International Index of Erectile Function (IIEF-5)
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
1. How do you rate your confidence that you could get and keep an erection?
Please Select
Very low
Low
Moderate
High
Very high
2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
Please Select
Almost never/never
A few times (much less than half the time)
Sometimes (about half the time)
Most times (much more than half the time)
Almost always/always
3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?
Please Select
Almost never/never
A few times (much less than half the time)
Sometimes (about half the time)
Most times (much more than half the time)
Almost always/always
4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?
Please Select
Extremely difficult
Very difficult
Difficult
Slightly difficult
Not difficult
5. When you attempted sexual intercourse, how often was it satisfactory for you?
Please Select
Almost never/never
A few times (much less than half the time)
Sometimes (about half the time)
Most times
Almost always or always
Abridged IIEF-5 Score
5-7 Points: Severe Erectile Dysfunction
8-9 Points: Moderate Erectile Dysfunction
12-16 Points: Mild-Moderate Erectile Dysfunction
17-21 Points: Mild Erectile Dysfunction
22-25 Points: Erectile Dysfunction Unlikley
Should be Empty: