Erectile Dysfunction Assessment: The IIEF-5 Questionnaire

Last updated: August 25, 2026

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Erectile dysfunction is difficult to talk about and easy to postpone, which is why a short questionnaire is useful: it turns something vague and embarrassing into a number you can bring to an appointment. The tool used worldwide is the IIEF-5, also known as the Sexual Health Inventory for Men (SHIM) — a five-question version of the longer International Index of Erectile Function, designed to be completed in about two minutes.

This article explains what it asks, how it is scored and what the result means. But before any of that, there are two things the score cannot tell you, and one of them matters more than the erection does.

What the Score Cannot Tell You

First: it cannot tell you why. A score of 11 tells you the problem is moderate; it says nothing about whether the cause is vascular, hormonal, neurological, drug-related or psychological — and those are treated very differently. Self-scoring and then buying tablets online skips the only step that actually matters.

Second, and more important: erectile dysfunction is frequently the earliest sign of vascular disease. The arteries supplying the penis are narrower than the coronary arteries, so the same process shows up there first — often years before any heart symptom. A man in his forties or fifties with new erectile dysfunction and no obvious explanation is, statistically, a man who should have his cardiovascular risk assessed. That is the single strongest argument for not treating this quietly by yourself, and it is why the assessment covers blood pressure, blood sugar, cholesterol, weight, sleep and testosterone rather than just the erection. I have written more about that in the four causes behind almost every case of ED.

Get seen urgently for these

• Chest pain or breathlessness on exertion, or on sexual activity — emergency department, or 1669 in Thailand
• An erection lasting more than four hours, especially a painful one without arousal. This is priapism, a true emergency: treated within four to six hours it usually resolves, while delay beyond twenty-four hours makes permanent erectile dysfunction likely
• Erectile dysfunction that began suddenly after an injury to the perineum or pelvis, or alongside new numbness in the groin, leg weakness or bladder or bowel changes — these need assessment now, not a questionnaire

What the IIEF-5 Asks About

A note on why the questions themselves are not reproduced here: the IIEF is a copyrighted instrument, and licensing for its use is administered by the Mapi Research Trust. Publishing the item wording on a public web page requires permission, which this site does not hold, so what follows is a description of what the five items cover rather than the items themselves. Your doctor will give you the actual questionnaire — and completing it in the clinic is better anyway, because the score is interpreted alongside your history rather than on its own.

All five items ask about the last six months, and each is answered on a five-point scale worth 1 to 5. Between them they cover:

1. Confidence — how confident you feel that you could get and keep an erection, rated from very low to very high
2. Firmness — how often erections were hard enough for penetration, rated from almost never to almost always
3. Maintenance — how often the erection was kept after penetration
4. Difficulty — how hard it was to keep the erection until intercourse was finished, rated from extremely difficult to not difficult
5. Satisfaction — how often intercourse was satisfactory for you

Notice what that list is and is not. Four of the five items are about the erection itself and one is about satisfaction; none asks about desire, ejaculation or orgasm. If your actual complaint is low libido, or coming too quickly, or reaching orgasm and feeling nothing, this questionnaire will not capture it — and those are common, treatable and quite separate problems. Say so at the appointment rather than letting the score speak for you.

How the Score Is Interpreted

The five answers are added together, giving a total from 5 to 25.

Total score	Severity
22–25	No erectile dysfunction
17–21	Mild
12–16	Mild to moderate
8–11	Moderate
5–7	Severe

A cutoff of 21 separates men with erectile dysfunction from those without, with high sensitivity and reasonable specificity in the original validation study. A score of 21 or below is worth discussing rather than ignoring.

Two further caveats on the number. Because it looks back six months, a problem that started only recently may score better than it currently feels — mention that if it applies, because sudden-onset erectile dysfunction is a different clinical picture from a gradual decline. And the questionnaire assumes you have been attempting intercourse, so it works poorly for a man who has not, or who does not have a partner: a low score in that situation reflects the instrument’s design rather than his physiology.

If your total is 21 or below, the next step is finding the cause, not choosing a treatment. Assessment covers cardiovascular risk, diabetes, blood pressure, weight, sleep apnoea, testosterone, medications and the psychological side — several of which are reversible. The erectile dysfunction service page sets out what that involves, including penile duplex ultrasound where it is indicated.

Frequently Asked Questions

What is the IIEF-5 questionnaire?

A validated five-item questionnaire, also called the Sexual Health Inventory for Men (SHIM), abridged from the longer International Index of Erectile Function. It covers confidence, erection firmness, ability to maintain an erection, difficulty maintaining it, and satisfaction with intercourse, over the past six months. It is used to screen for erectile dysfunction and to grade its severity, and to track change over time. It is a copyrighted instrument licensed through the Mapi Research Trust, so the item wording is not reproduced here.

How is the IIEF-5 score interpreted?

The total runs from 5 to 25: 22 to 25 indicates no erectile dysfunction, 17 to 21 mild, 12 to 16 mild to moderate, 8 to 11 moderate, and 5 to 7 severe. A cutoff of 21 best separates men with erectile dysfunction from those without. The score grades severity but does not identify the cause, which is what determines treatment.

Is erectile dysfunction a warning sign of heart disease?

It frequently is. The arteries supplying the penis are narrower than the coronary arteries, so vascular disease often becomes apparent there first, sometimes years before any cardiac symptom. New erectile dysfunction without an obvious explanation, particularly in a man in his forties or fifties, is a reason to have cardiovascular risk assessed — blood pressure, blood sugar, cholesterol and weight. Chest pain or breathlessness on exertion or during sexual activity needs emergency assessment.

What are the treatment options for erectile dysfunction?

In rough order of escalation: treating the underlying causes, which is where most benefit comes from; oral PDE5 inhibitors such as sildenafil and tadalafil; vacuum erection devices; injection therapy into the penis; and a penile implant for men who have not responded to conservative treatment. Low-intensity shockwave therapy and platelet-rich plasma injection are also used, but they sit in a different evidence category from the treatments above and should be described as such rather than listed alongside them — PRP in particular is still classified as investigational by the major urological associations.

Can I take ED tablets with my other medication?

Not always, and one combination is genuinely dangerous. PDE5 inhibitors must never be taken by a man using nitrates for angina, including sprays, patches and the tablets placed under the tongue, because together they can cause a catastrophic drop in blood pressure. Caution is also needed with alpha blockers, which are widely prescribed for the prostate, since both lower blood pressure. Tell the prescribing doctor everything you take, and never use a tablet obtained from a friend or an unregulated online source, where neither the dose nor the contents can be relied upon.

Does the IIEF-5 cover low libido or premature ejaculation?

No. Four of its five items concern the erection and one concerns satisfaction with intercourse. Desire, ejaculation and orgasm are not assessed at all. If your main difficulty is low libido, ejaculating too quickly, or reaching orgasm without pleasure, the IIEF-5 will look reassuring while missing the actual problem — so raise it directly at the appointment. Those are common and separately treatable.

When should I see a urologist about erectile dysfunction?

When the difficulty is persistent rather than occasional — as a rough guide, occurring in more than half of attempts — or when it began suddenly, or when it is affecting your relationship or your mood. Occasional failure is normal and universal. What is worth attention is a consistent change from your own baseline, and the earlier it is looked at, the more of the underlying causes turn out to be reversible.

Book an Appointment

Dr. Soarawee Weerasopone assesses and treats erectile dysfunction at Bangkok Hospital Headquarters and at Samitivej Sriracha Hospital, Chonburi — Urology department 088-022-1445. The questionnaire is completed in the clinic; what helps most is bringing a list of every medication you take, since several common ones affect erections. Questions about cost are answered by the hospital rather than by Dr. Soarawee — for Bangkok Hospital, by email to bhquro@bdms.co.th.

Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. It suits an initial discussion and reviewing results you already have; examination, blood tests and ultrasound require an in-person visit. Samitivej Sriracha is in-person only.

References

1. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319-326. — PubMed: https://pubmed.ncbi.nlm.nih.gov/10637462/
2. Sangkum P, Sukying C, Viseshsindh W, et al. Validation and reliability of a Thai version of the International Index of Erectile Function (IIEF-5) for Thai population. J Med Assoc Thai. 2017;100(Suppl 9):S73-S79. — Full text: http://www.jmatonline.com/PDF/S73-S79-PB-100-S9.pdf

Disclaimer: This article is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is educational only, is not medical advice, and does not create a doctor–patient relationship. The IIEF-5 grades symptom severity and does not diagnose a cause or exclude other conditions; it is a copyrighted instrument and its item wording is not reproduced here. Never take a PDE5 inhibitor with nitrates, and do not obtain prescription medication from unregulated sources. No diagnosis, prescription or individual medical advice is given through personal messaging channels or social media, and Dr. Soarawee operates no public social media account — any account offering private consultation in his name is fraudulent. An erection lasting more than four hours, or chest pain during sexual activity, means an emergency department or 1669 in Thailand.