SEXUAL 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 like Cenforce, Vidalista 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:
VERY LOW LOW MODERATE HIGH VERY HIGH 1. How do you rate your
confidence that you
could get and keep an
erection? 1 2 3 4 5
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
2. When you had
erections with sexual
stimulation, how often
were your erections hard
enough for penetration
(entering your partner)? 0 1 2 3 4 5
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
3. During sexual
intercourse, how often
were you able to
maintain your erection
after you had penetrated
(entered) your partner? 0 1 2 3 4 5
DID NOT
ATTEMPT
INTERCOURSE
EXTREMELY
DIFFICULT
VERY
DIFFICULT DIFFICULT
SLIGHTLY
DIFFICULT NOT DIFFICULT
4. During sexual
intercourse, how difficult
was it to maintain your
erection to completion of
intercourse? 0 1 2 3 4 5
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
5. When you attempted
sexual intercourse, how
often was it satisfactory
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:
1-7 Severe ED 8-11 Moderate ED 12-16 Mild to Moderate ED 17-21 Mild ED