Welcome to your Premature Ejaculation Check-up 1. How is your sexual libido or interest? Please select your answer A. Very low B. Low C. General D. High E. Very high 2. Is your erection rigid enough for sexual intercourse? Please select your answer A. Almost never B. Seldom C. Half of time D. Often E. Always 3. Can you maintain erection until the end of sexual intercourse? Please select your answer A. Almost never B. Seldom C. Half of time D. Often E. Always 4. What is the duration from penis penetration to ejaculation? Please select your answer A. Too short (30 sec) B. Very short (2 min) C. Short (3 min) D. Often short (4 min) E. Not short (8 min) 5. How difficult is it to prolong the sexual intercourse? Please select your answer A. Very difficult B. Always difficult C. Difficult D. Seldom difficult E. Not difficult 6. Are you satisfied with your sexual life? Please select your answer A. Very dissatisfied B. Always dissatisfied C. Generally satisfied D. Often satisfied E. Always satisfied 7. Is your partner satisfied with her sexual life? Please select your answer A. Very dissatisfied B. Always dissatisfied C. Generally satisfied D. Often satisfied E. Always satisfied 8. Does your partner reach orgasm during sexual intercourse? Please select your answer A. Almost never B. Seldom C. Half of time D. Often E. Always 9. How is your confidence in completing sexual intercourse? Please select your answer A. Very low B. Low C. General D. High E. Very high 10. Do you feel anxious, depressed or stressful during sexual intercourse? Please select your answer A. Always B. Often C. Half of time D. Seldom E. Almost never Time's up
