ED Assessment in 5 Minutes - PenileProstheses.com.au

Step 1 of 11

Which best describes your situation?(Required)

I have erectile dysfunction.

My partner has erectile dysfunction.

Do you or your partner have morning erections?(Required)

Yes

How long have you or your partner suffered from erectile dysfunction?(Required)

0 - 6 months

6 months - 2 years

2 - 5 years

More than 5 years

Rate your confidence that you or your partner can get and keep an erection.(Required)

Very low

Low

Moderate

High

Very High

When you or your partner have had erections with sexual stimulation, how often have the erections been hard enough for penetration (entering partner)?(Required)

No sexual activity

Almost never or never

A few times (less than half the time)

Sometimes (about half the time)

Most times (more than half the time)

Almost always or always

During sexual intercourse, how often have you or your partner been able to maintain an erection after penetration (entering of partner)?(Required)

No longer attempting intercourse

Almost never or never

A few times (less than half the time)

Sometimes (about half the time)

Most times (more than half the time)

Almost always or always

During sexual intercourse, how difficult has it been for you or your partner to maintain your erection to completion of intercourse?(Required)

Did not attempt intercourse

Extremely difficult

Very difficult

Difficult

Slightly difficult

Not difficult

When attempting sexual intercourse, how often has it been satisfactory for you?(Required)

No longer attempting intercourse

Almost never or never

A few times (less than half the time)

Sometimes (about half the time)

Most times (more than half the time)

Almost always or always

Select all treatments you have tried.(Required)

Pills

Vacuum

Injections

Suppositories

None

Have you been diagnosed with any of the following medical conditions which may be related to ED?

Diabetes

Prostate Cancer

Heart Disease

None

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Email(Required)

Phone(Required)

Have you seen your GP?(Required)

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City/Country(Required)

City Country

Why Country/City? So we can give you more customized options like specialists and events near you.

Consent(Required)

I accept the Privacy Policy | Terms & Conditions(Required)

Consent(Required)

I accept the Terms of Consultation Confidentiality.(Required)

Unique ID

Terms of Consultation Confidentiality

By checking this box, you acknowledge and understand that your consultation is strictly confidential and solely between you and your physician. It’s important to recognize that your doctor is the primary source of information and is familiar with your medical history and needs. Please note that Rigicon, Inc. does not assume any liability or responsibility regarding the consultation or any medical procedures. We strongly encourage you to discuss all aspects of your treatment with your doctor.

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Date of Lead

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Lead Source

ED Assessment ~5 min

There are many reasons for ED. This simple erectile dysfunction quiz will help you assess the severity of your ED symptoms and how erectile dysfunction may be impacting your life.

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