Male Sexual Dysfunction

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Self-Assessment Questionnaire

This self-assessment questionnaire aims to assist individuals in evaluating their symptoms
related to male sexual dysfunction. It is not a substitute for professional medical advice.
Always consult with a healthcare provider for accurate diagnosis and personalized treatment
recommendations.

Self-Assessment Questionnaire for Male Sexual Dysfunction

Self-Assessment Questionnaire for Male Sexual Dysfunction

1. Do you have difficulty achieving an erection?
2. Can you maintain an erection during sexual activity?
4. Do you ejaculate sooner than desired during sexual activity?
6. Do you experience dissatisfaction with the intensity or frequency of orgasms?
7. Do you have a history of cardiovascular disease (e.g., heart disease, hypertension)?
8. Do you smoke cigarettes or use tobacco products?
9. Are you currently being treated for diabetes or high cholesterol?
10. Are there any significant changes in your sexual desire or libido recently?
11. Do you experience high levels of stress or anxiety related to sexual performance?

Scoring Instructions:

Add up the points based on your responses:

  • Each “Always” response counts as 3 points.
  •  Each “Frequently” response counts as 2 points.
  •  Each “Occasionally” response counts as 1 point.
  •  Each “Never” response counts as 0 points.

What is your score?

  • 0-5 Points: Mild symptoms; consider monitoring or discussing with a healthcare provider.
  •  6-10 Points: Moderate symptoms; consultation with a healthcare provider recommended.
  •  11 or more Points: Severe symptoms; prompt medical evaluation advised.
  • If you have scored 6 or more points or have concerns about your sexual health, it is recommended to seek medical advice. You can schedule a free counselling with Ankur Urja team member, who can provide insights into the next steps.

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