Home Patient Information         Important Safety Info        Health Care Professionals   
Sign Up for Your Free Men’s Facts Kit
LEVITRA (Vardenafil HCl)
Sexual Health Inventory for Men (SHIM)
This questionnaire is an assessment tool designed to help you and your doctor determine if you are having erection problems that may be classified as erectile dysfunction (ED).

Each question has several possible responses. Choose the response that best describes your own situation.

If your score indicates that you have signs of erectile dysfunction, share it with your doctor. He may recommend ways to improve erectile function.

Over the past six months:

1. 

How do you rate your confidence that you could get and keep an erection?
Very low
Low
Moderate
High
Very high
2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration (entering your partner)?
No sexual activity
Almost never or never
A 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
3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?
Did not attempt intercourse
Almost never or never
A 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
4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?
Did not attempt intercourse
Extremely difficult
Very difficult
Difficult
Slightly difficult
Not difficult
5. When you attempted sexual intercourse, how often was it satisfactory for you?
Did not attempt intercourse
Almost never or never
A 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

 

This tool is the Sexual Health Inventory for Men (SHIM). Nothing in this questionnaire should be construed as the giving of medical advice or the making of a recommendation, and the questionnaire should not be relied on as the basis for any decision or action. It is important that you rely only on a health care professional to advise you on health matters.