urology

IIEF-5 / SHIM — International Index of Erectile Function (5-item)

5-item self-report of erectile function over past 6 months (Rosen 1999). Each item 1–5, total 5–25. Lower = worse. Validated screening for ED.

Q1. Confidence in getting and keeping an erection?*

Q2. With sexual stimulation, how often were erections hard enough for penetration?*

Q3. During intercourse, how often were you able to maintain erection after penetration?*

Q4. How difficult was it to maintain erection to completion?*

Q5. When attempting intercourse, how often was it satisfactory?*

Score interpretation

No ED 22–25

→ Reassure. Address psychological / lifestyle factors if symptomatic.

Mild ED 17–21

→ Lifestyle: weight loss, smoking cessation, exercise. PDE5 inhibitor (sildenafil 50 mg PRN) trial. Address comorbidities (T2DM, HTN, depression).

Mild-to-moderate ED 12–16

→ PDE5 inhibitor at higher dose (sildenafil 100 mg, tadalafil 10–20 mg). Test morning testosterone, lipids, fasting glucose, TFTs. Cardiovascular risk assessment — ED is a marker for occult CAD.

Moderate ED 8–11

→ Daily tadalafil 5 mg or alternative agent. Refer to specialist andrology clinic if PDE5 inhibitor fails. Consider vacuum erection device, intracavernosal alprostadil.

Severe ED 5–7

→ Specialist urology referral. Investigate for vasculogenic, neurogenic, endocrine, psychogenic causes. Consider penile Doppler, intracavernosal alprostadil test, second-line therapies (vacuum, MUSE), penile prosthesis.

Interpretation bands for the IIEF-5 (SHIM). Apply clinical judgement and local guidance.

References

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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