Welcome to your erectile dysfunction Self Assessment

Find out more about your health condition and the related services we offer, by completing in a simple health assessment.

*This questionnaire is for reference only. It is not a medical diagnosing tool.

Please answer the questions based on your situation in the recent four weeks

Your Name
Phone No.
Your Email
1. How often have you managed to get an erection during sexual activity in the last month?
2. When you had erections with sexual stimulation in the last month, how often were your erections hard enough for penetration?
3. When you attempted sexual intercourse in the last month, how often were you able to penetrate your partner?
4. During sexual intercourse in the last month, how often were you able to maintain your erection after you had penetrated your partner?
5. During sexual intercourse in the last month, how difficult was it to maintain your erection to completion of intercourse?
6. How often have you attempted sexual intercourse in the last month?
7. When you attempted sexual intercourse, how often was it satisfactory for you?
8. How much did you like your sexual intercourse in the last month?
9. When you have had sexual stimulation or intercourse during the last month, how often have you ejaculated?
10. When you have had sexual stimulation or intercourse during the last month, how often have you had the feeling of orgasm (with or without ejaculation)?
11. How often did you feel sexual desire during the last month?
12. How high would you rate your sexual desire during the last month?
13. How satisfied have you been with your overall sex life during the last month?
14. How satisfied have you been with your sexual relationship with your partner during the last month?
15. How do you rate your confidence with regard to the last month that you could get and keep an erection?