Introduction
The International Index of Erectile Function (IIEF) is one of the most trusted tools for checking male sexual function. Doctors created it in the mid-1990s. Today, it’s the top method for measuring erectile dysfunction (ED) in clinics and studies worldwide. This guide explains what the IIEF is, how it works, and why it matters for your health.
What is the International Index of Erectile Function?
The IIEF is a simple questionnaire men fill out themselves. It gives doctors a reliable way to measure erectile function and other parts of male sexual health. Dr. Raymond Rosen led a team of doctors and psychologists who created this tool in 1996.
“The IIEF gives us a quick but thorough assessment that works across cultures and languages,” says Dr. Michael Peterson from Northwestern University. “It was a big step forward in how we measure erectile function.”
The questionnaire first appeared during testing for sildenafil (Viagra), the first ED pill. Since then, experts have translated it into more than 32 languages. It truly lives up to its “international” name.
Structure and Scoring of the IIEF
The Original IIEF-15
The full IIEF has 15 questions (that’s why people call it IIEF-15). It checks five areas of male sexual function:
- Erectile Function (Questions 1-5, 15): Checks ability to get and keep erections
- Orgasmic Function (Questions 9-10): Looks at ejaculation and orgasm
- Sexual Desire (Questions 11-12): Measures interest in sex
- Intercourse Satisfaction (Questions 6-8): Checks happiness with sexual intercourse
- Overall Satisfaction (Questions 13-14): Rates overall sexual satisfaction
Each question scores from 0 or 1 to 5. Higher scores mean better sexual function. Doctors add up scores in each area. The total possible score is 75.
The IIEF-5 (SHIM)
There’s a shorter version called IIEF-5 or SHIM (Sexual Health Inventory for Men). It uses just five questions and focuses on erectile function.
“Many family doctors prefer the IIEF-5 because it’s quick but still gives useful information,” explains Dr. Janice Chen from Mayo Clinic.
The IIEF-5 has a top score of 25 points:
- 22-25: 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
How Doctors Use the IIEF
As a Diagnostic Tool
The IIEF helps doctors understand ED problems. “It turns patients’ experiences into clear data that guides treatment,” says Dr. Robert Williams from Johns Hopkins Medicine.
In clinics, the questionnaire helps doctors:
- Screen for erectile dysfunction
- Check how severe the problem is
- Sometimes tell the difference between mental and physical causes
- Create a starting point to track treatment results
In Research
The IIEF also proves valuable for research:
- Testing new ED medications
- Studying how common ED is in different groups
- Comparing different treatments
A 2018 study found that the IIEF works well across many cultures. This makes it perfect for international research.
Strengths and Limitations
Strengths
The IIEF is popular because it:
- Has been tested thoroughly in many languages and cultures
- Measures multiple aspects of sexual function
- Can detect changes after treatment
- Provides consistent results across different settings
“The IIEF turns personal sexual experiences into measurable data without losing meaning,” says Dr. Sarah Martinez from UCLA Medical Center. “This has changed how we research and treat erectile dysfunction.”
Limitations
The IIEF isn’t perfect. Its limits include:
- Focus mainly on penetrative sex
- Limited coverage of relationship factors
- Some questions may mean different things in different cultures
- Relies on the patient’s memory
Dr. James Thompson from University College London advises, “Doctors should use the IIEF along with a full sexual history and physical exam. Don’t rely just on questionnaire scores.”
Other Assessment Tools
While the IIEF is most common, other tools include:
- Erectile Hardness Score (EHS): A simple 4-point scale about penis firmness
- Male Sexual Health Questionnaire (MSHQ): Goes deeper into ejaculation issues
- Brief Male Sexual Function Inventory (BMSFI): Covers sex drive, erections, ejaculation, problems, and satisfaction
- PROMIS Sexual Function Measures: Computer-based testing system
“Different tools work for different needs,” says Dr. Elizabeth Wong. “The MSHQ gives more details about ejaculation than the IIEF, which helps certain patients.”
How Assessment Has Changed
The IIEF marked a turning point in how doctors check male sexual function. Before this, they used unstructured interviews that made comparisons difficult.
Dr. Thomas Jenkins from Columbia University explains, “Before the 1990s, people often thought ED was mainly psychological. The IIEF helped doctors see it as a real medical issue worthy of serious attention.”
Recent updates to medical guidelines stress the importance of questionnaires like the IIEF as part of a complete evaluation.
Using IIEF Scores for Treatment
Doctors use IIEF scores to help choose treatments, but they also consider each man’s unique situation.
For example, a man with moderate ED (scoring 13-16 on the IIEF-5) might try:
- Lifestyle changes (exercise, better diet, quitting smoking)
- ED pills
- Vacuum devices
- Treatment for other health issues
“The IIEF score is just one piece of the puzzle,” says Dr. Maria Garcia from Cleveland Clinic. “We also look at heart health, mental health, relationships, and what the patient wants.”
Research shows that better IIEF scores usually mean happier patients. An increase of 4 points in the erectile function score (or 2 points in the IIEF-5) is considered meaningful improvement.
Impact on Men’s Health
The IIEF has helped men’s health beyond just measuring ED.
“Tools like the IIEF have made it more normal for men to talk about sexual health with their doctors,” says Dr. David Chen, a men’s health specialist. “This has helped more men seek care for sexual problems.”
The questionnaire has also helped show the link between ED and other health issues. Studies show that ED can warn of heart disease. One major study found that men with ED had a 45% higher risk of heart problems.
By measuring erectile function clearly, the IIEF has helped researchers study these connections better.
Future Directions
Sexual medicine keeps evolving. Future trends may change how doctors use the IIEF:
- Digital versions in electronic health records
- More focus on patient experiences
- Broader views of sexual health beyond just erections
- Personalized treatment based on individual risk factors
Dr. Rebecca Taylor from Stanford University predicts, “Future assessment tools will likely include more detailed measures of satisfaction while using technology to collect better data.”
Research teams are working on new methods that may someday work alongside or replace parts of the IIEF.
Common Questions
What is the main purpose of the IIEF?
It provides a standard, tested tool for checking erectile function and male sexual health in clinics and research.
How is the IIEF given?
Men usually fill it out privately on paper or computer. Sometimes a doctor helps if questions are unclear.
How long does it take to complete?
The full 15-question version takes 5-10 minutes. The shorter 5-question version takes 2-3 minutes.
Is the IIEF only for men who might have ED?
While mostly used for suspected ED, doctors also use it before procedures that might affect sexual health (like prostate surgery) or to monitor men with high-risk conditions like diabetes.
Can the IIEF be used for all men regardless of sexual orientation?
It was designed mainly for heterosexual men having penetrative sex. Some questions may be less relevant for men who have sex with men or those who enjoy different sexual activities. Modified versions exist but aren’t as widely tested.
How often should men retake the IIEF during treatment?
There’s no strict rule, but doctors often give it again after 1-3 months of treatment. For ongoing care, it might be used every 3-6 months.
Is the IIEF available in different languages?
Yes, it has been translated and validated in over 32 languages, making it truly international.
Do doctors use only the IIEF score to diagnose ED?
No. While the score helps, proper diagnosis requires a complete medical history, physical exam, and sometimes additional tests to find the underlying causes.
Conclusion
The International Index of Erectile Function has changed how we measure male sexual function. It gives doctors a reliable tool for checking erectile function and related issues.
Despite some limitations, healthcare providers value the IIEF. It helps men talk about sexual concerns, measures treatment results, and shows how sexual health connects to overall health.
As our understanding grows, assessment methods will evolve too. But the IIEF has already made a lasting impact. It has helped reduce shame around ED and established sexual health as an important medical field. For patients with erectile concerns, the IIEF provides more than just a score – it offers a way to have helpful talks with doctors about this key part of life quality.