Premature Ejaculation Training Questionnaire
Please complete this confidential questionnaire to help us understand your experiences and training needs related to premature ejaculation. Your responses will guide personalized support and remain strictly confidential.
Age
*
How long have you been experiencing concerns related to premature ejaculation?
*
Please Select
Less than 6 months
6-12 months
1-3 years
More than 3 years
How often do you experience ejaculation sooner than you would like during sexual activity?
*
Always
Often
Sometimes
Rarely
Never
How much does premature ejaculation impact your overall satisfaction with sexual activity?
*
No impact
1
2
3
4
5
6
7
8
9
Severe impact
10
1 is No impact, 10 is Severe impact
How confident do you feel in controlling ejaculation during sexual activity?
*
1
2
3
4
5
Please indicate how much you agree with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel anxious about sexual performance.
1
2
3
4
5
Premature ejaculation affects my self-esteem.
6
7
8
9
10
I am interested in learning techniques to improve control.
11
12
13
14
15
I have discussed this issue with a partner.
16
17
18
19
20
Have you previously tried any methods or training to manage premature ejaculation?
*
Yes
No
If yes, please specify which methods or approaches you have tried.
Are you currently taking any medication or receiving treatment for sexual health concerns?
*
Yes
No
What are your main goals or expectations from a premature ejaculation training program?
Would you like to receive information or support regarding premature ejaculation training?
*
Yes
No
Submit
Should be Empty: