Epic-Connect

Patient Questionnaire

SHIM Questionnaire

1. How often were you able to insert your penis into your partner's vagina (or rectum)? (0 = Never, 4 = Almost Always)

2. During sexual activity, how often were your erections hard enough for penetration? (0 = Never, 4 = Almost Always)

3. When you attempted sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner? (0 = Never, 4 = Almost Always)

4. During sexual intercourse, how difficult was it for you to maintain your erection to the completion of intercourse? (0 = Extremely Difficult, 5 = Not Difficult)

5. When you attempted sexual intercourse, how would you rate your confidence that you could get and maintain an erection? (1 = Very Low, 5 = Very High)

IPSS Questionnaire

1. Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating? (0 = Not at all, 5 = Almost Always)

2. Over the past month, how often have you had to urinate again less than two hours after you finished urinating? (0 = Not at all, 5 = Almost Always)

3. Over the past month, how often have you found you stopped and started again several times when you urinated? (0 = Not at all, 5 = Almost Always)

4. Over the past month, how often have you found it difficult to postpone urination? (0 = Not at all, 5 = Almost Always)

5. Over the past month, how often have you had a weak urinary stream? (0 = Not at all, 5 = Almost Always)

6. Over the past month, how often have you had to strain to start urination? (0 = Not at all, 5 = Almost Always)

7. Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning? (0 = None, 5 = 5 or more times)