IIEF-5

name: ______________________________ date: _______ The following 5 questions assess your ability and confidence in being able to get and maintain erections. To the right of each question, please tick the box that describes your experience over the last six months, or other time period that you and your therapist want to evaluate.

1
how do you rate your confidence that you could get and keep an erection? when you had erections with sexual stimulation, how often were your erections hard enough for penetration? during sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner? during sexual intercourse how difficult was it to maintain your erection to the completion of intercourse? when you attempted sexual intercourse, how often was it satisfactory for you? very low

2
low

3
moderat e

4
high

5
very high

almost never or never

much less than half the time much less than half the time

about half the time

much more than half the time much more than half the time

almost always or always almost always or always

almost never or never

about half the time

extremel y difficult

very difficult

difficult

slightly difficult

not difficult

almost never or never

much less than half the time

about half the time

much more than half the time

almost always or always

The numbers at the top of each column give the score for ticking a box in that column. Your total score is simply the sum of these five numbers.

total=

Rosen, R.C., et al., 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. International Journal of Impotence Research, 1999. 11(6): p. 319-26.