correctly in order for us to respond to your assessment promptly.

Your Name (required):

Your Email (required):


Over the past six months


QUESTION 01:
How do you rate your confidence that you could get and keep an erection?

QUESTION 02:
When you had erections with sexual stimulation, how often were your erections hard enough for penetration?

QUESTION 03:
During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

QUESTION 04:
During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

QUESTION 05:
When you attempted sexual intercourse, how often was it satisfactory for you?


Submit your self assessment form to the Mens Clinic International Doctor for evaluation: