EFTA00314091.pdf
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Muutniane Jeffrey Epstein
Chairman OW of Urology
Icahn School of medians al Mount Sinai
Ph (212) 241-9955
003 Jan 20 1953 0 Did not attempt intercourse
Sinai 1 Extremely difficult
2 Very difficult
0 During sexual intercourse, how difficult was it to maintain your 3 Difficult
O5
erection to completion of intercourse? 4 Slightly difficult
0 Not difficult
0 No attempts
1 One or two attempts
2 Three or four attempts
0 Q6 How many times have you attempted sexual intercourse? 3 Fwe Of six attempts
< Seven to ten attempts
Eleven or more attempts
0 Did not attempt intercourse
1 Almost never or never
2 A few times (less than half of the time)
When you attempted sexual intercourse, how often was it
0 07 3 Sometime (about half of the time)
satisfactory for you? if) most times (more than half of the time)
5 Almost always or always
0 No intercourse
1 No enjoyment at all
2 Not very enjoyable
0 Q8 How much have you enjoyed Sexual intercourse? 3 Fairly enjoyable
0 Hight*, enjoyable
5 Very highly enjoyable
0 No sexual stimulation or intercourse
1 Almost never or never
2 A few times (less than half of the time)
0 When you had sexual stimulation or intercourse, how often did
Q9 3 Sometime (about hall of the time)
you ejaculate? 4 Most times (more than half of the time)
5 Almost always or always
1 Almost never or never
2 A few times (less than half of the time)
When you had sexual stimulation or intercourse, how often did 3 Sometime (about half of the time)
1 010 4 Most times (more than half of the time)
you have the feeling of orgasm or climax?
S Almost always or always
1 Almost never or never
2 A few times (less than hall of the time)
3 Sometime (about half of the time)
1 011 How often have you felt sexual desire? 4 Most times (more than half of the time)
S Almost always M always
1 Very low or none at all
2 Low
3 Moderate
1 012 How would you rate your level of sexual desire? 4 High
5 Very high
1 Very dissatisfied
2 Moderately dissatisfied
3 Equally satisfied & dissatisfied
1 013 How satisfied have you been with your overall sex life? 4 Moderately satisfied
5 very satisfied
1 Very dissatisfied
2 Moderately dissatisfied
How satisfied have you been with your sexual relationship with 3 Equally satisfied & dissatisfied
1 014 4 Moderately satisfied
your partner?
very satisfied
3 Very low or none at ail
2 Low
How do you rate your confidence that you could get and keep
1 015 3 Moderate
an erection? 4 Nigh
5 Very high
EFTA00314091
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EFTA00314091
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