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—Please choose an option—Abu DhabiAl AinDubaiSharjahAjman
Every timeHalf the timeOn occasionRarely
Yes, and it was normalYes, but there were issuesNo, I haven’t had a physical exam in the past 3 years
NoYes, the medication worked for meYes, but the medication didn't work for meI have tried multiple types of medication
Tell us more about the drug, including its name, dose, and any adverse effects
Tell us more about the drug, including whether or not it worked for you, its name, dose, and any adverse effects
0 - 3 months3 - 12 monthsLonger than 12 monthsI don't have symptoms
TobaccoAlcoholNone of these
How many drinks per day?
Kidney problems including having had a kidney transplantLiver problemsNeurological problems like Parkinson's, multiple sclerosis or motor neuron diseaseHIVSpinal cord injury or paralysisA history of prostate or pelvic surgeriesLow testosteroneTight foreskinScarring of the genital organ. Feels like lumps or hard tissue under the skinPain during intercourse or during erectionsPeyronie's diseaseA history of radiation therapyAny condition where intercourse is not advisedNone of these apply to me
Low blood pressureAnginaHeart diseaseHeart attackHeart surgeryHeart failureStrokeQT prolongationIrregular heartbeatHeart valve problemsHypertrophic obstructive cardiomyopathy (HCM)Peripheral vascular disease or claudicationNone of these apply to me
Inflammatory bowel disease - ulcerative colitis or Crohn's diseaseBleeding stomach or peptic ulcerPriapism (persistent, usually painful, erection that lasts for more than 4 hours)Retinitis pigmentosa (eye disease causing vision loss)Anterior ischemic optic neuropathy (loss of blood flow to the optic nerve causing sudden painless vision loss in one eye)Sickle cell diseaseBlood clotting disorder, abnormal bleeding or bruising, or coagulopathyMyeloma or leukemiaNone of these apply to me
Chest pain or shortness of breath while climbing two flights of stairsChest pain or shortness of breath while walking four blocksChest pain or shortness of breath during sexUnexplained fainting or dizzinessCramping of the legs during exerciseAn abnormal heartbeatDiabetesHigh blood pressureHypothyroidism (low thyroid)Heartburn (GERD)ADHD (Attention Deficit/Hyperactivity Disorder)PTSD (Post-Traumatic Stress Disorder)Enlarged prostate (BPH)Cold soresGenital herpesFamily history of heart attack or heart diseaseHigh cholesterolNone of these apply to me
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