Erectile Dysfunction Quiz: Severity Band and Pattern Clues
- Screener
- About 4 min
- Original items, modeled on the IIEF-5 (SHIM) structure
- Runs in your browser, nothing is sent
- Medical review: Medical review pending
Three things this quiz separates
Erectile dysfunction is defined by what happens in the moment, but it is explained by what sits behind it: blood vessels, nerves, hormones, medication, or mood and circumstance. Scoring severity and the pattern clues apart tells you how much of a problem it is and where a clinician should look first.
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5
Severity over three months
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8
Physical versus situational clues
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1
The next thing to check
How this compares with a typical online quiz
| Feature | Typical free quiz | Regenerated.com |
|---|---|---|
| Items modeled on a published structure | Sometimes | Yes, the five-domain IIEF-5 structure, original wording |
| Physical versus situational clues | Rarely | Yes, eight clues with a breakdown |
| Names the labs a clinic should run | No | Yes, from the AUA guideline |
| Honest about shockwave, PRP and stem cells | No | Yes, investigational per the AUA |
| Time window stated | Rarely | Yes, the past three months |
| Email required for the result | Often | Never |
| Answers sent to a server | Often | Never; scored in your browser, counts-only events |
Physical or situational: reading the clues
Clinicians have used a handful of history questions for decades to get a first sense of what is driving erectile difficulty. Erections during sleep and on waking are driven by the same vessels and nerves as sexual erections but not by desire or confidence, so when they have faded, a physical cause becomes more likely. A gradual onset over months, the same result in every setting, and risk factors such as diabetes, high blood pressure, high cholesterol, smoking or heart disease point the same way. A sudden onset tied to a stressful period, firm erections alone or on waking with difficulty only with a partner, and wide variation from one occasion to the next point toward a situational pattern, where anxiety about performing, relationship strain or low mood is doing the work.
The split is a starting point, not a verdict. Most erectile difficulty in men over forty has a physical component, and almost all of it picks up a situational layer once the worry about the next occasion sets in. Medications are a third category the clues cannot see: some blood pressure drugs, many antidepressants, finasteride and some prostate medicines can cause or worsen the problem, so bring a full medication list to any appointment.
What a good evaluation looks like
The American Urological Association guideline describes a history that covers the onset, the pattern across situations, morning erections, desire, ejaculation, relationship factors and medications; a physical examination including blood pressure, pulses, the genitals and, where indicated, the prostate; and laboratory tests chosen by the history, commonly a morning total testosterone, fasting glucose or A1c and a lipid panel. For men whose history points strongly to a situational pattern, the physical work-up is still worth doing once, because the two patterns coexist.
Erectile difficulty with a physical pattern is also an early warning for the heart. The small arteries of the penis narrow before the larger coronary arteries do, and in long-term studies erectile dysfunction preceded coronary events by two to five years on average. Consensus guidance treats a new vascular-pattern erectile problem in a man over forty as a reason to assess cardiovascular risk, not just to prescribe for the symptom.
Treatment options, by the strength of the evidence
Oral PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) are the first-line treatment and work for most men whose nerves and blood supply are reasonably intact; they need sexual stimulation to act and are not combined with nitrates. Behind them sit vacuum erection devices, alprostadil as a urethral pellet or as an injection into the penis, and, where nothing else works, a surgically placed implant with high satisfaction rates. Lifestyle changes carry real weight on their own: regular aerobic exercise, weight loss, stopping smoking and limiting alcohol improve erectile function in trials, and treating sleep apnea, diabetes and blood pressure helps.
Low-intensity shockwave therapy, platelet-rich plasma injections and stem cell treatments are offered by many clinics. The AUA guideline classes shockwave as investigational and PRP and stem cell therapies as experimental, meaning they should be offered within a research protocol with the evidence explained, not sold as proven. If a clinic leads with these, ask what it has done to exclude the vascular, hormonal and medication causes first.
Methodology and sources
The five severity items are original wording modeled on the structure of the five-item International Index of Erectile Function (IIEF-5, also called the Sexual Health Inventory for Men or SHIM) published by Rosen and colleagues in 1999, which covers confidence, achieving an erection, maintaining it after penetration, maintaining it to completion and satisfaction. The IIEF-5 is a copyrighted instrument and nothing here reproduces its items, response labels, order or scoring thresholds. The items on this page ask instead what actually happened over the past three months, in concrete situations of the page's own choosing, with their own frequency labels, and the bands are educational rather than validated cut-offs. The eight pattern clues are drawn from the history elements the AUA and EAU guidelines describe for separating organic from psychogenic erectile dysfunction.
Scoring: each severity item is counted 0 (not once), 1 (once or twice), 2 (three to five times), 3 (six to ten times) or 4 (more than ten times), for a total of 0 to 20; higher means more difficulty. The bands (0 to 3 minimal, 4 to 8 mild, 9 to 14 moderate, 15 to 20 severe) were chosen for readability and sit near the proportions of the IIEF-5's published severity categories, which were validated on that instrument's own items, not on these. The eight clues are yes/no, scored separately and shown as a breakdown of physical versus situational points; they do not change the band.
This is an educational screener. A questionnaire cannot measure blood flow, nerve function, testosterone or the effect of a medication, and it cannot tell a vascular cause from a situational one with certainty, because most erectile difficulty has elements of both. A clinician does that with a history, an examination and a short set of blood tests. Chest pain, breathlessness or an erection lasting more than four hours are reasons to seek care at once, whatever the score.
Medical review: Medical review pending. Last updated .
References
- Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319-326. doi:10.1038/sj.ijir.3900472
- Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633-641. doi:10.1016/j.juro.2018.05.004
- Salonia A, Bettocchi C, Boeri L, et al. European Association of Urology guidelines on sexual and reproductive health, 2021 update: male sexual dysfunction. Eur Urol. 2021;80(3):333-357. doi:10.1016/j.eururo.2021.06.007
- Nehra A, Jackson G, Miner M, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012;87(8):766-778. doi:10.1016/j.mayocp.2012.06.015