{"id":99,"date":"2023-07-05T07:00:33","date_gmt":"2023-07-05T07:00:33","guid":{"rendered":"https:\/\/appointment.srujanahospital.com\/?page_id=99"},"modified":"2023-07-12T14:03:08","modified_gmt":"2023-07-12T14:03:08","slug":"the-iief-5-questionnaire-shim","status":"publish","type":"page","link":"https:\/\/appointment.srujanahospital.com\/index.php\/the-iief-5-questionnaire-shim\/","title":{"rendered":"The IIEF-5 Questionnaire (SHIM)"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"99\" class=\"elementor elementor-99\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c1a3b88 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c1a3b88\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d43672e\" data-id=\"d43672e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-09e9fa2 elementor-widget elementor-widget-heading\" data-id=\"09e9fa2\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.23.0 - 05-08-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">The IIEF-5 Questionnaire (SHIM)<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8ff3123 elementor-widget elementor-widget-wpforms\" data-id=\"8ff3123\" data-element_type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style id=\"wpforms-css-vars-root\">\n\t\t\t\t:root {\n\t\t\t\t\t--wpforms-field-border-radius: 3px;\n--wpforms-field-background-color: #ffffff;\n--wpforms-field-border-color: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-text-color: rgba( 0, 0, 0, 0.7 );\n--wpforms-label-color: rgba( 0, 0, 0, 0.85 );\n--wpforms-label-sublabel-color: rgba( 0, 0, 0, 0.55 );\n--wpforms-label-error-color: #d63637;\n--wpforms-button-border-radius: 3px;\n--wpforms-button-background-color: #066aab;\n--wpforms-button-text-color: #ffffff;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-87\"><form id=\"wpforms-form-87\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"87\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/99\" data-token=\"f85a39b5036352592d6703794efebded\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-87-field_1-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"1\"><div id=\"wpforms-87-field_1\" aria-errormessage=\"wpforms-87-field_1-error\">Over the past 6 months:\r\n1-7: Severe ED 8-11: Moderate ED 12-16: Mild-moderate ED 17-21: Mild ED 22-25: No ED<\/div><\/div><div id=\"wpforms-87-field_7-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-87-field_7\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][7][first]\" aria-errormessage=\"wpforms-87-field_7-error\" required><label for=\"wpforms-87-field_7\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-87-field_7-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][7][last]\" aria-errormessage=\"wpforms-87-field_7-last-error\" required><label for=\"wpforms-87-field_7-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-87-field_8-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-87-field_8\">Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-87-field_8\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-87-field_8-error\" required><\/div><div id=\"wpforms-87-field_9-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">Date \/ Time <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-87-field_9\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][9][date]\" aria-errormessage=\"wpforms-87-field_9-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-87-field_9\" class=\"wpforms-field-sublabel after \">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-87-field_9-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][9][time]\" aria-errormessage=\"wpforms-87-field_9-time-error\" required><label for=\"wpforms-87-field_9-time\" class=\"wpforms-field-sublabel after \">Time<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-87-field_2-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"2\"><fieldset><legend class=\"wpforms-field-label\">How do you rate your confidence that you could get and keep an erection <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-87-field_2\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_2_1\" name=\"wpforms[fields][2]\" value=\"Very Low\" aria-errormessage=\"wpforms-87-field_2_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_2_1\">Very Low<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_2_2\" name=\"wpforms[fields][2]\" value=\"Low\" aria-errormessage=\"wpforms-87-field_2_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_2_2\">Low<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_2_3\" name=\"wpforms[fields][2]\" value=\"Moderate\" aria-errormessage=\"wpforms-87-field_2_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_2_3\">Moderate<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_2_4\" name=\"wpforms[fields][2]\" value=\"High\" aria-errormessage=\"wpforms-87-field_2_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_2_4\">High<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_2_5\" name=\"wpforms[fields][2]\" value=\"Very high\" aria-errormessage=\"wpforms-87-field_2_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_2_5\">Very high<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-87-field_3-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"3\"><fieldset><legend class=\"wpforms-field-label\">When you had erections with sexual stimulation, how often were your erections hard enough  for penetration? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-87-field_3\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_3_1\" name=\"wpforms[fields][3]\" value=\"Almost never or never\" aria-errormessage=\"wpforms-87-field_3_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_3_1\">Almost never or never<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_3_2\" name=\"wpforms[fields][3]\" value=\"A few times\" aria-errormessage=\"wpforms-87-field_3_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_3_2\">A few times<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_3_3\" name=\"wpforms[fields][3]\" value=\"Sometimes\" aria-errormessage=\"wpforms-87-field_3_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_3_3\">Sometimes<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_3_4\" name=\"wpforms[fields][3]\" value=\"Most times\" aria-errormessage=\"wpforms-87-field_3_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_3_4\">Most times<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_3_5\" name=\"wpforms[fields][3]\" value=\"Almost always or always\" aria-errormessage=\"wpforms-87-field_3_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_3_5\">Almost always or always<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-87-field_4-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"4\"><fieldset><legend class=\"wpforms-field-label\">During sexual intercourse, how often were you able  erection after you had to maintain your  penetrated your partner? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-87-field_4\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_4_1\" name=\"wpforms[fields][4]\" value=\"Almost never or never\" aria-errormessage=\"wpforms-87-field_4_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_4_1\">Almost never or never<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_4_2\" name=\"wpforms[fields][4]\" value=\"A few times\" aria-errormessage=\"wpforms-87-field_4_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_4_2\">A few times<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_4_3\" name=\"wpforms[fields][4]\" value=\"Sometimes\" aria-errormessage=\"wpforms-87-field_4_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_4_3\">Sometimes<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_4_4\" name=\"wpforms[fields][4]\" value=\"Most times\" aria-errormessage=\"wpforms-87-field_4_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_4_4\">Most times<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_4_5\" name=\"wpforms[fields][4]\" value=\"Almost always or always\" aria-errormessage=\"wpforms-87-field_4_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_4_5\">Almost always or always<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-87-field_5-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"5\"><fieldset><legend class=\"wpforms-field-label\">During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-87-field_5\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_5_1\" name=\"wpforms[fields][5]\" value=\"Extremely difficult\" aria-errormessage=\"wpforms-87-field_5_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_5_1\">Extremely difficult<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_5_2\" name=\"wpforms[fields][5]\" value=\"Very difficult\" aria-errormessage=\"wpforms-87-field_5_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_5_2\">Very difficult<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_5_3\" name=\"wpforms[fields][5]\" value=\"Difficult\" aria-errormessage=\"wpforms-87-field_5_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_5_3\">Difficult<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_5_4\" name=\"wpforms[fields][5]\" value=\"Slightly difficult\" aria-errormessage=\"wpforms-87-field_5_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_5_4\">Slightly difficult<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_5_5\" name=\"wpforms[fields][5]\" value=\"Not difficult\" aria-errormessage=\"wpforms-87-field_5_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_5_5\">Not difficult<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-87-field_6-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">When you attempted sexual intercourse, how often was it satisfactory for you? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-87-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_6_1\" name=\"wpforms[fields][6]\" value=\"Almost never or never\" aria-errormessage=\"wpforms-87-field_6_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_6_1\">Almost never or never<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_6_2\" name=\"wpforms[fields][6]\" value=\"A few times\" aria-errormessage=\"wpforms-87-field_6_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_6_2\">A few times<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_6_3\" name=\"wpforms[fields][6]\" value=\"Sometimes\" aria-errormessage=\"wpforms-87-field_6_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_6_3\">Sometimes<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_6_4\" name=\"wpforms[fields][6]\" value=\"Most times\" aria-errormessage=\"wpforms-87-field_6_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_6_4\">Most times<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-87-field_6_5\" name=\"wpforms[fields][6]\" value=\"Almost always or always\" aria-errormessage=\"wpforms-87-field_6_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-87-field_6_5\">Almost always or always<\/label><\/li><\/ul><\/fieldset><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"87\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-87\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/appointment.srujanahospital.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>The IIEF-5 Questionnaire (SHIM)<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":[],"_links":{"self":[{"href":"https:\/\/appointment.srujanahospital.com\/index.php\/wp-json\/wp\/v2\/pages\/99"}],"collection":[{"href":"https:\/\/appointment.srujanahospital.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/appointment.srujanahospital.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/appointment.srujanahospital.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/appointment.srujanahospital.com\/index.php\/wp-json\/wp\/v2\/comments?post=99"}],"version-history":[{"count":7,"href":"https:\/\/appointment.srujanahospital.com\/index.php\/wp-json\/wp\/v2\/pages\/99\/revisions"}],"predecessor-version":[{"id":167,"href":"https:\/\/appointment.srujanahospital.com\/index.php\/wp-json\/wp\/v2\/pages\/99\/revisions\/167"}],"wp:attachment":[{"href":"https:\/\/appointment.srujanahospital.com\/index.php\/wp-json\/wp\/v2\/media?parent=99"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}