Do you find it difficult to maintain an erection? *

Yes

No

First Name *

Last Name *

Email *

Phone *

Has this issue been affecting your confidence or relationships? *

Yes

No

Are you looking for a non-invasive solution? *

Yes

No

How confident are you in achieving and maintaining an erection? *

Very Low

Low

Moderate

High

Very High

How often are your erections firm enough for penetration? *

Never

Not Often

Sometimes

Most Times

Always

How often do you maintain an erection after penetration? *

Never

Not Often

Sometimes

Most Times

Always

How difficult is it to maintain your erection until intercourse is complete? *

Not Possible

Very Difficult

Difficult

Slightly Difficult

Not Difficult/Easy

How often is sexual intercourse satisfactory for you? *

Never

Not Often

Sometimes

Most Times

Always