Sexual Health Inventory for Men
Self Assessment Form

The IIEF-5 Questionnaire (SHIM)

Over the past 6 months:

Name Email


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 your partner?

During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

When you attempted sexual intercourse, how often was it satisfactory for you?

Your Score :
1-7 : Severe ED
8-11 : Moderate ED
12-16 : Mild-moderate ED
17-21 : Mild ED
22-25 : No ED

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