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Adapted from Pfizer self esteem and relationship questionairre
Over the past month:
I felt relaxed about initiating sex with my partner
Almost always or always
Most of the time (more than half)
Sometimes (about half)
A few times (much less than half)
Almost never or never
I felt confident that during sex my erection would last long enough
Almost always or always
Most of the time (more than half)
Sometimes (about half)
A few times (much less than half)
Almost never or never
I was satisfied with my sexual performance.
Almost always or always
Most of the time (more than half)
Sometimes (about half)
A few times (much less than half)
Almost never or never
I felt that sex could be spontaneous
Almost always or always
Most of the time (more than half)
Sometimes (about half)
A few times (much less than half)
Almost never or never
I was likely to initiate sex
Almost always or always
Most of the time (more than half)
Sometimes (about half)
A few times (much less than half)
Almost never or never
I felt confident about performing sexually.
Almost always or always
Most of the time (more than half)
Sometimes (about half)
A few times (much less than half)
Almost never or never
I was satisfied with our sex life
Almost never or never
A few times (much less than half)
Sometimes (about half)
Most of the time (more than half)
Almost always or always
My partner was happy with the quality of our sexual relations.
Almost never or never
A few times (much less than half)
Sometimes (about half)
Most of the time (more than half)
Almost always or always
I had good self-esteem.
Almost never or never
A few times (much less than half)
Sometimes (about half)
Most of the time (more than half)
Almost always or always
I felt like a whole man.
Almost never or never
A few times (much less than half)
Sometimes (about half)
Most of the time (more than half)
Almost always or always
I was not inclined to feel that I am a failure.
Almost never or never
A few times (much less than half)
Sometimes (about half)
Most of the time (more than half)
Almost always or always
I felt confident.
Almost never or never
A few times (much less than half)
Sometimes (about half)
Most of the time (more than half)
Almost always or always
My partner was satisfied with our relationship in general.
Almost never or never
A few times (much less than half)
Sometimes (about half)
Most of the time (more than half)
Almost always or always
I was satisfied with our relationship in general.
Almost never or never
A few times (much less than half)
Sometimes (about half)
Most of the time (more than half)
Almost always or always