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Diagnostic Survey

Fill out the Diagnosis Survey and use the Diagnosis Chart to better understand your status.   

International Index of Erectile Function (IIEF – EF) Questionnaire 

Write the number that best describes your erectile function for the past 4 weeks in the spaces provided

Over the past four weeks:
1. How often were you able to get an erection during sexual activity? __________

0 = No sexual activity
1 = Almost never/never
2 = A few times (much less than half the time)
3 = Sometimes (about half the time)
4 = Most times (much more than half the time)
5 = Almost always/always

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

0 = No sexual activity
1 = Almost never/never
2 = A few times (much less than half the time)
3 = Sometimes (about half the time)
4 = Most times (much more than half the time)
5 = Almost always/always

3. When you attempted sexual intercourse, how often were you able to penetrate (enter) your partner? __________

0 = Did not attempt intercourse
1 = Almost never/never
2 = A few times (much less than half the time)
3 = Sometimes (about half the time)
4 = Most times (much more than half the time)
5 = Almost always/always

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

0 = Did not attempt intercourse
1 = Almost never/never
2 = A few times (much less than half the time)
3 = Sometimes (about half the time)
4 = Most times (much more than half the time)
5 = Almost always/always

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

0 = Did not attempt intercourse
1 = Extremely difficult
2 = Very difficult
3 = Difficult
4 = Slightly difficult
5 = Not difficult

15. How would you rate your confidence that you could get and keep an erection? __________

1 = Very low
2 = Low
3 = Moderate
4 = High
5 = Very high

 Total IIEF-EF Score: __________

Clinical Interpretation

Erectile function total scores can be interpreted as follows:

Score

Interpretation

 

1-10

Severe dysfunction

 

11-16

Moderate dysfunction

 

17-21

Mild to moderate dysfunction

 

22-25

Mild dysfunction

 

26-30

No ED

 

The International Index of Erectile Function (IIEF): a state-of-the-science review

 

R C Rosen1, J C Cappelleri2 and N Gendrano III1

 

1Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, New Jersey, USA

2Pfizer Inc, Global Research and Development, Groton, Connecticut, USA

 

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