International Index and Assessment of Erectile Function (IIEF-5).

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What is your Name? *

Where do you live? *

Hong Kong

Mauca

China

British

Other:

How old are you? *

15-20

21-30

31-40

41-50

51-60

60 above

Do you suffer from any chronic illness? *

Hypertension

Diabetes

Depression

thyroid problems

No Chronic illness

Other:

What is your level of confidence in the ability to achieve and maintain an erection?
*

No Confidence(1)

Low Confidence(2)

Moderate Confidence(3)

High Confidence(4)

Full of Confidence(5)

Can you maintain an erection after your penis is inserted into your partner's body during sexual intercourse?
*

Almost Never(1)

Few time(2)

Sometime(3)

Usually(4)

Always(5)

How difficult is it for you to maintain an erection until sexual intercourse is completed?
*

Very difficult(1)

Quite difficult(2)

Difficult(3)

A bit Difficult(4)

No Difficult(5)

Are you satisfied with your overall sexual life?
*

Extremely dissatisfied (1 point)

Only satisfied a few times (2 points)

Moderately satisfied (3 points)

Mostly satisfied (4 points)

Almost always satisfied (5 points)

Please calculate the total score of the five questions above and fill in the assessment result below:
*

5-7 points indicate severe erectile dysfunction

8-11 points indicate moderate erectile dysfunction

12-21 points indicate mild erectile dysfunction.

22-25 points indicate no erectile dysfunction

psychological factors affect your sexual function? (Select multiple options if applicable)

(Selecting any one option indicates the presence of psychological factors affecting sexual function)"

Recalling past failures and feeling anxious before engaging in sexual activity.

Desiring to have sex but unable to achieve an erection

Feeling a significant amount of pressure when engaging in sexual activity

Experiencing tense muscles and sweaty palms during sexual activity

Being hard during foreplay but going soft upon attempted penetration

Losing sensation and going soft after penetration

Going soft when wearing a condom

Going soft when changing sexual positions

Premature ejaculation (inability to control ejaculation)

Feeling somewhat annoyed or bored during foreplay

None of the above

Required

"Which method would you prefer for the sex therapist to contact you, to report evaluation results and treatment suggestions? Or you can also email Ivan, the sex therapist, directly at edivan623623@gmail.com."
*

Wechat

Line

Other:

Please leave your contact method as mentioned above, WhatsApp/WeChat/Email are all acceptable. The sex therapist will report to you the evaluation results and give preliminary treatment suggestions.
*

Where did you come across this service?
*

GOOGLE

YOUTUBE

FACEBOOK

REEL

Other:

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