/a Chairman OW of Urology
/a Chairman OW of Urology
Icahn School of medians al Mount Sinai
Ph (212) 241-9955 Muutniane Jeffrey Epstein
Sinai
0 O5 003 Jan 20 1953
During sexual intercourse, how difficult was it to maintain your
erection to completion of intercourse? 0 Did not attempt intercourse
1 Extremely difficult
2 Very difficult
3 Difficult
4 Slightly difficult
0 Not difficult
0 No attempts
1 One or two attempts
2 Three or four attempts
0 Q6 How many times have you attempted sexual intercourse? 3 Fwe Of six attempts
<Seven to ten attempts
Eleven or more attempts
0 07
0
0
1
1
1
1
1
1 When you attempted sexual intercourse, how often was it
satisfactory for you? 0 Did not attempt intercourse
1 Almost never or never
2 A few times (less than half of the time)
3 Sometime (about half of the time)
if) most times (more than half of the time)
5 Almost always or always
Q8 How much have you enjoyed Sexual intercourse? 0 No intercourse
1 No enjoyment at all
2 Not very enjoyable
3 Fairly enjoyable
0 Hight*, enjoyable
5 Very highly enjoyable
0 No sexual stimulation or intercourse
1 Almost never or never
When you had sexual stimulation or intercourse, how often did 2 A few times (less than half of the time)
Q9 you ejaculate? 3
4 Sometime (about hall of the time)
Most times (more than half of the time)
5 Almost always or always
1 Almost never or never
2 A few times (less than half of the time)
When you had sexual stimulation or intercourse, how often did 3 Sometime (about half of the time)
010 you have the feeling of orgasm or climax? 4 Most times (more than half of the time)
S Almost always or always
1 Almost never or never
2 A few times (less than hall of the time)
011 How often have you felt sexual desire? 3
4 Sometime (about half of the time)
Most times (more than half of the time)
S Almost always M always
1 Very low or none at all
2 Low
012 How would you rate your level of sexual desire? 3
4 Moderate
High
5 Very high
1 Very dissatisfied
2 Moderately dissatisfied
3 Equally satisfied & dissatisfied
013 How satisfied have you been with your overall sex life? 4 Moderately satisfied
5 very satisfied
1 Very dissatisfied
2 Moderately dissatisfied
How satisfied have you been with your sexual relationship with 3 Equally satisfied & dissatisfied 014 4 Moderately satisfied
very satisfied your partner?
3 Very low or none at ail
2 Low
015 How do you rate your confidence that you could get and keep 3
4 Moderate
Nigh an erection?
5 Very high
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