Sexual Health Inventory For Men (Shim) : Patient Name: Today'S Date: Patient Instructions
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Marilena JuncuSexual Health Inventory For Men (Shim) : Patient Name: Today'S Date: Patient Instructions
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Marilena JuncuSEXUAL HEALTH INVENTORY FOR MEN (SHIM)
PATIENT NAME: TODAY’S DATE:
PATIENT INSTRUCTIONS
Sexual health is an important part of an individual's overall physical and emotional well-being. Erectile dysfunction,
also known as impotence, is one type of very common medical condition affecting sexual health. Fortunately, there
are many different treatment options for erectile dysfunction. This questionnaire is designed to help you and your
doctor identify if you may be experiencing erectile dysfunction. If you are, you may choose to discuss treatment
options with your doctor.
Each question has several possible responses. Circle the number of the response that best describes your own
situation. Please be sure that you select one and only one response for each question.
OVER THE PAST 6 MONTHS:
1. How do you rate your VERY LOW LOW MODERATE HIGH VERY HIGH
confidence that you
could get and keep an
erection? 1 2 3 4 5
2. When you had A FEW TIMES MOST TIMES
SOMETIMES ALMOST
erections with sexual NO SEXUAL ALMOST NEVER (MUCH LESS (MUCH MORE
(ABOUT HALF ALWAYS OR
stimulation, how often ACTIVITY OR NEVER THAN HALF THE THAN, HALF THE
THE TIME) ALWAYS
were your erections hard TIME) TIME)
enough for penetration
(entering your partner)? 0 1 2 3 4 5
3. During sexual A FEW TIMES MOST TIMES
DID NOT SOMETIMES ALMOST
intercourse, how often ALMOST NEVER (MUCH LESS (MUCH MORE
ATTEMPT (ABOUT HALF ALWAYS OR
were you able to OR NEVER THAN HALF THE THAN, HALF THE
INTERCOURSE THE TIME) ALWAYS
maintain your erection TIME) TIME)
after you had penetrated
(entered) your partner? 0 1 2 3 4 5
4. During sexual DID NOT
EXTREMELY VERY SLIGHTLY
intercourse, how difficult ATTEMPT DIFFICULT NOT DIFFICULT
DIFFICULT DIFFICULT DIFFICULT
was it to maintain your INTERCOURSE
erection to completion of
intercourse? 0 1 2 3 4 5
A FEW TIMES MOST TIMES
DID NOT SOMETIMES ALMOST
5. When you attempted ALMOST NEVER (MUCH LESS (MUCH MORE
ATTEMPT (ABOUT HALF ALWAYS OR
sexual intercourse, how OR NEVER THAN HALF THE THAN, HALF THE
INTERCOURSE THE TIME) ALWAYS
often was it satisfactory TIME) TIME)
for you?
0 1 2 3 4 5
Add the numbers corresponding to questions 1-5. TOTAL:
The Sexual Health Inventory for Men further classifies ED severity with the following breakpoints:
