Erectile dysfunction (ED) is far more common than most men think: roughly 52 % of men aged 40–70 experience it — usually in silence. With the IIEF-5 you can self-assess in under 2 minutes whether your symptoms are in the clinically relevant range.
This article explains the test, the severity bands published by Cappelleri & Rosen (2005), the most common causes, and what actually helps.
What is the IIEF-5?
The International Index of Erectile Function (IIEF-5) — also known as SHIM (Sexual Health Inventory for Men) — is the validated 5-question short form of the longer IIEF-15. Developed by Raymond Rosen and colleagues in 1999, it is now the global standard for ED screening.
Each of the 5 questions is rated on a 1–5 scale. The total score ranges from 5 (severe ED) to 25 (no ED).
Sensitivity: 98 % — catches almost every case of ED.
Specificity: 88 % — few false positives at a cutoff of ≤ 21.
Severity bands (Cappelleri & Rosen)
| Score | Severity | Action |
|---|---|---|
| 22 – 25 | No ED | Monitor |
| 17 – 21 | Mild | Lifestyle changes |
| 12 – 16 | Mild to moderate | See your GP |
| 8 – 11 | Moderate | Urologist + workup |
| 5 – 7 | Severe | See a urologist soon |
A cutoff of ≤ 21 is the established clinical threshold for medical evaluation.
The most common causes
ED is rarely purely psychological. In more than 80 % of cases, an organic factor is involved:
Vascular (most common)
Atherosclerosis, hypertension, high cholesterol and smoking damage the small penile arteries — often years before other symptoms emerge. ED is considered an early marker for cardiovascular disease with a 3–5 year lead time.
Endocrine / hormonal
Low testosterone (hypogonadism) and diabetes are common. About 50 % of diabetic men develop ED within 10 years — primarily through nerve and vascular damage.
Drug-induced
Beta-blockers, thiazide diuretics, SSRI antidepressants, finasteride, opioids and some antipsychotics can trigger ED. If you suspect a medication, talk to your doctor — never stop on your own.
Psychogenic
Performance anxiety, stress, relationship issues, depression — typical sign: morning erections are present but fail during sex. More common in younger men.
ED as an early warning sign
A landmark study in JAMA (Inman et al., 2009) showed that men under 50 with ED have a 50-fold higher risk of heart attack within 5–10 years compared to peers without ED. Penile arteries are only 1–2 mm in diameter and react to atherosclerosis earlier than the 3–4 mm coronary arteries.
That's why ED workup should always include cardiovascular risk factors — blood pressure, cholesterol, blood glucose, waist circumference and smoking status.
Calculate your IIEF-5 score now
5 questions, instant Cappelleri & Rosen severity, anonymous and no sign-up — runs entirely in your browser.
Take the test for free →What actually works
Studies show that for mild-to-moderate ED, lifestyle interventions are often as effective as medication:
- Exercise: 150 minutes of moderate activity per week reduce ED risk by 40 %
- Weight loss: if BMI > 30, a 10 % reduction markedly improves erectile function
- Mediterranean diet: olive oil, fish, nuts, plenty of vegetables — improves endothelial function
- Quit smoking: nicotine is one of the strongest ED risk factors
- Sleep: 7–9 hours — sleep apnea is an underdiagnosed ED cause
- Pelvic floor training: Kegel exercises improved 40 % of men with mild ED in one trial
For low testosterone, replacement therapy can help; for vascular causes, PDE-5 inhibitors (sildenafil, tadalafil) are first-line — prescription-only and only after medical evaluation.
Related calculators
Because ED clusters with other risk factors, it's worth checking your testosterone level (rule out hypogonadism), your diabetes risk score (FINDRISC) and your biological age as a holistic health marker.
Bottom line
The IIEF-5 is a reliable screen — but only the first step. If your score is below 22, a medical evaluation is worth it: ED is often the tip of an iceberg of vascular, hormonal or metabolic risk factors. Use our IIEF-5 calculator for an anonymous self-check — and bring concerning results to your doctor.