ED Assessment in 5 Minutes - PenileImplant.in

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HOMEPAGE
UNDERSTANDING ED
- UNDERSTANDING ED
- GENERAL INFORMATION
PENILE PROSTHESIS
- GENERAL INFORMATION
ABOUT US
ED ASSESSMENT
REQUEST INFORMATION

HOMEPAGE
UNDERSTANDING ED
- UNDERSTANDING ED
  
  What is erectile dysfunction (ED)?
  
  What is an erection?
  
  How common is ED?
  
  Diagnosis of ED
  
  Treatment of ED
- GENERAL INFORMATION
  
  Causes of ED
  
  Cardiovascular disease and ED
  
  Psychological risk factors for ED
  
  ED after treatment of localised prostate cancer
  
  Why is prostate cancer treatment associated with erection problems?
  
  Will I be able to have normal erections after the treatment?
  
  Living with erectile dysfunction
  
  Personal relationships and sexual intercourse
PENILE PROSTHESIS
- GENERAL INFORMATION
ABOUT US
ED ASSESSMENT
REQUEST INFORMATION

ED Assessment ~5 min

There are many reasons for ED. This simple erectile dysfunction quiz will help you assess the severity of your ED symptoms and how erectile dysfunction may be impacting your life.

Step 1 of 11

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Which best describes your situation?(Required)

I have erectile dysfunction.

My partner has erectile dysfunction.

Do you or your partner have morning erections?(Required)

Yes

No

How long have you or your partner suffered from erectile dysfunction?(Required)

0 - 6 months

6 months - 2 years

2 - 5 years

More than 5 years

Rate your confidence that you or your partner can get and keep an erection.(Required)

Very low

Low

Moderate

High

Very High

When you or your partner have had erections with sexual stimulation, how often have the erections been hard enough for penetration (entering partner)?(Required)

No sexual activity

Almost never or never

A few times (less than half the time)

Sometimes (about half the time)

Most times (more than half the time)

Almost always or always

During sexual intercourse, how often have you or your partner been able to maintain an erection after penetration (entering of partner)?(Required)

No longer attempting intercourse

Almost never or never

A few times (less than half the time)

Sometimes (about half the time)

Most times (more than half the time)

Almost always or always

During sexual intercourse, how difficult has it been for you or your partner to maintain your erection to completion of intercourse?(Required)

Did not attempt intercourse

Extremely difficult

Very difficult

Difficult

Slightly difficult

Not difficult

When attempting sexual intercourse, how often has it been satisfactory for you?(Required)

No longer attempting intercourse

Almost never or never

A few times (less than half the time)

Sometimes (about half the time)

Most times (more than half the time)

Almost always or always

Select all treatments you have tried.(Required)

Pills

Vacuum

Injections

Suppositories

None

Have you been diagnosed with any of the following medical conditions which may be related to ED?

Diabetes

Prostate Cancer

Heart Disease

None

Receive your custom results in your inbox.

Name(Required)

First Last

Email(Required)

Age(Required)

Please enter a number from 18 to 120.

Phone(Required)

City/Country(Required)

City Country

Why Country/City? So we can give you more customized options like specialists and events near you.

Consent(Required)

I would like to speak to an ED patient education coordinator.(Required)

Sign me up to receive educational information and/or notification of events in my area. NOTE: by checking this box, you will receive men's health communications from us.

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Date of Lead

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