SHIM Form

SHIM

IIEF-5 Questionnaire (SHIM)

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?

Total Score

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

WaveTech Birmingham
2100 Southbridge Parkway Suite 260
Birmingham, AL 35209

Phone (205) 777-3736

Fax (205) 224-4747