Take the test

Question 1: Which age group are you?
18-29
30-42
43-50
51-62
62-70
70+

Question 2: Which population group do you belong to?
Black
White
Coloured
Indian
Other

Question 3: Do you suffer from / have recently experienced any of the following conditions?
Diabetes
Depression
Recent Prostatectomy
Pelvic Injuries / Surgery
Spinal Chord Injury
Heart Disease
High Cholesterol
Smoking
High Blood Pressure
Other

Question 4: Have you been treated for ED before?
Yes
No

Question 5: If your answer to Question 4 was "Yes", pleas state the name of the treatment you used.

Question 6: How do you rate your cofidence that you can get and keep an erection?
Very Low
Low
Moderate
High
Very High

Question 7: When you had erections with stimulation, how often were your erections hard enough for penetration?
No sexual activity
Almost never or never
A few times (less than half)
Sometimes (half the time)
Most times (more than half)
Almost always, or always.

Question 8: During sexual intercourse, how often were you able to maintain your erectio after you had penetration (entered your partner)?
Did not attempt intercourse
Almost never or never
A few times (less than half)
Sometimes (half the time)
Most times (more than half)
Almost always, or always

Question 9: During sexual intercourse, how difficult was it to maintain your erection to complete the intercourse?
Did not attempt intercourse
Almost never or never
A few times (less than half)
Sometimes (half the time)
Most times (more than half)
Almost always or always

Question 10: When you attempted sexual intercourse, how often was it satisfactory for you?
Did not attempt intercourse
Almost never or never
A few times (less than half)
Sometimes (half the time)
Most times (more than half)
Almost always or always