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. 2007 Apr-Jun;49(2):109–112. doi: 10.4103/0019-5545.33257
In the past 12 months… Yes = 1 No = 0
Global Situational
  1. Has the prospect of having sex with your partner produced such aversion, fear or anxiety that you avoided any sexual activity (Aversion to sex)?

  2. Have you had a lack or loss of sexual desire, which has led you to initiating sexual activity with your partner or engaging in solitary masturbation, at a frequency clearly lower than previous levels (Low sexual desire)?

  3. Have you had a difficulty in getting an erection sufficient for intercourse (Difficulty achieving erection)?

  4. Have you had difficulty in maintaining erection (full erection occurs during the early stages of lovemaking but disappears when intercourse is attempted or before ejaculation if it occurs) (Difficulty maintaining erection)?

  5. Have you found that frequently (or always) you have ejaculated before you would like to: before entry?

    < 1 min?

    < 3 min?

    (Premature ejaculation)

  6. Have you frequently had problems in ejaculating even when erect (Inhibited / delayed ejaculation)?

  7. Have you ever ejaculated without getting full erection (Orgasm with flaccid penis)?

  8. Do you have difficulty in reaching the peak of pleasure at the time of ejaculation (Anorgasmia)?

  9. Have you felt pain in the genitals during sexual intercourse (Coital pain)?

  10. Are you satisfied with the frequency of sex (Frequency dissatisfaction)?

  11. Are you satisfied with your sexual relationship with your partner (Dissatisfaction of sexual relation with partner)?

  12. Are you satisfied with your sexual performance (Dissatisfaction with own sexual function)?