Questionnaires

March 12th, 2012 Leave a comment Go to comments

INTERNATIONAL INDEX OF ERECTILE FUNCTION. (IIEF)

 

 

This is a multidimensional Scale for Assesment of Erectile Dysfunction.

IIEF consists of total 15 questions, each being scored from a

minimum of 0 to a maximum of 5.

This Multidimesional Scale provides evaluation of male sexual dysfunction over five domains.

Domain: ErectileFunction IntercourseSatisfaction OrgasmicFunction SexualDesire OverallDesire
Question Numbers 1 to 5& 15 6 to 8 9 to 10 11 to 12 13 to 14

A score of less than 21 (out of 25) in the first five questionnaire indicates

Sexual dysfunction.

Overall Evaluation of the score provides insight in to the domains affected and may be helpful in deciding the treatment needed.

Evaluation of the score before and after treatment (of about 4 weeks) can be

Used as an effective tool for detecting treatment related response.

Source: International Index of Erectile Function (IIEF) – A multidimensional scale for assessment of erectile dysfunction. Adopted from Urology, Published by El Servier Science.

Female Sexual Concerns: – Please Check all that apply.

  1. My sexual complaints are :
    1. Lack of sexual interest
    2. Difficulty getting aroused
    3. Difficulty achieving orgasm with intercourse
    4. Difficulty achieving orgasm with oral stimulation
    5. Difficulty achieving orgasm with manual stimulation by partner
    6. Difficulty achieving orgasm by myself
    7. I have never had an orgasm
    8. I’m not sure whether I’m having orgasms or not
    9. Pain with intercourse
    10. Difficulty with penetration (vaginismus)
    11. Difficulty with vaginal dryness
    12. Concern about my partner’s sexual functioning,
  1. My sexual complaints have affected my desire for sex.

True _____ False _____

  1. I have the same sexual complaints with masturbation as with my partner.

True _____ False _____

  1. I have never masturbated.

True _____ False _____

  1. I am being treated with medication for anxiety or depression.

True _____ False _____

  1. I am post-menopausal.

True _____ False _____

  1. I take birth control pills or injections.

True _____ False _____

  1. I take medications for a neurological disorder.

True _____ False _____

  1. I was molested or raped.

True _____ False _____

Men’s Sexual Concerns – Please Check all that apply:

I am concerned about:

_____my partner’s low libido

_____my partner’s lack of arousal or orgasm

_____my partner’s painful intercourse

_____my partner’s vaginismus

_____my problems keeping an erection

_____how long it takes me to reach orgasm

_____early ejaculation

_____my use of porn, cybersex, phone sex

_____my visits to adult bookstores, strip clubs

_____my use of escorts

_____my low sexual desire

_____ my fantasies or sexual desires

Some other instruments to evaluate Sexual Dysfunctions are as follows:

SFQ28_US_ENSFQ28_Scoring  For Female Sexual Dysfunctions

FSFI questionnaire2000FSFI Scoring Appendix For Female Sexual Dysfunctions

SQOLF_US_ , ENSQOL_Scoring For Sexual  Quality of Life

IPE_US_ENIPE_Scoring For Premature Ejaculations

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