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International Index of Erectile Function Questionnaire (IIEF)Investigator: ______________________________________ Please use an X where applicable and be sure to initial and date all corrections Score 0 if not done_______________ Subject questionnaire Section 1 Instructions: These questions ask about the effects your erection problems have had on your sex life, over the past 4 weeks. Please answer the following questions as honestly and clearly as possible. In answering these questions, the following definitions apply: Definitions: Sexual activity includes intercourse, caressing, foreplay and masturbation Sexual intercourse is defined as vaginal penetration of the partner (you entered the partner) Sexual stimulation includes situations like foreplay with a partner, looking at erotic pictures, etc. Ejaculate is defined as the ejection of semen from the penis (or the feeling of this) Mark ONLY one circle per question: 1. Over the past 4 weeks, how often were you able to get an erection during sexual activity?
2. Over the past 4 weeks, when you had erections with sexual stimulation, how often were your erections hard enough for penetration?
Questions 3, 4 and 5 will ask about erections you may have had during sexual intercourse. 3. Over the past 4 weeks, when you attempted sexual intercourse, how often were you able to penetrate (enter) your partner?
4. Over the past 4 weeks, during sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?
5. Over the past 4 weeks, during sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?
6. Over the past 4 weeks, how many times have you attempted sexual intercourse?
7. Over the past 4 weeks, when you attempted sexual intercourse how often was it satisfactory for you?
8. Over the past 4 weeks, how much have you enjoyed sexual intercourse?
9. Over the past 4 weeks, when you had sexual stimulation or intercourse how often did you ejaculate?
10. Over the past 4 weeks, when you had sexual stimulation or intercourse how often did you have the feeling of orgasm or climax (with or without ejaculation)?
Questions 11 and 12 ask about sexual desire. Let's define sexual desire as a feeling that may include wanting to have a sexual experience (for example, masturbation or intercourse), thinking about having sex or feeling frustrated due to a lack of sex. 11. Over the past 4 weeks, how often have you felt sexual desire?
12. Over the past 4 weeks, how would you rate your level of sexual desire?
13. Over the past 4 weeks, how satisfied have you been with you overall sex life?
14. Over the past 4 weeks, how satisfied have you been with your sexual relationship with your partner?
15. Over the past 4 weeks, how do you rate your confidence that you can get and keep your erection?
All items are scored in 5 domains as follows:
Clinical Interpretation I. Erectile function total scores can be interpreted as follows:
II. Orgasmic function total scores can be interpreted as follows:
III. Sexual desire total scores can be interpreted as follows:
IV. Intercourse satisfaction total scores can be interpreted as follows:
V. Overall satisfaction total scores can be interpreted as follows:
Source: Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. References: See Bibliography August 2006 |
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