International Index of Erectile Function (IIEF)

Purpose

The International Index of Erectile Function (IIEF) is a widely used, validated, multidimensional, 15-item self-administered questionnaire designed to evaluate male sexual function, with a primary focus on erectile dysfunction (ED). It assesses various aspects of sexual function over the preceding four weeks. It is commonly used in clinical practice and research settings to measure the severity of ED and treatment outcomes.

Sources and Validation

The IIEF was developed and validated by Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A, and colleagues. The key publication is: Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997 Jun;49(6):822-30. It has demonstrated good psychometric properties (reliability, validity, sensitivity to change) across various populations and is considered a standard instrument in the field of sexual medicine.

Clinical Workflow and Parameters

The questionnaire is typically completed by the patient before or during a clinical consultation. It addresses five key domains of male sexual function:

• Erectile Function (EF)
• Orgasmic Function (OF)
• Sexual Desire (SD)
• Intercourse Satisfaction (IS)
• Overall Satisfaction (OS)

An overall score, summing all 15 items, ranges from 1 to 75, providing a global measure of sexual function. Lower scores indicate poorer sexual function across domains.

💡 Key Points from the IIEF Guidelines:

• "No sexual activity" or "No intercourse" (zero score) is not a measure of dysfunction — it simply means that the activity didn’t occur. It is conceptually distinct from responses on sexual function.
• If a participant answers "No sexual activity" or "No intercourse" for one IIEF question then the domain is scored as "0".
• For domains other than Desire and overall satisfaction, if any question within that domain is marked "No sexual activity" or "no intercourse", you should not score the domain at all for that participant. The other (numeric) answers would bias the score downward and create invalid data.
• Desire domain and the overall satisfaction domain are the only ones that can be scored regardless of activity, since it does not require sexual behavior—only interest.
• For these reasons, this app asks a triage question (Have you had any sexual activity or intercourse in the past 4 weeks?). If the answer is no, the corresponding domain questions are not presented and the following result will appear:
  • No sexual activity or intercourse reported in the past 4 weeks. Unable to assess the following domains:
    • Erectile Function
    • Orgasm Function
    • Intercourse Satisfaction
  • Consider modified version of IIEF (e.g., IIEF-5, a short form) or an adapted approach (e.g., including qualifiers for inactivity might be more appropriate.

Limitations

The IIEF relies on subjective patient self-report and recall over the past four weeks, which may be subject to bias. It assesses the presence and severity of dysfunction but does not diagnose the underlying etiology. Relationship factors, psychological state, and cultural background can influence responses. It is designed for men in stable sexual relationships who have attempted intercourse.