Questionnaire for Erectile Dysfunction

Here's a more detailed questionnaire specifically tailored for Erectile Dysfunction assessment:

1. Personal Information:

   • Age:
   • Gender:
   • Ethnicity:
   • Occupation:

2. Medical History:

   • Do you have any chronic medical conditions? If yes, please specify:
   • Are you currently being treated for any medical conditions? If yes, please specify:
   • Have you had any surgeries or procedures in the past? If yes, please specify:

3. Lifestyle Factors:

   • Do you smoke cigarettes or use tobacco products?
   • How often do you consume alcohol? Please specify the frequency and quantity:
   • Do you use recreational drugs? If yes, please specify the types and frequency:

4. Medication History:

   • Are you currently taking any prescription medications? If yes, please specify:
   • Are you taking any over-the-counter medications or supplements? If yes, please specify:

5. Erectile Function:

   • How would you rate the quality of your erections during sexual activity?
     • Excellent
     • Good
     • Fair
     • Poor
     • Very poor
   • How often do you experience difficulty getting an erection when you want to engage in sexual activity?
     • Never
     • Rarely
     • Sometimes
     • Often
     • Always
   • Can you achieve an erection through self-stimulation (masturbation)?
     • Yes, always
     • Yes, sometimes
     • No, rarely
     • No, never
   • Can you maintain an erection during sexual activity?
     • Yes, always
     • Yes, most of the time
     • Sometimes
     • Rarely
     • Never
   • Do you have morning erections?
     • Yes, regularly
     • Yes, occasionally
     • No, rarely
     • No, never

6. Psychological Factors:

   • Do you experience stress or anxiety related to sexual performance?
   • Have you experienced any traumatic sexual experiences in the past?
   • Do you have any psychological conditions such as depression or anxiety?

7. Relationship Factors:

   • Are you currently in a relationship? If yes, how satisfied are you with your sexual relationship?
     • Very satisfied
     • Satisfied
     • Neutral
     • Dissatisfied
     • Very dissatisfied

8. Additional Symptoms:

   • Have you experienced any pain or discomfort during sexual activity or erections?
   • Do you have any other symptoms related to sexual function that you would like to mention?

9. Impact on Daily Life:

   • How does erectile dysfunction affect your quality of life and relationships?

10. Additional Comments:

    • Please feel free to share any additional information or concerns you may have regarding your sexual health.

Once completed, it is advisable to discuss the questionnaire responses with a healthcare professional for further evaluation and appropriate management of erectile dysfunction.