Erectile Function Score (IIEF-5)
A 5-question clinical screening tool used worldwide to assess erectile function. Takes about two minutes. Tells you where you stand — and what kinds of causes are worth investigating.
Most guys don’t talk about this with anyone. Not their partner, not their doctor, not their friends. The result is a lot of men quietly assuming the worst about themselves while sitting on a problem that, in most cases, has clear medical explanations and effective treatments.
This calculator uses the IIEF-5 — the Sexual Health Inventory for Men — a validated questionnaire developed by Rosen and colleagues in 1999 and used by urologists, primary care doctors, and men’s health clinics globally as the standard first-line screening tool for erectile dysfunction.
No email gate. No identifying information. The result is yours.
What this quiz actually measures
The IIEF-5 (also called the Sexual Health Inventory for Men, or SHIM) is the abridged 5-question version of the longer International Index of Erectile Function. It was developed specifically for clinical screening — quick enough to be used in a primary care visit, validated enough to inform real medical decisions.
5 dimensions of erectile function
Confidence in achieving an erection, hardness during stimulation, ability to maintain an erection during intercourse, ability to complete intercourse, and overall satisfaction. Together they form a composite picture of how erectile function is actually working in practice.
Range of 5 to 25
Each question scored 1 to 5. Total score determines severity: 22–25 indicates no ED, 17–21 mild, 12–16 mild-to-moderate, 8–11 moderate, and 5–7 severe. These thresholds are validated against clinical diagnosis and are used in major urology guidelines worldwide.
The 5-question SHIM
Answer based on how things have been over the last 6 months — not how they were when you were 22, and not just last week. Honesty matters. Nobody sees your answers but you, and the result is only as useful as the truth you put in.
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For educational purposes only. The IIEF-5 is a validated screening tool, not a diagnostic instrument. A low score indicates that clinical evaluation is appropriate — it does not constitute a diagnosis of erectile dysfunction or any other medical condition. Many ED causes are treatable, including hormonal, vascular, and lifestyle factors. A qualified clinician should evaluate any concerning result.
What actually causes ED
ED is rarely “just one thing.” For most men, it’s a combination of factors — and the IIEF-5 score doesn’t tell you which factors apply to you. What it does tell you is whether further investigation is warranted. Here are the main causes, roughly in order of how commonly they’re at play:
Vascular causes
Erections require healthy blood flow. The arteries supplying blood to the penis are smaller than those supplying the heart, which is why ED is often the first warning sign of cardiovascular disease — sometimes years before a cardiac event. Atherosclerosis, high blood pressure, high cholesterol, and diabetes all damage these vessels and impair erectile function. If you’re over 40 and developing ED, the cardiovascular angle deserves serious attention — independent of how you address the ED itself.
Hormonal causes
Low testosterone is a major and often overlooked contributor. Testosterone affects libido directly, but also plays a role in erectile function through several mechanisms including nitric oxide signaling in penile tissue. Importantly, ED from low testosterone often comes with other low-T symptoms — fatigue, low drive, poor recovery, mood changes — so if you have multiple symptoms together, getting testosterone tested is high-yield. Less commonly, thyroid issues and elevated prolactin also contribute.
Neurological and psychological causes
The brain initiates erections, and any disruption in that signaling can cause problems. Anxiety, depression, performance anxiety, relationship stress, and chronic stress all measurably affect erectile function. So do neurological conditions like diabetic neuropathy. Psychological causes are most commonly suspected in younger men with sudden onset and otherwise normal health markers.
Medications
Many common medications affect erectile function as a side effect. Antidepressants (especially SSRIs), blood pressure medications (especially beta-blockers and diuretics), antihistamines, and several others. If you developed ED after starting a new medication, that connection is worth raising with your prescriber — there are often alternatives with fewer sexual side effects.
Lifestyle factors
Smoking, excessive alcohol, poor sleep, obesity, and lack of exercise all measurably worsen erectile function. The good news is they’re all addressable. The bad news is that lifestyle change alone often isn’t enough once underlying vascular or hormonal damage has occurred — but combined with appropriate medical treatment, it can be transformative.
The intersection that matters most
Here’s the practical truth most clinics don’t say out loud: for most men over 35 with ED, the underlying cause is some combination of vascular health (which correlates with overall metabolic health) and hormonal status (testosterone). Both of those are visible on standard bloodwork. Both are treatable. And both interact — low testosterone worsens vascular health, and vascular dysfunction often comes with hormonal changes.
ED as a warning sign worth taking seriously
This section is the most important one on the page, so read it carefully.
The arteries supplying the penis are about 1 to 2 millimeters in diameter. The coronary arteries supplying the heart are 3 to 4 millimeters. The same disease processes — atherosclerosis, endothelial dysfunction, inflammation — affect both. Because the smaller vessels are affected first, ED frequently shows up years before a cardiac event in men with developing cardiovascular disease.
This is well documented in the medical literature. Multiple large studies have shown that men with new-onset ED have a significantly elevated risk of heart attack, stroke, and overall cardiovascular mortality in the years that follow, particularly if the ED appears before age 60. The American Heart Association now treats ED as an independent cardiovascular risk factor.
What this means in practice: if you’re developing ED, especially before age 60, getting metabolic and cardiovascular bloodwork done is not optional. It’s potentially life-saving. The same panel that screens for hormonal causes — fasting glucose, HbA1c, full lipid panel including ApoB, inflammatory markers — also tells you whether you’re on a cardiovascular trajectory that needs intervention.
Many men avoid this conversation because they’re embarrassed about the ED. The cost of that avoidance is potentially measured in years of life. The conversation is much easier than the alternative.
What your score actually means
The standard IIEF-5 severity bands, validated against clinical diagnosis.
Erectile function is severely impaired. Penetrative intercourse is rarely or never possible. This score warrants prompt clinical evaluation — both for the ED itself and for the underlying causes, which in this severity range are commonly some combination of vascular disease, low testosterone, diabetic complications, or neurological issues. The good news: most causes are treatable, and treatment outcomes are generally better the earlier you start.
Erectile function is meaningfully impaired most of the time. Intercourse is sometimes possible but often unsatisfactory. This is the most common severity band in clinical practice. Causes vary widely but commonly involve vascular factors, hormonal status, and sometimes psychological components layered on top. Treatment options are excellent at this severity — most men respond well to a combination of addressing the underlying cause and direct treatment.
Function is impaired enough to be noticeable and impact satisfaction, but penetrative intercourse is still usually possible. Men in this band often hesitate to seek treatment because “it’s not that bad” — but this is actually the band where early intervention often produces the cleanest outcomes, both because the underlying causes are easier to address before they worsen and because lifestyle and hormonal optimization alone can sometimes restore full function.
Function is mostly normal but with some inconsistency or reduced satisfaction. Common patterns include occasional difficulty maintaining an erection, slower onset, or reduced firmness compared to earlier years. Often the first signal that something is shifting — and the right time to investigate underlying causes (especially hormonal and cardiovascular) before they progress.
Erectile function falls within the normal range. If you took this quiz because you had concerns, your function is probably better than you think. If you’re concerned about preserving function as you age — which is a reasonable thing to care about — the same factors that prevent ED are the ones that support general health: cardiovascular fitness, healthy body composition, adequate sleep, and stable hormonal status.
What to do next
Three possible paths depending on your score and your situation.
Get a complete panel
ED is a symptom, not a diagnosis. Treating it without understanding what’s causing it tends to produce mediocre results. A complete blood panel identifies the variables most commonly involved: testosterone (free and total), SHBG, thyroid, fasting glucose, HbA1c, full lipid panel including ApoB, and inflammatory markers. This is the data that determines whether you need TRT, vascular intervention, sexual health treatment, or some combination.
Total testosterone plus essentials. Limited picture.
Hormone-focused panel. Covers the testosterone angle thoroughly but limited cardiovascular markers.
Hormones, thyroid, fasting glucose, HbA1c, full lipid panel, and metabolic markers. Covers both the hormonal and vascular angles in one panel.
Talk to a specialist
Two clinical paths depending on what’s most likely going on for you. If your symptoms suggest a broader hormonal pattern — fatigue, low drive, poor recovery, weight gain — TRT consultation explores the testosterone angle. If ED is your primary concern and you want direct treatment, a sexual health consultation discusses the medication options and combination protocols available for your situation.
- Telehealth-based — no in-person visits required
- Licensed clinicians who treat these conditions full-time
- Discreet, judgment-free conversations about what you’re actually dealing with
- Ongoing monitoring throughout treatment
- Transparent pricing — no insurance gymnastics required
For most men, the sequence is: bloodwork first, then consultation. Walking into any clinical conversation with current labs makes the appointment dramatically more useful — you know what’s actually going on and the conversation moves directly to treatment options rather than guesswork.
Frequently asked questions
How accurate is the IIEF-5?
The IIEF-5 is one of the most thoroughly validated screening tools in men’s health. It has high sensitivity and specificity for identifying clinically significant erectile dysfunction when compared to comprehensive clinical assessment. It’s used in urology guidelines worldwide, in major pharmaceutical clinical trials, and in primary care practice. A low score does not constitute a diagnosis on its own — but it does correctly identify most men who would benefit from further evaluation.
I’m in my 30s — should I be worried if I scored low?
Yes, but probably not in the way you fear. New ED in younger men is rarely the result of severe disease, but it does warrant investigation. Common causes in younger men include psychological factors (anxiety, depression, relationship stress), lifestyle factors (poor sleep, excessive alcohol, low physical activity), low testosterone (which is increasingly common in men under 40), and certain medications. The good news is that earlier intervention generally produces better outcomes. The investigation typically starts with bloodwork and a clinical conversation.
How is ED connected to heart health?
The arteries supplying the penis are smaller than those supplying the heart, and they’re affected first by the same disease processes — atherosclerosis, endothelial dysfunction, inflammation. ED in men under 60 is now considered an independent cardiovascular risk factor by the American Heart Association, and multiple large studies have shown that new-onset ED frequently precedes cardiac events by several years. This is why a complete metabolic and cardiovascular panel is part of any thorough ED workup, regardless of how the ED itself is being treated.
Could low testosterone be causing my ED?
It’s a meaningful possibility, especially if you have other symptoms typical of low testosterone — fatigue, low libido, poor recovery from exercise, mood changes, weight gain, reduced muscle mass. Testosterone affects erectile function through multiple mechanisms, including direct effects on penile tissue and indirect effects on libido and vascular health. A simple blood test (total and free testosterone, plus SHBG) tells you whether testosterone is part of the picture. If it is, TRT often produces meaningful improvement in erectile function alongside the other symptoms.
Are ED medications safe?
The most commonly prescribed ED medications (PDE5 inhibitors) have an extensive safety record across more than two decades of use. They’re not appropriate for everyone — men taking nitrates for cardiac conditions cannot use them, and there are other contraindications — but for most men they’re safe and effective. They’re also not the only option. A specialist will walk through which medications fit your situation, what doses are appropriate, and what alternatives exist if PDE5 inhibitors aren’t ideal for you.
Will TRT alone fix my ED?
It depends on the cause. If low testosterone is the primary driver, TRT often produces significant improvement in erectile function over several months. If vascular or psychological factors are contributing, TRT alone may improve function but not fully restore it. The most predictable outcomes come from addressing all the relevant factors — hormonal, vascular, and lifestyle — rather than relying on any single intervention. A clinician will help you figure out which combination is most likely to work for you.
Is this score affected if I don’t have a current partner?
The IIEF-5 assumes some sexual activity over the past 6 months for accurate scoring. If you haven’t been sexually active during that period, the questionnaire may underestimate your erectile function. In those situations, clinicians often supplement the IIEF-5 with other assessment tools or use it as a partial signal alongside symptom history. If this applies to you, take the score with a grain of salt and consider it a starting point rather than a definitive measurement.
Does this calculator save my data?
No. Your answers exist only in your browser session. We don’t store them, log them, or attach them to your account if you have one. You can retake the quiz as many times as you want without anything being saved on our end.
The right answer is the one you actually find out.
ED is one of the most treatable conditions in men’s health — and one of the most underdiscussed. Whether your score landed in the mild range or the severe range, the next step is the same: real data and a clinical conversation. Both options below get you there.
This calculator and the information on this page are for educational purposes only. The IIEF-5 is a validated screening tool, not a diagnostic instrument. ED can have many causes, several of which are serious and require clinical evaluation. A qualified clinician should evaluate any concerning result before treatment decisions are made.