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Instructions. Each question has 5 possible responses. Circle the number that best describes your own situation. Select only 1 answer for each question. Over the past 6 months: 1. How do you rate your confidence that you could keep an erection? 1 Very low. 2 Low. 3 Moderate. 4 High. 5 Very high. 2.
This questionnaire can help you and your doctor determine if you have symptoms of ED (erectile dysfunction). For each question, note your answer by circling the number that approximates your belief. . Add your numbers together and refer to the table below to see what your score may mean.
SEXUAL HEALTH INVENTORY FOR MEN (SHIM) (IIEF-5 Questionnaire) NAME_____ DATE:_____ Questions: Based on last 6 months (each answer assigned 1-5 score) 1. How do you rate your confidence that you could get and keep an erection? 1. Score 1: Very Low 2. Score 2: Low 3. Score 3: Moderate 4.
29 Μαΐ 2017 · In order to record the information revealed during the examination, your doctor will use an examination form. Download free physical examination templates!
PATIENT SEXUAL HEALTH INVENTORY FOR MEN (SHIM)1. This questionnaire is designed to help you and your doctor identify if you may be experiencing erectile dysfunction. If you are, you may choose to discuss treatment options with your doctor. Each question has several possible responses.
Sexual Health Questionnaire. More than 30 million American men have erectile dysfunction (ED). ED can be an early sign of heart disease or diabetes. Complete this questionnaire to assess your sexual health. If needed, treatments are available.
A 66-year old man presents with decreased libido and osteopenia. His exam is remarkable for a BMI of 31 and is otherwise normal. Serum total testosterone at 8 AM is 250 and 265 ng/dL (normal: 270-890 ng/dL) on 2 different days. Serum calculated free testosterone is 90 pg/mL (normal: 50-200 pg/mL). Serum FSH
