Investigational Device
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Investigational Device
About the Clinical Study
Find a Participating Study Site
Do I Qualify?
Request Information
About us
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Do I Qualify?

Find a Participating Study Site

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Erectile Function Self-Check (Informational Only)

This brief self-check is for information only and is not a medical diagnosis, screening, or eligibility tool. The questions are based on the International Index of Erectile Function (IIEF-5), a validated research tool. This self-check is intended to see whether you may be a potential candidate. Only the study site can determine eligibility during screening. Please speak with your urologist for clinical advice and to determine eligibility for this clinical study.

Important:

This self-check is not a substitute for professional medical advice. Final eligibility for the clinical study is determined by the study team through a comprehensive medical evaluation. Completing this self-check does not guarantee study eligibility or enrollment.

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

Please answer the following questions based on your experience over the past 4 weeks.

No sexual activity

Very Low

Low

Moderate

High

Very High

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

No sexual activity

Almost never/never

A few times (much less than half the time)

Sometimes (about half the time)

Most times (greater than half the time)

Almost always/always

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

Did not attempt intercourse

Almost never/never

A few times (much less than half the time)

Sometimes (about half the time)

Most times (greater than half the time)

Almost always/always

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

Extremely difficult/Did not attempt intercourse

Difficult

Slightly difficult

Easy

Very easy

Extremely easy

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

Did not attempt intercourse

Almost never/never

A few times (much less than half the time)

Sometimes (about half the time)

Most times (greater than half the time)

Almost always/always

Have you had Erectile Dysfunction for a duration of 6 months or longer?*

Please answer the following questions to check for preliminary eligibility for the Inflatable Penile Prosthesis clinical trial.

Yes

Have you failed to achieve satisfactory erections with any of the following other treatments?*

Oral medication (e.g., Viagra®, Cialis®)

Intracavernosal injection (e.g., TriMix®)

Vacuum Constriction Device (VCD)

None of the above

Do you have any of the conditions below?

Previous penile prosthesis or prior enlargement surgeries
Use of immunosuppressive drugs
Have a history of kidney transplantation
Currently receiving chemotherapy
Compromised immune system, any of the autoimmune diseases

Do you have any of the conditions below?*

Yes

Are you willing and able to undergo a surgical procedure and follow post-operative instructions?*

Yes

Are you currently participating in any other clinical trial for Erectile Dysfunction?*

Yes

Name*

First name Last name

Email*

Phone*

State*

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Country*

When should we contact you?*

Consent*

I accept the Privacy Policy | Terms & Conditions*

Consent*

I accept the Terms of Consultation Confidentiality.*

Consent*

I accept the Contact Consent Terms.*

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Total*

SID

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Date of Lead*

MM slash DD slash YYYY

Contact Consent Terms

I hereby provide my express consent to be contacted by Rigicon and/or authorized representatives of participating clinical study sites regarding the UNITED Clinical Study. I agree that the contact information I provide (including phone and email) may be used for pre-screening evaluation purposes and to provide information about the next steps in the study.

I understand and agree that:

Providing my information and being contacted does not guarantee my eligibility or enrollment in the study.
My personal data will be processed and may be transferred to the selected study site for the purpose of scheduling a consultation or further evaluation.
My information will be handled in strict compliance with the Privacy Policy and applicable data protection laws.
I have the right to withdraw my consent at any time without penalty by contacting Rigicon directly or by using the opt-out instructions provided in future communications.

Consultation Confidentiality Terms

Rigicon is committed to protecting the privacy and confidentiality of your personal and health-related information. By submitting this form, you acknowledge that the information provided is solely for the purpose of evaluating your potential eligibility for the UNITED Clinical Study.

Please note that:

This preliminary communication does not establish a formal doctor-patient relationship.
The information provided on this website is for general educational purposes only and should not be interpreted as professional medical advice, diagnosis, or treatment.
All medical decisions should be made in consultation with your qualified healthcare provider.
Your data will be stored securely and accessed only by authorized personnel involved in the clinical study screening process.

Investigational Device. Limited by Federal (or United States) law to investigational use.

Investigational Device
About the Clinical Study
Find a Participating Study Site
Do I Qualify?
Request Information
About us
Español

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Erectile Function Self-Check (Informational Only)

Important:

Do you have any of the conditions below?

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Marketing

Erectile Function Self-Check (Informational Only)

Important:

Do you have any of the conditions below?

Contact Consent Terms

Consultation Confidentiality Terms

Privacy Settings

Functional

Preferences

Marketing