- Optionally enter your name, age, sex, and the date for a personalized printout — this information stays in your browser only and is never transmitted.
- Answer all 5 questions by clicking the response that best matches your experience over the past 4 weeks. Each question has 5–6 options ranging from worst to best.
- Click Calculate My Score. Your total score (range 1–25) appears immediately along with a severity category and recommended next steps.
- Use Print / Save PDF to create a printout to bring to your nephrologist or urologist consultation.
- Click Reset All to clear the form and start over.
All computation runs in your browser; no values are stored or transmitted.
When to Use
Use the IIEF-5 (also called the Sexual Health Inventory for Men, SHIM) to screen for erectile dysfunction (ED) in adult men with chronic kidney disease, on maintenance hemodialysis or peritoneal dialysis, or following kidney transplantation. It is appropriate at baseline and at follow-up visits whenever sexual health is part of the quality-of-life discussion.
Appropriate population
Adult men (18 years and older) who have been sexually active in the past 4 weeks. Particularly useful in CKD G3–G5, hemodialysis, peritoneal dialysis, and post-transplant patients — populations where ED prevalence reaches 60–80% due to hormonal disruption, uremic neuropathy, vascular disease, and medication side effects. The questionnaire takes approximately 2–3 minutes to complete.
When NOT to rely on it alone
The IIEF-5 screens for the presence and severity of ED but does not identify its cause. A low score should prompt a full clinical evaluation including hormonal panel (total testosterone, LH, FSH, prolactin), medication review (antihypertensives, beta-blockers, diuretics are common offenders), cardiovascular risk assessment, and psychosocial history. Do not use to monitor response to therapy without paired clinical assessment. The tool was validated in men — there is no equivalent abbreviated version for women (use the full 19-item FSFI administered by a clinician).
Pearls & Pitfalls
ED as a cardiovascular signal
In the general population, new-onset ED often precedes symptomatic coronary artery disease by 2–5 years. In CKD patients — who carry compounded vascular risk — a low IIEF-5 score should prompt cardiovascular review, including blood pressure control, lipid status, and glycaemic management in diabetic nephropathy.
Check testosterone before prescribing PDE5 inhibitors
PDE5 inhibitors (sildenafil, tadalafil) are substantially less effective in men with low testosterone. In CKD, hypogonadism is common (uremic suppression of LH pulsatility; hyperprolactinaemia). Always check a morning total testosterone before initiating a PDE5 inhibitor — hypogonadal men need testosterone optimization first for PDE5 inhibitors to work.
Pitfalls
(1) The IIEF-5 is not validated in female patients — do not use it for women; the FSFI is the appropriate tool. (2) Do not prescribe PDE5 inhibitors in men taking nitrates (any formulation) — the combination causes potentially fatal hypotension. (3) The score captures the past 4 weeks; acute causes (intercurrent illness, new medication, hospital admission) can transiently lower scores — repeat after the acute event resolves before acting on a single low result. (4) Cultural or linguistic barriers may affect interpretation; use a professional interpreter, never a family member, for sensitive sexual health discussions.
Why Use It
Erectile dysfunction is among the most prevalent and under-reported quality-of-life impairments in kidney disease. Studies consistently show that 60–80% of men on dialysis experience some degree of ED, compared with roughly 20% of age-matched men with normal kidney function. The mechanisms are multifactorial: uremic toxins suppress the hypothalamic-pituitary-gonadal axis, causing low testosterone and elevated prolactin; autonomic neuropathy impairs parasympathetic vasodilation; anaemia reduces tissue oxygen delivery; and vascular calcification — accelerated by hyperphosphatemia and elevated Ca×P product — damages the penile microvasculature. Medications used heavily in CKD (antihypertensives, beta-blockers, aldosterone antagonists, H2 blockers) compound the problem. Despite this burden, nephrology consultations rarely include a structured sexual history. The IIEF-5 provides a validated, reproducible, stigma-reducing entry point for this conversation.
IIEF-5 Self-Assessment — Erectile Function over the Past 4 Weeks
Answer each of the 5 questions by selecting the response that best describes your experience over the past 4 weeks. All 5 answers are required before scoring.
Rosen RC et al. Int J Impot Res. 1999;11(6):319-326. This calculator is a validated clinical screening tool, not a diagnostic instrument. A low score indicates you should discuss erectile function with your nephrologist or urologist.
Next Steps
Use the result to support — not replace — clinical judgment.
- Interpret the value against the targets shown in the calculator and the Evidence section below, in the context of the full clinical picture.
- Trend serial measurements rather than acting on a single result; confirm abnormal or unexpected values before changing management.
- Apply the relevant KDIGO / specialty-guideline threshold and document the indication.
- Escalate or refer to nephrology when results are out of range, rapidly changing, or discordant with the clinical picture — and discuss the implications with the patient.
Evidence & References
Formula & Equations
Each of the 5 questions is scored 0–5 (Question 1 is scored 1–5, Questions 2–5 are scored 0–5). The total score ranges from 1 to 25. Higher scores indicate better erectile function.
| IIEF-5 Score | Severity Category | Recommended Action |
|---|---|---|
| 22–25 | No ED | Reassure; routine nephrology follow-up. Re-screen if symptoms develop or medications change. |
| 17–21 | Mild ED | Optimize dialysis adequacy, correct anaemia (Hb target 10–12 g/dL), review medications. Recheck in 3 months. |
| 12–16 | Mild to Moderate ED | Hormonal panel (testosterone, LH, FSH, prolactin), cardiovascular assessment, medication review. Discuss PDE5 inhibitor options with nephrologist/urologist (cardiovascular clearance required). |
| 8–11 | Moderate ED | Formal sexual dysfunction evaluation. Specialist referral (urology or endocrinology). PDE5 inhibitors, testosterone replacement (if hypogonadal), or psychosexual counselling as indicated. |
| 1–7 | Severe ED | Priority specialist referral. Multidisciplinary assessment — nephrology, urology, cardiology, psychosexual medicine. Consider all reversible causes before irreversible interventions. |
The cut-point of 21 (score ≤ 21 = any ED) was validated by Rosen et al. (1999) against the full 15-item IIEF. In CKD populations, some authors use ≤ 16 as the threshold for clinically significant ED warranting specialist evaluation, given the high background prevalence. A single score should not trigger treatment; clinical judgment and serial assessment are essential.
Evidence & References
The IIEF-5 was derived from the original 15-item IIEF by Rosen and colleagues in 1999. It was explicitly developed as a brief, practical office screening tool while retaining the diagnostic accuracy of the full instrument. The IIEF-5 has been validated against gold-standard measures in multiple populations, including CKD and dialysis cohorts, and is recommended by the AUA, EAU, and the International Consultation on Sexual Medicine for routine ED screening in high-risk medical populations.
- Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena 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.
- Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822–830.
- Kouidrat Y, Pizzol D, Cosco T, et al. High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies. Diabet Med. 2017;34(9):1185–1192. [Provides CKD/dialysis comparison data]
- Vecchio M, Palmer S, Tonelli M, et al. Depression and sexual dysfunction in chronic kidney disease: a narrative review of the evidence in areas of significant unmet need. Nephrol Dial Transplant. 2015;30(9):1414–1423.
