International Index of Erectile Function (IIEF)
Also known as: IIEF, IIEF-15
The IIEF is a 15-item, multidimensional self-report instrument developed by Rosen and colleagues in 1997 to assess erectile function and sexual satisfaction in men. It remains the most widely used psychometric tool for evaluating erectile dysfunction in clinical and research settings, with validation across 29 countries and translations into 40+ languages.
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When to use it
The IIEF is indicated in men ≥18 years with concern for erectile dysfunction, whether primary (lifelong) or acquired. Clinical contexts include: urology evaluation of ED to characterize severity and guide therapy; endocrinology assessment of erectile function in men with diabetes or hypogonadism; cardiology screening for vascular dysfunction in men with cardiovascular risk; andrology and sex medicine specialty practice; pharmaceutical trials evaluating efficacy of phosphodiesterase-5 inhibitors or other ED treatments; and epidemiologic surveys of sexual health in population-based cohorts.
Strengths & limitations
- Multidimensional and flexible: separately measures erectile capacity, desire, orgasm, and satisfaction, allowing clinicians to distinguish isolated erectile dysfunction from global sexual dysfunction.
- Psychometrically excellent: strong internal consistency (Cronbach's α > 0.75 for most domains), robust test–retest reliability, and convergent validity with clinical assessment.
- Highly responsive to treatment: sensitive to improvement following PDE5 inhibitor therapy, testosterone replacement, vacuum devices, and psychotherapy.
- Internationally validated: normative data and clinical cutoff scores established across diverse populations (age, ethnicity, comorbidity), enhancing applicability.
- Time-efficient: takes only 5–10 minutes, suitable for routine clinical screening.
- Assumes partnered, heterosexual intercourse: IIEF questions reference vaginal intercourse; application to men with same-sex partners or non-penetrative preferences requires adaptation.
- Recall and context effects: responses may be influenced by recall bias over the four-week period and by partner presence during completion.
- Doesn't directly assess etiology: IIEF identifies dysfunction but does not distinguish vascular, neurologic, hormonal, or psychologic causes; additional testing is needed.
- Partner-dependent: IIEF score partly reflects partner characteristics (availability, receptivity, sexual function) alongside the respondent's physiology, complicating longitudinal interpretation when partner changes.
Frequently asked
What is the most important IIEF domain?
The Erectile Function domain (EF, 6 items, 0–30) is the primary measure of erectile capacity and the most widely cited in clinical and research settings. However, orgasmic, desire, and satisfaction domains are equally important clinically; a patient with isolated ED but preserved desire and satisfaction has a different clinical profile than one with global sexual dysfunction.
Is there a total IIEF score?
No. Domain scores are not summed. Each of the five domains (EF, OF, SD, IS, OS) is interpreted separately. This multidimensional approach preserves specificity; a global 'total score' would obscure the pattern of dysfunction.
What IIEF score indicates erectile dysfunction?
An Erectile Function domain score below 26 (on a 0–30 scale) indicates erectile dysfunction. Scores are classified as: 26–30 = no ED, 17–25 = mild, 11–16 = mild-to-moderate, 6–10 = moderate, 1–5 = severe. However, clinical judgment is essential; a 70-year-old with EF score 24 may be functioning normally for age, whereas a 40-year-old with the same score warrants investigation.
How sensitive is IIEF to pharmacotherapy?
IIEF is highly responsive to PDE5 inhibitor therapy, with mean EF domain improvements of 7–12 points in responders to sildenafil, tadalafil, or vardenafil. Response varies by baseline severity, comorbidity (diabetes, cardiovascular disease), and psychological factors; 60–80% of men show clinically meaningful improvement.
Can IIEF be used in men without sexual partners?
The original IIEF assumes partnered intercourse. In abstinent or unpartnered men, administration requires modification; some clinicians use hypothetical prompts ('If you were with a partner'), while others defer assessment pending partnered activity. No consensual best practice exists; clinical judgment and explicit instruction to the respondent are advisable.
Sources
- Rosen, R. C., Riley, A., Wagner, G., Osterloh, I. H., Kirkpatrick, J., & Mishra, A. (1997). The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology, 49(6), 822–830. DOI: 10.1016/S0090-4295(97)00238-0 ↗
- Cappelleri, J. C., Rosen, R. C., Smith, M. D., Mishira, A., & Osterloh, I. H. (1999). Diagnostic validation of the Sexual Health Inventory for Men. International Journal of Impotence Research, 11(4), 319–326. link ↗
How to cite this page
ScholarGate. (2026, June 3). International Index of Erectile Function (IIEF). ScholarGate. https://scholargate.app/en/urology-gynecology/international-index-erectile-function
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
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- Female Sexual Function IndexUrology Gynecology↔ compare
- Male Sexual Health QuestionnaireUrology Gynecology↔ compare
- Sexual Satisfaction ScaleUrology Gynecology↔ compare