| Over the past six months: |
| 1. How do you rate your confidence that you could get and keep an erection? | Very low | Low | Moderate | High | Very high |
| 2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration? | Almost never or never | A few times* | Sometimes† | Most times‡ | Almost always or always |
| 3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner? | Almost never or never | A few times* | Sometimes† | Most times‡ | Almost always or always |
| 4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? | Extremely difficult | Very difficult | Difficult | Slightly difficult | Not difficult |
| 5. When you attempted sexual intercourse, how often was it satisfactory for you? | Almost never or never | A few times* | Sometimes† | Most times‡ | Almost always or always |