Peyronie's Disease Questionnaire (PDQ)

A 15-item questionnaire assessing the psychosexual impact of Peyronie's Disease. Comprises three subscales: psychological and physical symptoms, penile pain, and symptom bother.

Instructions:

Please answer all questions honestly based on your experience with Peyronie's Disease. This questionnaire is intended for men who have had vaginal intercourse within the last 3 months.

Problems During Vaginal Intercourse

Q1. Concern about damaging penis while having vaginal intercourse

None

Mild

Moderate

Severe

Very Severe

Q2. Bending or collapsing of penis while having vaginal intercourse

None

Mild

Moderate

Severe

Very Severe

Q3. Trouble inserting erect penis into partner's vagina

None

Mild

Moderate

Severe

Very Severe

Q4. Difficulty with some positions that you used to enjoy when having vaginal intercourse

None

Mild

Moderate

Severe

Very Severe

Q5. Awkwardness with some positions that you used to enjoy when having vaginal intercourse

None

Mild

Moderate

Severe

Very Severe

Q6. Discomfort with some positions that you used to enjoy when having vaginal intercourse

None

Mild

Moderate

Severe

Very Severe

Pain and Discomfort

Q7. In the LAST 24 HOURS, how much pain or discomfort have you felt in your penis when it was NOT erect?

No Pain

Severe Pain

Q8. Thinking about the LAST TIME you were erect, how much pain or discomfort did you feel in your penis when it was erect?

No Pain

Severe Pain

Q9. Thinking about the LAST TIME you had vaginal intercourse, how much pain or discomfort did you feel in your penis when having vaginal intercourse?

No Pain

Severe Pain

Symptom Bother

Q10. Thinking about the LAST TIME you had an erection, how bothered were you by any pain or discomfort you may have felt in your erect penis?

Not at all bothered

A little bit bothered

Moderately bothered

Very bothered

Extremely bothered

Q11. Thinking about the LAST TIME you looked at your erect penis, how bothered were you by the way your penis looked?

Not at all bothered

A little bit bothered

Moderately bothered

Very bothered

Extremely bothered

Q12. Does your Peyronie's Disease make having vaginal intercourse difficult or impossible? (If No - Please go to Q14. If Yes - Please go to Q13.)

Yes

Q13. Thinking of the LAST TIME you had or tried to have vaginal intercourse, how bothered were you by your Peyronie's Disease?

Not at all bothered

A little bit bothered

Moderately bothered

Very bothered

Extremely bothered

Q14. Are you having vaginal intercourse LESS OFTEN than you used to due to your Peyronie's Disease? (If No, thank you, you have completed the questionnaire. If Yes, please go to Q15.)

Yes

Q15. How bothered are YOU with having vaginal intercourse less often?

Not at all bothered

A little bit bothered

Moderately bothered

Very bothered

Extremely bothered

Patient Watch Form - 4/2/2026