Erectile Dysfunction Test

Answer the following questions about yourself:

1.
During sexual activity, can you sustain an erection much more than half the time of the intercourse session?
Yes
No
2.
When you have an erection, is it hard enough to penetrate your partner much more than half the time of sexual intercourse?
Yes
No
3.
Do you extremely experience difficulties to maintain an erection in an intercourse?
Yes
No
4.
In a sexual intercourse, are you able to maintain your erection after you have entered your partner for much more than half the time of the sexual intercourse?
Yes
No
5.
Do you suffer from premature ejaculation?
Yes
No
6.
Do you feel satisfied of your sexual intercourse in most of the times?
Yes
No
7.
Do you have confidence that you can get and maintain an erection during sexual intercourse?
Yes
No
8.
Do you feel nervosity or tension before having sex?
Yes
No
9.
During orgasm, is your penis very hard?
Yes
No
10.
Are you a smoker or do you suffer from any of these conditions (hypertension or diabetes mellitus)?
Yes
No
Please answer all of the questions before continuing.

Please provide us with your contact information to email your test results.

First Name:
Last Name:
Phone:
E-mail: