All male patients should complete this questionnaire before seeing any of our doctors at MySexualHealth.co.za.
The information you provide will remain fully confidential.
Please do not be offended by the nature of these questions. Since this is your first visit, we just want to make sure we have good background information. All patients answer exactly the same quesions, we do not imply anything by asking you these questions.
Where dates are requested, estimations are always appropriate.
Some fields are required and others not. If you do not complete a section that is not compulsory it will be assumed that you do not have a problem in this area or wish not to address it.
INTERNATIONAL INDEX OF ERECTILE FUNCTION (IIEF-5) QUESTIONNAIRE
This is a standardised questionnaire to determine your erectile function. Please answer these questions about your erectile function during the PAST SIX MONTHS: