Q1. Your sexual libido or interest?

1. Very low
2. Low
3. General
4. High
5. Very high

Q2. Is your erection rigid enough for sexual intercourse?

1. Almost never
2. Seldom
3. Half of time
4. Often
5. Always

Q3. Can you maintain erection until the completion of sexual intercourse?

1. Almost never
2. Seldom
3. Half of time
4. Often
5. Always

Q4. How long from intromission to ejaculation?

1. Too short (<30 sec)
2. Very short (2 min)
3. Short (3 min)
4. Often short (4 min)
5. Not short (8 min)

Q5. Can you prolong the tine of sexual intercourse?

1. Very difficult
2. Always difficult
3. Difficult
4. Seldom difficult
5. Not difficult

Q6. Your sexual satisfaction?

1. Very dissatisfied
2. Always dissatisfied
3. Generally satisfied
4. Often satisfied
5. Always satisfied?

Q7. Your partner's sexual satisfaction?

1. Very dissatisfied
2. Always dissatisfied
3. Generally satisfied
4. Often satisfied
5. Always satisfied?

Q8. Does your partner reach orgasm in sexual intercourse?

1. Almost never
2. Seldom
3. Half of time
4. Often
5. Always

Q9. How about your confidence in completing sexual activity?

1. Very low
2. Low
3. General
4. High
5. Very high

Q10. Do you feel anxiety, depression or stress in sexual activity?

1. Always
2. Often
3. Half Of Time
4. Seldom
5. Almost Never

Score analysis:

If you score is below 35, you have a high possibility in having premature ejaculation. Please feel free to contact our medical professional for further analysis.

* This questionnare is for reference only. It is not a medical diagnosing tool.