Summary
PurposeThe 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 ValidationThe 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 ParametersThe 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 RangeRecommendationsOverall IIEF ScoreThe 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 ScoreThe Overall Satisfaction Score is the sum of scores from Q13 & 14.Score range 2-10 ptsConsider 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 ScoreThe 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 ScoreThe Erectile Function Score is the sum of score from Q9-10.Score range 0-10Patients demonstrating primary orgasmic or ejaculatory dysfunction ought to be referred for specialist investigation.Sexual Desire ScoreThe 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 ScoreThe 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. 💡 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 FunctionOrgasm FunctionIntercourse SatisfactionConsider 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. LimitationsThe 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.