For each problem below, indicate the number that best describes how severe the problem was the last time you had vaginal intercourse. If you did not experience this problem, choose 0.
1. Concern about damaging your penis during vaginal intercourse
2. Deflection or total loss of rigidity of your penis during sexual intercourse with vaginal penetration
3. Difficulty inserting your erect penis into your partner's vagina
4. Difficulties with certain positions that you used to enjoy during vaginal intercourse
5. Clumsiness when performing certain positions that you used to enjoy during vaginal intercourse.
6. Discomfort when performing certain positions that you used to enjoy during vaginal intercourse
Level of pain or discomfort. If you experienced no pain or discomfort, choose 0.
7. Over the past 24 hours, what level of pain or discomfort have you experienced in your penis when it was NOT erect?
8. Thinking back to the LAST TIME you had an erection, what level of pain or discomfort did you feel in your penis when it was erect?
9. Thinking back to the LAST TIME you had vaginal penetrative sex, what level of pain or discomfort did you experience in your penis during those encounters?
10. Thinking back to the LAST TIME you had an erection, how bothered were you by any pain or discomfort in your erect penis?
11. Thinking back to the LAST TIME you looked at your erect penis, how embarrassed were you by its appearance?
12. Does your Peyronie's disease make sexual intercourse with vaginal penetration difficult or impossible?
13. Thinking about the LAST TIME you had or attempted to have sexual intercourse with vaginal penetration, how much were you bothered by your Peyronie's disease?
14. Are you having sexual intercourse with vaginal penetration LESS OFTEN than before because of your Peyronie's disease?
15. To what extent are you bothered by having less frequent sexual intercourse with vaginal penetration?
Complete the questionnaire
