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International Index of Erectile Function Questionnaire
SUMMARY: Questionnaire for assessing impotence/erectile dysfunction.
Questions: Based on last 6 months (each answer assigned 1-5 score)
[select name="Q1" value="Very Low - 1 point=1|Low - 2 points=2|Moderate - 3 points=3|High - 4 points=4|Very High - 5 points=5"] <-- How do you rate your confidence that you could get and keep an Erection?
[select name="Q2" value="Never or almost never - 1 point=1|A few times - 2 points=2|Sometimes (about half the time) - 3 points=3|Most times - 4 points=4|Always or almost always - 5 points=5"] <-- When you had Erections with sexual stimulation, how often were your Erections hard enough for penetration?
[select name="Q3" value="Never or almost never - 1 point=1|A few times - 2 points=2|Sometimes (about half the time) - 3 points=3|Most times - 4 points=4|Always or almost always - 5 points=5"] <-- During sexual intercourse, how often were you able to maintain your Erection after you had penetrated or entered your partner?
[select name="Q4" value="Extremely difficult - 1 point=1|Very difficult - 2 points=2|Difficult - 3 points=3|Slightly difficult - 4 points=4|Not difficult - 5 points=5"] <-- During sexual intercourse, how difficult was it maintain your Erection to completion of intercourse?
[select name="Q5" value="Never or almost never - 1 point=1|A few times - 2 points=2|Sometimes (about half the time) - 3 points=3|Most times - 4 points=4|Always or almost always - 5 points=5"] <-- When you attempted sexual intercourse, how often was it satisfactory for you?
Score --> [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)" memo="total"] points
Interpretation --> [calc value="score2=(Q1)+(Q2)+(Q3)+(Q4)+(Q5);score2>21?'Normal erectile function':score2>16?'Mild erectile dysfunction':score2>11?'Mild to moderate erectile dysfunction':score2>7?'Moderate erectile dysfunction':'Severe erectile dysfunction'" memo="Interpretation"]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference:
[link url="//www.ncbi.nlm.nih.gov/pubmed/10637462" memo="#1"] Rosen (1999) Int J Impot Res. 11:319-26
[link url="//www.fpnotebook.com/Uro/Exam/IntrntnlIndxOfErctlFnctnQstnr.htm" memo="#2"] FPNotebook page
[/conditional]
International Index of Erectile Function Questionnaire
SUMMARY: Questionnaire for assessing impotence/erectile dysfunction.
Questions: Based on last 6 months (each answer assigned 1-5 score)
<-- How do you rate your confidence that you could get and keep an Erection?
<-- When you had Erections with sexual stimulation, how often were your Erections hard enough for penetration?
<-- During sexual intercourse, how often were you able to maintain your Erection after you had penetrated or entered your partner?
<-- During sexual intercourse, how difficult was it maintain your Erection to completion of intercourse?
<-- When you attempted sexual intercourse, how often was it satisfactory for you?
Score --> totalscore=(Q1)+(Q2)+(Q3)+(Q4)+(Q5) points
Interpretation --> Interpretationscore2=(Q1)+(Q2)+(Q3)+(Q4)+(Q5);score2>21?'Normal erectile function':score2>16?'Mild erectile dysfunction':score2>11?'Mild to moderate erectile dysfunction':score2>7?'Moderate erectile dysfunction':'Severe erectile dysfunction'
display/hide references
Result - Copy and paste this output: