Sexual Health Inventory for Men (SHIM / IIEF-5)
Patient Name: ____________________________ *Date:* ____________
Date of Birth: ____________ *Medical Record #:* ____________
Instructions: Each question has 5 or 6 possible responses. Circle the number of the response that best describes your experience over the past 6 months. If you have not had sexual activity in the past 6 months, please answer based on your best estimate. Please answer every question.
1. Erection Confidence
How do you rate your confidence that you could get and keep an erection?
| Very Low | Low | Moderate | High | Very High |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
2. Erection Firmness During Sexual Stimulation
When you had erections with sexual stimulation, how often were your erections hard enough for penetration (entering your partner)?
| No Sexual Activity | Almost Never or Never | A Few Times (Much Less Than Half the Time) | Sometimes (About Half the Time) | Most Times (Much More Than Half the Time) | Almost Always or Always |
|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 | 5 |
3. Maintenance of Erection During Intercourse
During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?
| Did Not Attempt Intercourse | Almost Never or Never | A Few Times (Much Less Than Half the Time) | Sometimes (About Half the Time) | Most Times (Much More Than Half the Time) | Almost Always or Always |
|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 | 5 |
4. Maintenance of Erection to Completion
During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?
| Did Not Attempt Intercourse | Extremely Difficult | Very Difficult | Difficult | Slightly Difficult | Not Difficult |
|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 | 5 |
5. Satisfaction with Intercourse
When you attempted sexual intercourse, how often was it satisfactory for you?
| Did Not Attempt Intercourse | Almost Never or Never | A Few Times (Much Less Than Half the Time) | Sometimes (About Half the Time) | Most Times (Much More Than Half the Time) | Almost Always or Always |
|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 | 5 |
TOTAL SHIM SCORE (Questions 1–5): _______ / 25
HOW TO INTERPRET YOUR SCORE
| Score Range | Classification | What It Means |
|---|---|---|
| 22–25 | No Erectile Dysfunction | Erections are normal or near-normal. No treatment needed. |
| 17–21 | Mild ED | Occasional difficulty. Lifestyle changes or medication may help. |
| 12–16 | Mild to Moderate ED | Noticeable difficulty with erections. Treatment options should be discussed. |
| 8–11 | Moderate ED | Frequent difficulty. Multiple treatment options are available. |
| 1–7 | Severe ED | Significant difficulty with erections. Comprehensive evaluation and treatment recommended. |
What is a meaningful change?
An improvement of 4 or more points is generally considered a clinically meaningful change.
IMPORTANT NOTES FOR PATIENTS
- Erectile dysfunction is very common, especially after prostate cancer treatment. You are not alone.
- ED can also be caused by diabetes, heart disease, high blood pressure, medications, stress, anxiety, and depression — not just prostate problems.
- Many effective treatments are available, including oral medications (PDE5 inhibitors such as sildenafil/Viagra, tadalafil/Cialis), vacuum erection devices, penile injections, and penile implants.
- If you are about to start prostate cancer treatment, completing this questionnaire before treatment provides a baseline that helps your doctor track changes and plan your care.
- Be honest with your answers — your doctor needs accurate information to help you.
TRACKING YOUR SCORES OVER TIME
| Date | SHIM Score (0–25) | Classification | Treatment/Notes |
|---|---|---|---|
| _____ | ______________ | ||
| _____ | ______________ | ||
| _____ | ______________ | ||
| _____ | ______________ | ||
| _____ | ______________ |
Notes for your doctor: _______________________________________________