EVAL
Book a demo
Book a demo

International Index of Erectile Function (IIEF)

Assesses ED and related male sexual functions: erectile, orgasmic, desire, intercourse/overall satisfaction using IIEF.

Provided by SMSNA
Play

Triage

0%

Purpose

The International Index of Erectile Function (IIEF) is a widely used, validated, multidimensional, 15-item self-administered questionnaire designed to evaluate male sexual function, with a primary focus on erectile dysfunction (ED). It assesses various aspects of sexual function over the preceding four weeks. It is commonly used in clinical practice and research settings to measure the severity of ED and treatment outcomes.

 

Sources and Validation

The IIEF was developed and validated by Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A, and colleagues. The key publication is: Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997 Jun;49(6):822-30. It has demonstrated good psychometric properties (reliability, validity, sensitivity to change) across various populations and is considered a standard instrument in the field of sexual medicine.

 

Clinical Workflow and Parameters

The questionnaire is typically completed by the patient before or during a clinical consultation. It addresses five key domains of male sexual function:

  • Erectile Function (EF)
  • Orgasmic Function (OF)
  • Sexual Desire (SD)
  • Intercourse Satisfaction (IS)
  • Overall Satisfaction (OS)

 

An overall score, summing all 15 items, ranges from 1 to 75, providing a global measure of sexual function. Lower scores indicate poorer sexual function across domains.

 

DomainScore RangeRecommendations
Overall IIEF Score
  • The Overall IIEF Score is the sum of scores from all 15 questions.
  • Score Range: 1-75 pts (Note: min score assumes Q1-5 and 15 require at least 1 point if sexual activity occurred).
 
Overall Satisfaction Score
  • The Overall Satisfaction Score is the sum of scores from Q13 & 14.
  • Score range 2-10 pts
  • Consider psychosexual counselling with low scores in the Intercourse Satisfaction Domain and the Overall Satisfaction Domain especially if there a moderately lowered score (14-25 pts) in the Erectile Function Domain.
Erectile Function Score
  • The Erectile Function Score is the sum of score from Q1-5 & Q 15.
  • Score range up to 30 pts.
  • No erectile dysfunction (26-30 pts)
  • Mild dysfunction (22-25 pts)
    • Consider psychosexual counselling with low scores in the Intercourse Satisfaction Domain and the Overall Satisfaction Domain especially if there a moderately lowered score (14-25 pts) in the Erectile Function Domain.
  • Mild to moderate dysfunction (17-21 pts)
    • Consider psychosexual counselling with low scores in the Intercourse Satisfaction Domain and the Overall Satisfaction Domain especially if there a moderately lowered score (14-25 pts) in the Erectile Function Domain.
  • Moderate dysfunction (11-16 pts)
    • Consider psychosexual counselling with low scores in the Intercourse Satisfaction Domain and the Overall Satisfaction Domain especially if there a moderately lowered score (14-25 pts) in the Erectile Function Domain.
    • Patients with low erectile function scores (<14 pts) may be considered for a trial course of therapy with a PDE5 inhibitor unless contraindicated. Specialist referral is indicated if this is unsuccessful. 
  • Severe erectile dysfunction (1-10 pts)
    • Patients with low erectile function scores (<14 pts) may be considered for a trial course of therapy with a PDE5 inhibitor unless contraindicated. Specialist referral is indicated if this is unsuccessful. 
Orgasmic Function Score
  • The Erectile Function Score is the sum of score from Q9-10.
  • Score range 0-10
  • Patients demonstrating primary orgasmic or ejaculatory dysfunction ought to be referred for specialist investigation.
Sexual Desire Score
  • The Sexual Desire score is calculated by summing the scores for Q11 and 12.
  • Score range: 2-10.
  • Consider testing blood levels of androgen and prolactin in patients with reduced sexual desire.
Intercourse Satisfaction Score
  • The Intercourse Satisfaction score is calculated by summing the scores for Q6, 7 and 8.
  • Score range: 0-15.
  • Consider psychosexual counselling with low scores in the Intercourse Satisfaction Domain and the Overall Satisfaction Domain especially if there a moderately lowered score (14-25 pts) in the Erectile Function Domain.

 

đź’ˇ Key Points from the IIEF Guidelines:

  • "No sexual activity" or "No intercourse" (zero score) is not a measure of dysfunction — it simply means that the activity didn’t occur. It is conceptually distinct from responses on sexual function.
  • If a participant answers "No sexual activity" or "No intercourse" for one IIEF question then the domain is scored as "0".
  • For domains other than Desire and overall satisfaction, if any question within that domain is marked "No sexual activity" or "no intercourse", you should not score the domain at all for that participant. The other (numeric) answers would bias the score downward and create invalid data.
  • Desire domain and the overall satisfaction domain are the only ones that can be scored regardless of activity, since it does not require sexual behavior—only interest.
  • For these reasons, this app asks a triage question (Have you had any sexual activity or intercourse in the past 4 weeks?). If the answer is no, the corresponding domain questions are not presented and the following result will appear:
    • No sexual activity or intercourse reported in the past 4 weeks. Unable to assess the following domains:
      • Erectile Function
      • Orgasm Function
      • Intercourse Satisfaction
    • Consider modified version of IIEF (e.g., IIEF-5, a short form) or an adapted approach (e.g., including qualifiers for inactivity might be more appropriate.

 

Limitations

The IIEF relies on subjective patient self-report and recall over the past four weeks, which may be subject to bias. It assesses the presence and severity of dysfunction but does not diagnose the underlying etiology. Relationship factors, psychological state, and cultural background can influence responses. It is designed for men in stable sexual relationships who have attempted intercourse.

 

All questions & possible results

Triage
Over the last month, have you had any sexual stimulation or sexual intercourse?

Select one option:

  • Yes
  • No
Erectile Function (Questions 1-5)
1. Over the last month, how often were you able to get an erection during sexual activity?

Select one option:

  • Almost always or always
  • Most times (much more than half the time)
  • Sometimes (about half the time)
  • A few times (much less than half the time)
  • Almost never or never
2. Over the last month, when you had erections with sexual stimulation, how often were your erections hard enough for penetration?

Select one option:

  • Almost always or always
  • Most times (much more than half the time)
  • Sometimes (about half the time)
  • A few times (much less than half the time)
  • Almost never or never
3. Over the last month, when you attempted intercourse, how often were you able to penetrate your partner?

Select one option:

  • No sexual intercourse attempted
  • Almost always or always
  • Most times (much more than half the time)
  • Sometimes (about half the time)
  • A few times (much less than half the time)
  • Almost never or never
4. Over the last month, during sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner?

Select one option:

  • No sexual intercourse attempted
  • Almost always or always
  • Most times (much more than half the time)
  • Sometimes (about half the time)
  • A few times (much less than half the time)
  • Almost never or never
5. Over the last month, during sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

Select one option:

  • No sexual intercourse attempted
  • Extremely difficult
  • Very difficult
  • Difficult
  • Slightly difficult
  • Not difficult
Intercourse Satisfaction (Questions 6-8)
6. Over the last month, how many times have you attempted sexual intercourse?

Select one option:

  • No attempts
  • 1-2 times
  • 3-4 times
  • 5-6 times
  • 7-10 times
  • 11-20 times
7. Over the last month, when you attempted sexual intercourse how often was it satisfactory for you?

Select one option:

  • No sexual intercourse attempted
  • Almost always or always
  • Most times (much more than half the time)
  • Sometimes (about half the time)
  • A few times (much less than half the time)
  • Almost never or never
8. Over the last month, how much have you enjoyed sexual intercourse?

Select one option:

  • No intercourse
  • Very highly enjoyable
  • Highly enjoyable
  • Fairly enjoyable
  • Not very enjoyable
  • No enjoyment
Orgasmic Function (Questions 9-10)
9. Over the last month, when you had sexual stimulation or intercourse, how often did you ejaculate?

Select one option:

  • No sexual stimulation/intercourse
  • Almost always or always
  • Most times (much more than half the time)
  • Sometimes (about half the time)
  • A few times (much less than half the time)
  • Almost never or never
10. Over the last month, when you had sexual stimulation or intercourse, how often did you have the feeling of orgasm (with or without ejaculation)?

Select one option:

  • No sexual stimulation/intercourse
  • Almost always or always
  • Most times (much more than half the time)
  • Sometimes (about half the time)
  • A few times (much less than half the time)
  • Almost never or never
Sexual Desire (Questions 11-12)
11. Over the last month, how often have you felt sexual desire?

Select one option:

  • Almost always or always
  • Most times (much more than half the time)
  • Sometimes (about half the time)
  • A few times (much less than half the time)
  • Almost never or never
12. Over the last month, how would you rate your level of sexual desire?

Select one option:

  • Very high
  • High
  • Moderate
  • Low
  • Very low or not at all
Overall Satisfaction (Questions 13-14)
13. Over the last month, how satisfied have you been with your overall sex life?

Select one option:

  • Very satisfied
  • Moderately satisfied
  • About equally satisfied and dissatisfied
  • Moderately dissatisfied
  • Very dissatisfied
14. Over the last month, how satisfied have you been with your sexual relationship with your partner?

Select one option:

  • Very satisfied
  • Moderately satisfied
  • About equally satisfied and dissatisfied
  • Moderately dissatisfied
  • Very dissatisfied
Erectile Function (Question 15)
15. Over the last month, how do you rate your confidence that you can get and keep your erection?

Select one option:

  • Very high
  • High
  • Moderate
  • Low
  • Very low
Possible results
Intercourse Satisfaction Domain Score
  • Consider psychosexual counselling with low scores in the Intercourse Satisfaction Domain and the Overall Satisfaction Domain especially if there a moderately lowered score (14-25 pts) in the Erectile Function Domain.
  • The Intercourse Satisfaction domain score is calculated by summing the scores for questions 6, 7 and 8. Score range: 0-15.
    • Q6: How many times have you attempted sexual intercourse?
    • Q7: When you attempted sexual intercourse how often was it satisfactory for you?
    • Q8: How much have you enjoyed sexual intercourse?
Orgasmic Function Domain Score
  • A low score indicates possible sexual dysfunction.
  • Patients demonstrating primary orgasmic or ejaculatory dysfunction ought to be referred for specialist investigation.
  • The Orgasmic Function domain score is calculated by summing the scores for questions 9 and 10. Score range: 0-10.
    • Q9: When you had sexual stimulation or intercourse, how often did you ejaculate?
    • Q10: When you had sexual stimulation or intercourse, how often did you have the feeling of orgasm (with or without ejaculation)?
Overall Satisfaction Domain Score (Score range 2-10 pts)
  • Consider psychosexual counselling with low scores in the Intercourse Satisfaction Domain and the Overall Satisfaction Domain especially if there a moderately lowered score (14-25 pts) in the Erectile Function Domain.
  • The Overall Satisfaction domain score is calculated by summing the scores for questions 13 and 14. Score range: 2-10.
    • Q13: How satisfied have you been with your overall sex life?
    • Q14: How satisfied have you been with your sexual relationship with your partner?
Sexual Desire Domain Score
  • A low score indicates possible sexual dysfunction.
  • Consider testing blood levels of androgen and prolactin in patients with reduced sexual desire.
  • The Sexual Desire domain score is calculated by summing the scores for questions 11 and 12. Score range: 2-10.
    • Q11: How often have you felt sexual desire?
    • Q12: How would you rate your level of sexual desire?
Erectile Function Domain: Moderate dysfunction (11-16 pts)
  • Consider psychosexual counselling with low scores in the Intercourse Satisfaction Domain and the Overall Satisfaction Domain especially if there a moderately lowered score (14-25 pts) in the Erectile Function Domain.
  • Patients with low erectile function scores (<14 pts) may be considered for a trial course of therapy with a PDE5 inhibitor unless contraindicated. Specialist referral is indicated if this is unsuccessful. 
Erectile Function Domain: Mild dysfunction (22-25 pts)
  • Consider psychosexual counselling with low scores in the Intercourse Satisfaction Domain and the Overall Satisfaction Domain especially if there a moderately lowered score (14-25 pts) in the Erectile Function Domain.
Overall IIEF Score

A low score indicates possible sexual dysfunction.

Erectile Function Domain: No erectile dysfunction (26-30 pts)
  • Q1: How often were you able to get an erection during sexual activity?
  • Q2: When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
  • Q3: When you attempted intercourse, how often were you able to penetrate your partner?
  • Q4: During sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner?
  • Q5: During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?
  • Q15: How do you rate your confidence that you can get and keep your erection?
Erectile Function Domain: Severe erectile dysfunction (1-10 pts)
  • Patients with low erectile function scores (<14 pts) may be considered for a trial course of therapy with a PDE5 inhibitor unless contraindicated. Specialist referral is indicated if this is unsuccessful. 
Erectile Function Domain: Mild to moderate dysfunction (17-21 pts)
  • Consider psychosexual counselling with low scores in the Intercourse Satisfaction Domain and the Overall Satisfaction Domain especially if there a moderately lowered score (14-25 pts) in the Erectile Function Domain.
Erectile Function Domain: Score 0 (Due to no activity or intercourse).
  • To score this domain, all six questions (Q1-5 & Q15) must have a response > 1 point.
  • Any question marked "No sexual activity" or "No intercourse attempted" skews the domain's reliability.
  • For example, a score of 0 due to “no activity” is not the same as a score of 0 due to true dysfunction.
  • If using the IIEF in a clinical setting, you should document the reason for sexual inactivity — it could be relational, contextual, health-related, or due to a partner’s absence.
  • Use clinical judgment to interpret responses in the context of inactivity vs dysfunction.
Reported lack of any sexual activity in the past one month

Due to the reported lack of sexual activity or intercourse, the following domains were not assessed:

  • Erectile Function
  • Orgasmic Function
  • Intercourse Satisfaction

 

To score a domain, all of the questions in a given domain must have a response > 1 point.

  • Any question marked "No sexual activity" or "No intercourse attempted" skews the domain's reliability.
  • For example, a score of 0 due to “no activity” is not the same as a score of 0 due to true dysfunction.
  • If using the IIEF in a clinical setting, you should document the reason for sexual inactivity — it could be relational, contextual, health-related, or due to a partner’s absence.
  • Use clinical judgment to interpret responses in the context of inactivity vs dysfunction.
  • If the individual has not been sexually active at all in the past 4 weeks, the IIEF-5 (a short form) or an adapted approach (e.g., including qualifiers for inactivity) might be more appropriate.
Intercourse Satisfaction Domain: Score 0 (Due to no intercourse).
  • To score this domain, all questions (Q6-8) must have a response > 1 point.
    • Q6: How many times have you attempted sexual intercourse?
    • Q7: When you attempted sexual intercourse how often was it satisfactory for you?
    • Q8: How much have you enjoyed sexual intercourse?
  • Any question marked "No sexual activity" or "No intercourse attempted" skews the domain's reliability.
  • For example, a score of 0 due to “no activity” is not the same as a score of 0 due to true dysfunction.
  • If using the IIEF in a clinical setting, you should document the reason for sexual inactivity — it could be relational, contextual, health-related, or due to a partner’s absence.
  • Use clinical judgment to interpret responses in the context of inactivity vs dysfunction.
Orgasmic Function Domain: Score 0 (Due to no activity or intercourse)
  • To score this domain, both questions (Q9 & Q10) must have a response > 1 point.
    • Q9: When you had sexual stimulation or intercourse, how often did you ejaculate?
    • Q10: When you had sexual stimulation or intercourse, how often did you have the feeling of orgasm (with or without ejaculation)?
  • Any question marked "No sexual activity" or "No intercourse attempted" skews the domain's reliability.
  • For example, a score of 0 due to “no activity” is not the same as a score of 0 due to true dysfunction.
  • If using the IIEF in a clinical setting, you should document the reason for sexual inactivity — it could be relational, contextual, health-related, or due to a partner’s absence.
  • Use clinical judgment to interpret responses in the context of inactivity vs dysfunction.

Citation

IIEF © 2007 IQVIA Inc.

 

Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997 Jun;49(6):822-30. doi: 10.1016/s0090-4295(97)00238-0. PMID: 9187685.

 

 

Literature

Related evaluations

Also from SMSNA

Brief Sexual Function Inventory (BSFI)

Assessment of male sexual function and any disturbance due to lower urinary tract symptoms (LUTS).

SMSNA

International Index of Erectile Function-6 (IIEF-6)

6-item quiz to identify erectile dysfunction and severity over the past 4 weeks.

SMSNA

International Prostate Symptoms Score (IPSS)

Used to quantify benign prostatic hyperplasia (BPH) & to monitor treatment success.

SMSNA

Locke-Wallace Marital Adjustment Test (MAT)

AKA the Short Marital Adjustment Test (SMAT) used to assess marital satisfaction and adjustment within married couples.

SMSNA

Peyronie's Disease Questionnaire (PDQ)

Evaluates symptoms & psychological effects in patients with PD who have had vaginal intercourse within the last 3 months

SMSNA

Premature Ejaculation Diagnostic Tool (PEDT)

A 5-question tool to help identify men who may have a problem with premature ejaculation (PE) during sexual activity.

SMSNA

Premature Ejaculation Profile (PEP)

A 4-item patient self-reported questionnaire to assess the impact and severity of premature ejaculation (PE).

SMSNA

Sexual Desire Inventory-2 (SDI-2)

Self-report questionnaire designed to measure various facets of sexual desire.

SMSNA
Browse all evaluations