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Questionnaires

Questionnaires are tools that are not only useful for research purposes – but more importantly, they can help assess the severity of a condition objectively. This allows the comparison of a condition before and after a treatment and hence is useful in looking at treatment efficacy. The questionnaires can be done in private and the patient can give an honest answer, without the pressure of ‘trying to please’ the doctor.

IPSS: International Prostate Symptom Score

Useful for men with prostate related bladder symptoms. A score of 0 – 7 indicates mild symptoms, 8 – 19 indicates moderate symptoms and 20 – 35 indicates severe symptoms

Download IPSS: International Prostate Symptom Score – PDF (57Kb)

ICIF-SF: International Consultation on Incontinence Questionnaire

Useful for men and women with all types of incontinence to assess impact on quality of life

Download ICIF-SF: International Consultation on Incontinence Questionnaire - Short Form - PDF (171 KB)

ICIQ-OAB: International Consultation on Incontinence Questionnaire

Useful for men and women with overactive bladder to assess its severity and impact on quality of life.

Download ICIQ-OAB: International Consultation on Incontinence Questionnaire – Overactive Bladder PDF (275 KB)

International Index of Erectile Function (IIEF - 5)

A simple questionnaire involving 5 questions to identify and assess the severity of erectile dysfunction; the lower the score, the more severe the ED.

A score of < 7 = severe ED, 8 – 11 = moderate ED, 12 – 16 = mild to moderate ED, 17 – 21 = mild ED, > 21 = no ED

Download International Index of Erectile Function (IIEF - 5) – PDF (35 KB)

Androgen deficiency in aging men (ADAM) Questionnaire

Used to assess men with symptoms of low testosterone; A positive result is defined as a ‘Yes’ answer to questions 1 or 7 or any 3 other questions.

Download Androgen deficiency in aging men (ADAM) Questionnaire - PDF (25 KB)

Urinary Incontinence Questions Urinary Incontinence Questions

Useful for men and women who want to know roughly what type of incontinence they may have. Not a validated questionnaire.

Download Urinary Incontinence Questions Urinary Incontinence Questions - PDF (28 KB)

Overactive Bladder Questionnaire

Useful for men and women who want to know if they may have an overactive bladder. Not a validated questionnaire.

Download Overactive Bladder Questionnaire Overactive Bladder Questionnaire - PDF (30 KB)

Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire

This is a validated questionnaire that is a useful aid to the diagnosis of premature ejaculation. However, it should not replace a proper consultation with a healthcare professional. The reference values are included and should just act as a guide.

Download Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire - PDF (48 KB)