Sexual Health Inventory Men (SHIM)

Sexual Health Inventory Men (SHIM)
Name

First NameMiddle NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
DOB

MonthDayYear
Date
Date

MonthDayYear
Date
Please indicate the response that best describes your experience over the past 6 months for the following five questions:
1. How do you rate your confidence that you could get and keep an erection?

Very LowLowModerateHighVery High
2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration?

Almost Never or NeverA Few Times (much less than half the time)Sometimes (about half the time)Most Time (much more thanhalf the time)Almost Always or Always
3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner?

Almost Never or NeverA Few Times (much less than half the time)Sometimes (about half the time)Most Time (much more thanhalf the time)Almost Always or Always
4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

Extremely DifficultVery DifficultDifficultSlightly DifficultNot Difficult
5. When you attempted sexual intercourse, how often was it satisfactory for you?

Almost Never or NeverA Few Times (much less than half the time)Sometimes (about half the time)Most Times (much more than half the time)Almost Always or Always
Total Score
Should be Empty: