Shim Form

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

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 total Score

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