Take the Free 60-Second Pelvic Floor Assessment

Take the FREE 60-Second

Pelvic Floor Assessment

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This will help us determine what list of questionnaires you can take on the next page. Thanks for your cooperation.

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International Index of Erectile Function

These questions inquire about how your erection problems have affected your sex life over the past four weeks.

Please answer the questions as honestly and clearly as possible.

Your responses will assist your doctor in selecting the most appropriate treatment for your condition. When answering, the following definitions apply:

1. How often were you able to get an erection during sexual activity?

2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration?

3. When you attempted intercourse, how often were you able to penetrate (enter) your partner?

4. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

5. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

6. How many times have you attempted sexual intercourse?

7. When you attempted sexual intercourse, how often was it satisfactory for you?

8. How much have you enjoyed sexual intercourse?

9. When you had sexual stimulation or intercourse, how often did you ejaculate?

10. When you had sexual stimulation or intercourse, how often did you have the feeling of orgasm or climax?

11. How often have you felt sexual desire?

12. How would you rate your level of sexual desire?

13. How satisfied have you been with your overall sex life?

14. How satisfied have you been with your sexual relationship with your partner?

15. How do you rate your confidence that you could get and keep an erection?

Pelvic Floor Disability Index (PFDI-20)

Instructions:

Please answer all of the questions in this survey. These questions will ask if you have certain bowel, bladder, or pelvic symptoms, and if so, how much they bother you. To answer, please circle the appropriate number. When responding, consider your symptoms over the past 3 months.

Separated into three subscales:

1) Urinary Distress Inventory 6 (UDI-6)

2) Colorectal-Anal Distress Inventory 8 (CRADI-8)

3) Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6)

Pelvic Organ prolapse Distress Inventory 6 (POPDI-6)

Usually experience pressure in the lower abdomen?

Usually experience heaviness or dullness in the pelvic area?

Usually have a bulge or something falling out that you can see or feel in your vaginal area?

Ever have to push on the vagina or around the rectum to have or complete a bowel movement?

Usually experience a feeling of incomplete bladder emptying?

Ever have to push up on a bulge in the vaginal area with your fingers to start or complete urination?

Colorectal-Anal distress Inventory 8 (CRAD-8)

Feel you need to strain too hard to have a bowel movement?

Feel you have not completely emptied your bowels at the end of a bowel movement?

Usually lose stool beyond your control if your stool is well formed?

Usually lose stool beyond your control if your stool is loose?

Usually lose gas from the rectum beyond your control?

Usually have pain when you pass your stool?

Experience a strong sense of urgency and have to rush to the bathroom to have a bowel movement?

Does part of your bowel ever pass through the rectum and bulge outside during or after a bowel movement?

Urinary distress Inventory 6 (UDI-6)

Usually experience frequent urination?

Usually experience urine leakage associated with a feeling of urgency, that is, a strong sensation of needing to go to the bathroom?

Usually experience urine leakage related to coughing, sneezing or laughing?

Usually experience small amounts of urine leakage (that is, drops)?

Usually experience difficulty emptying your bladder?

Usually experience pain or discomfort in the lower abdomen or genital region?

✔ Secure Checkout

✔ Licensed PTs

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Dr. Alona Stein, PT, DPT, PRPC

Doctor of Physical Therapy · Pelvic Health Specialist · Licensed in Alaska

A Note from Dr. Stein

“When I first put this program together, I focused on creating a comprehensive guide that’s accessible to beginners yet substantial enough to deliver tangible benefits. The lessons are easy to follow and packed with valuable techniques. By the end, you’ll have a stronger pelvic floor and the knowledge to maintain it — improving bladder control, posture, and even intimacy.”

With gratitude, Dr. Alona Stein

Dr. Marty Sanchez, PT, DPT

Movement & Functional Health Expert · Founder, Desire Wellness

“Our goal is simple — to empower you with the skills to feel better, get stronger, and thrive in life through our anytime, anywhere programs — available worldwide.”

Take the FREE 60-Second

Pelvic Floor Assessment

Your score results will be delivered directly to your inbox.

This will help us determine what list of questionnaires you can take on the next page. Thanks for your cooperation.

International Index of Erectile Function

Pelvic Floor Disability Index (PFDI-20)

Instructions:

Pelvic Organ prolapse Distress Inventory 6 (POPDI-6)

✔ Secure Checkout

✔ Licensed PTs

✔ Lifetime Access

Dr. Alona Stein, PT, DPT, PRPC

Doctor of Physical Therapy · Pelvic Health Specialist · Licensed in Alaska

A Note from Dr. Stein

Dr. Marty Sanchez, PT, DPT

Movement & Functional Health Expert · Founder, Desire Wellness

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