Description:

Z6051 International Index of Erectile Function Questionnaire (IIEF) Laparoscopic-Assisted Resection or Open Resection in Treating Patients With Stage IIA, Stage IIIA, or Stage IIIB Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4AE9A885-FEFA-574B-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4AE9A885-FEFA-574B-E044-0003BA3F9857

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Versions (3) ▾
  1. 8/27/12
  2. 3/20/14
  3. 1/9/15
Uploaded on:

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT00726622 Quality of Life - Z6051 International Index of Erectile Function Questionnaire (IIEF) - 2740994v1.0

INSTRUCTIONS: These questions ask about your sexual feelings and responses during the past 4 weeks. Please answer the following questions as honestly and clearly as possible. Your responses will be kept completely confidential.

Header Module
Type of Visit
IIEF
Over the past 4 weeks, how often were you able to have an erection during sexual activity
Over the past 4 weeks, when you had erections with sexual stimulation, how often were your erections hard enough for penetration
Over the past 4 weeks, when you attempted sexual intercourse, how often were you able to penetrate (enter) your partner
Over the past 4 weeks, during sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner
Over the past 4 weeks, during sexual intercourse, how difficult was it to maintain your erection to complete intercourse
Over the past 4 weeks, how many times did you attempt sexual intercourse
Over the past 4 weeks, when you attempted sexual intercourse, how often was it satisfactory for you
Over the past 4 weeks, how much did you enjoy sexual intercourse
Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you ejaculate
Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you have the feeling of orgasm or climax
Over the past 4 weeks, how often did you feel sexual desire
Over the past 4 weeks, how would you rate your level of sexual desire
Over the past 4 weeks, how satisfied have you been with your overall sexual life
Over the past 4 weeks, how satisfied have you been with your sexual relationship with your partner
Over the past 4 weeks, how do you rate your confidence that you could have and keep an erection

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