IIEF5 – Erectile dysfunction questionnaire Personal InformationName(Required) First name Last name E-mail(Required) Date of birth(Required) YYYY slash MM slash DD Select your practitioner(Required)Dre Anne Isabelle DionneDre Evelyne Bourduas-RoyDre Nathaël Leduc Arbour QuestionnaireThis questionnaire allows you to evaluate your sexual function over the last 6 months:In the last six months:1. How sure were you that you could get an erection and maintain it?(Required) Not sure at all Not very sure Moderately safe Sure Very sure 2. When you had erections as a result of sexual stimulation, how often was your penis rigid (hard) enough to allow penetration?(Required) I was not sexually stimulated Almost never or never Rarely (much less than half the time) Sometimes (about half the time) Most of the time (much more than half the time) Almost all the time or all the time 3. When you tried to have sex, how often were you able to stay erect after penetrating your partner?(Required) I didn’t try to have sex Almost never or never Rarely (much less than half the time) Sometimes (about half the time) Most of the time (much more than half the time) Almost all the time or all the time 4. During your sexual intercourse, how hard was it for you to stay erect until the end of this intercourse?(Required) I didn’t try to have sex Extremely difficult Very difficult Difficult A bit difficult Not difficult 5. When you tried to have sex, how often were you satisfied?(Required) I didn’t try to have sex Almost never or never Rarely (much less than half the time) Sometimes (about half the time) Most of the time (much more than half the time) Almost all the time or all the time CAPTCHA
