• International Index of Erectile Dysfunction

    (IIEF) Questionnaire (Merit Medical)
  • TODAY'S DATE:
     / /
    2 digit month, 2 digit day, 4 digit year

  • The first five questions refer to erectile function.

  • 1. Over the last month, how often were you able to get an erection during sexual activity?
  • 2. Over the last month, when you had erections with sexual stimulations, how often were your erections hard enough for penetration?
  • 3. Over the last month, when you attempted intercourse, how often were you able to penetrate your partner?
  • 4. Over the last month, during sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner?
  • 5. Over the last month, during sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

  • The next three questions refer to satisfaction with intercourse.

  • 6. Over the last month, how many times have you attempted sexual intercourse?
  • 7. Over the last month, when you attempted sexual intercourse how often was it satisfactory for you?
  • 8. Over the last month, how much have you enjoyed sexual intercourse?

  • The next two questions refer to orgasmic function.

  • 9. Over the last month, when you had sexual stimulation or intercourse, how often did you ejaculate?
  • 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)?

  • The next two questions ask about sexual desire.  In this context, sexual desire is defined as a feeling that may include wanting to have a sexual experience (for example, masturbation or sexual intercourse), thinking about having sex, or feeling frustrated due to lack of sex.

  • 11. Over the last month, how often have you felt sexual desire?
  • 12. Over the last month, how would you rate your level of sexual desire?

  • The next two questions refer to overall sexual satisfaction.

  • 13. Over the last month, how satisfied have you been with your overall sex life?
  • 14. Over the last month, how satisfied have you been with your sexual relationship with your partner?

  • The last questions refers to erectile function.

  • 15. Over the last month, how do you rate your confidence that you can get and keep your erection?

  • ADD YOUR SCORES

  • Area Questions Score Range Maximum Score Your Score
    Erectile Function 1-5 & 15 0-5 30  
    Orgasmic Function 9-10 0-5 10  
    Sexual Desire 11-12 1-5 10  
    Intercourse Satisfaction 6-8 0-5 15  
    Overall Satisfaction 13-14 1-5 10  

  • SCORING:

    1-10: Severe Erectile Dysfunction

    11-16: Moderate dysfunction

    17-21: Mild to moderate dysfunction

    22-25: Mild dysfunction

    26-30: No dysfunction

    This information, including the questions, structure and completeness of the sample survey, is based on forms and/or scoring systems developed by independent organizations of relevance to the diagnosis and treatment of benign prostatic hyperplasia (BPH This material is not a substitute for a consultation or physical examination by a physician. Merit Medical disclaims any liability for the decisions a patient makes based on this information.

  • 403728001A ID 071717

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