The IIEF and Erectile Function


Many erectile dysfunction studies use IIEF scores to show improvments over control or placebo, making a basic understanding of this questionnaire and the scores underlying it critical for evaluation and comparison purposes.  The IIEF (International Index of Erectile Function) questionnaire comprises 15 questions aimed at assessing sexual function, and is divided into five domains . The questionnaire was devised for use in clinical trials when Viagra was under development.

The most often quoted domain is the IIEF-EF domain, where EF refers to Erectile Function. Within the IIEF-EF domain there are six questions, and you gain up to five points per question. The questions refer only to the previous four weeks and ask the following. (i) How often during sexual activity did you gain an erection? (ii) How often were erections hard enough for penetration? (iii) When you attempted penetration how often did you succeed? (iv) How well did you maintain the erection after penetration? (v) How well did you maintain the erection to orgasm? And (xv) how high was your confidence that you could get and keep an erection? The more positive/confident your answers: the more points.

Most Questionnaires define a score of at least 25 as no dysfunction . 19-24 is mild . 13-18 is mild to moderate. 7-12 is moderate, and 1-6 is severe. Some Questionnaires, more realistically, define a score of at least 26 as no dysfunction ; 22-25 as mild ; 17-21 as mild to moderate ; 11-16 as moderate and 1-10 as severe .

The IIEF questionnaire was developed for a purpose: to understand the effect of Viagra on men taking part in clinical trials, - and those men were expected to report in a scientific manner. In a random group of men, not taking part in a properly organised clinical trial, the questionnaire is far from ideal.

Some questions need explanation. In question 1, for example, does masturbation count as sexual activity? (The answer is yes. But suppose you don t masturbate?) Does a semi count as an erection? (The answer is again yes, as does any slight stiffening.) Does being drunk, tired and just eaten a heavy meal when you failed allow you not to lose so many points? Or being nervous with a new partner?

There are slightly different versions of the questionnaire, which employ slightly different phraseology.

When I filled in the questionnaire in November 2012 I wasn t given any guidance. Confusion in patients and doctors minds may partly explain why the charts and graphs in many trials appear irrational and contradictory.

The first five questions award no points only if you ve not attempted sexual activity in the previous four weeks. If you make the attempt (as you would if taking part in a clinical trial) have always failed, and have very low confidence, you get one point per question. So, even without a penis, you would score six points. On the other hand you may be a stud, who s had no sex activity for a month, and only score five points.

The IIEF-EF questionnaire misses some important questions. For example it does not give marks for speed of erection. You could take an hour to achieve an erection, need p**nogr*phy even to achieve that, and generally orgasm within five seconds of penetrating a hired hooker, but with such desperate performances on a regular basis you could score the maximum 30 points.

The final question awards at least one point (for having the lowest level of confidence) and so the technical range of possible scores spans from one to 30, but the useful clinical-trial range spans from 6 to 30.

You gain two points, in question 1, simply for occasionally eventually getting some slight increase in penis size, with ideal sexual stimulation. A man who never has a proper erection, can gain a just a very weak response only occasionally, and sustain it for only a few seconds, could score 7 points, and hence be in the moderate category. Whereas in reality his condition would be far from moderate.

The other four domain scores can help give a better perspective on the IIEF-EF score. These domains relate to Intercourse Satisfaction , Orgasmic Function , Sexual Desire and Overall Satisfaction . Intercourse Satisfaction is scored from 3-15 and the others 2-10 (assuming you made the relevant attempts in the previous four weeks).

The Intercourse Satisfaction domain seems a more useful, though slightly vague, guide. Strangely, it awards five points just for making at least eleven attempts in the previous four weeks, no matter how unsatisfactory they might have been. The other ten points more reasonably relate to how much enjoyment and to how much satisfaction you had. (Sounds almost like the same question asked twice.) Perhaps Overall Satisfaction is the most easily understood and useful domain, though half of the possible points relate to your relationship with your partner, which might be outside your control

Research with a random group of 111 normal men in Washington, found an average IIEF-ED score of 25.8. By some versions of the questionnaire that is mild dysfunction. Perhaps 50% had some level of e d, and 50% didn t? The published facts relating to the amount of erectile dysfunction in the world vary enormously, from around 10% of men, to more than 50% in the 40-70 age group.

There is usually significant increase in IIEF score in the placebo or sham group of men on clinical trials. This might just be wishful thinking by the guinea pigs, but perhaps these men were talking to, being more open with and relaxed with their partners; and that may cause genuine increase in scores (especially in the so-called psychogenic cases of dysfunction).

Increases in IIEF-EF score of 4, 5 or 6 are by most trials considered significant . Viagra trials tended to report increases in EF score of around 8 to 11 points, and PDE5i seems generally to offer the greatest beneficial effect. However, when judging questionnaire results, one might perhaps deduct the sham treatment group s increase score from the treated group s increase, to get a more realistic idea of average sustainable improvements.

The S H I M. There is a simplified version of the full questionnaire called the Sexual Health Inventory for Men, or the IIEF-5 Questionnaire . This, more realistically, covers the previous six months, and is more rational for a man not on a clinical trial. There are five questions and possible scores of 1 to 5, for each. Hence the minimum score is 5 and the maximum is 25.

The questions are (i) how did you rate your confidence to get and keep an erection? (ii) How often were they hard enough for penetration? (iii) How well did you maintain the erection after penetration? (iv) How well did you maintain the erection to completion? (v) How often was intercourse satisfactory for you?

Questions 1 and 2 include masturbation; and q1 must include any slight stiffening (or q2 would be redundant). Answers to questions 4 & 5 could depend on how self-centred or easily satisfied you are.

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