IIEF-5 Test: Check Your Erectile Function Yourself

Sometimes it is hard to describe erection problems clearly. The IIEF-5 questionnaire helps turn what you feel into a number that you and your doctor understand in the same way. It takes less than 3 minutes and you can do it at home.

What is the IIEF-5?

The IIEF-5 (International Index of Erectile Function, 5 items), also known as the SHIM (Sexual Health Inventory for Men), is a short version of the IIEF questionnaire developed by Rosen and colleagues (1997, 1999). It is used to screen for erectile dysfunction (ED) in clinics and research around the world.

Answer by thinking about the past 6 months. Each question is scored from 1 to 5.

Why it asks about the past 6 months

The IIEF-5 looks back over 6 months, unlike the full IIEF, which asks about the past 4 weeks. Because it was designed for screening, it aims for an overall picture that isn't skewed by a few nights when you were tired, had been drinking heavily or were stressed. If your problem only started a few weeks ago, tell your doctor as well, because your score may not reflect it yet.

The five questions (plain-language summary)

The wording below is a plain-English summary of what each item covers, not the official form. Your doctor can give you the validated questionnaire.

Question 1. How confident are you that you can get an erection and keep it?

1 = very low, 2 = low, 3 = moderate, 4 = high, 5 = very high

Question 2. When you are sexually stimulated, how often are your erections firm enough for penetration?

1 = almost never or never, 2 = less than half the time, 3 = about half the time, 4 = more than half the time, 5 = almost always or always

Question 3. During sex, after penetration, how often can you stay hard?

1 = almost never or never, 2 = less than half the time, 3 = about half the time, 4 = more than half the time, 5 = almost always or always

Question 4. During sex, how difficult is it to stay hard until the end?

1 = extremely difficult, 2 = very difficult, 3 = difficult, 4 = slightly difficult, 5 = not difficult

Question 5. When you try to have sex, how often do you find it satisfying?

1 = almost never or never, 2 = less than half the time, 3 = about half the time, 4 = more than half the time, 5 = almost always or always

IIEF-5

Question 1

• Confidence of getting and keeping an erection

Question 2

• How often hard enough for penetration

Question 3

• How often you stay hard after penetration

Question 4

• How hard to stay hard until the end

Question 5

• How often sex was satisfying

Each question scores 1-5.

How to interpret your score

Add up all five answers for a total between 5 and 25.

If you score 21 or below, it is a good idea to see a doctor to look for the cause, such as blood vessel problems, hormones, medicines or stress.

5-7Severe EDSee a doctor to find the cause

8-11Moderate EDSee a doctor to find the cause

12-16Mild to moderate EDSee a doctor to find the cause

17-21Mild EDA score of 21 or below: talk to a doctor

22-25No EDKeep monitoring yourself

SevereNormal

Rosen et al. (1997, 1999). Answer for the past 6 months. A screening tool, not a diagnosis.

What each score band means in real life

This is a rough picture; everyone is different.

• 22–25: firm enough and lasting almost every time, with the occasional miss when tired or after drinking. This is normal.
• 17–21: penetration works most of the time, but sometimes the erection fades halfway, and worry before sex starts to creep in.
• 12–16: success about half the time. Many men start avoiding sex or rushing to finish.
• 8–11: usually not firm enough, with a clear impact on confidence and the relationship.
• 5–7: penetration is rarely possible. Physical causes should be looked into properly.

Tips from a family physician

• The IIEF-5 is meant for initial screening. It does not tell you the cause and it is not a diagnosis.
• If you haven't had sex at all recently, your score may not reflect reality. Tell your doctor about it instead.
• This questionnaire doesn't measure premature ejaculation, delayed ejaculation or sex drive. If you have those concerns, see premature ejaculation (PE) and symptoms of low testosterone.
• Using it together with the Erection Hardness Score gives a clearer picture.
• Repeat it 1–3 months after treatment to see how much you have improved.

Using the IIEF-5 to track treatment

Complete the questionnaire before starting treatment and keep it as your baseline. Repeat it 1–3 months after treatment, thinking about the period since you started. If your score moves up into a different band, that usually reflects a change you can genuinely feel. If it doesn't move, your doctor will review how the medicine is being used, the dose, and look for other contributing causes.

A low score is not the end of the story

Most ED can be improved, through lifestyle changes, treating other conditions, help with anxiety, and PDE5 inhibitor medicines as assessed and prescribed by a doctor. Read about all the options in Erectile dysfunction (ED): causes, tests and treatment.

One more thing I want you to know: ED can be the first sign of heart disease or diabetes. A low score is therefore a good opportunity to check your overall health. See the list of tests in Health check-ups for working-age adults.

ED as an early warning sign of heart disease

The arteries in the penis are smaller than the arteries of the heart, so when artery walls start to deteriorate, symptoms often show up in the penis first, sometimes years earlier. A study in JAMA (2005) that followed more than 9,000 men aged 55 and over found that men with ED had about a 45% higher risk of later cardiovascular events. The Princeton III consensus therefore recommends that men with ED have their cardiovascular risk assessed, including blood pressure, blood sugar, cholesterol, weight and smoking.

When to see a doctor, and how the clinic can help

See a doctor if your score is 21 or below, if your score has fallen from before, or if the problem affects your happiness and relationship. Go to hospital immediately if you get chest pain or tightness during sex, or an erection that lasts more than 4 hours (in Thailand call 1669).

At Dr. Kris Clinic you are welcome to bring your IIEF-5 score to discuss with me, in person or online, and consultations in English are available. We will follow up with a history, physical examination and blood tests as needed, and then plan safe care together with you.