The International Index of Erectile Function (IIEF-5) Questionnaire

First Name *

Last Name *

DOB: *

Gender *

MaleFemaleOther

Name of clinician

Please start typing the name of the Doctor or Nurse Practitioner

Please read each statement and select the statement that best applies and which indicates how much the statement applied to you over the past six months. There are no right or wrong answers. Do not spend too much time on any statement.

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

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

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

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

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

Total Score22-25: No erectile dysfunction 17-21: Mild erectile dysfunction 12-16: Mild to moderate erectile dysfunction 8-11: Moderate erectile dysfunction 5-7: Severe erectile dysfunction

No erectile dysfunction

Mild Erectile Dysfunction

Mild-Moderate Erectile Dysfunction

Moderate Erectile Dysfunction

Severe Erectile Dysfunction

Rhoden, E., Telöken, C., Sogari, P. et al. The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction. Int J Impot Res 14, 245–250 (2002). https://doi.org/10.1038/sj.ijir.3900859