How is ED diagnosed?

The specialist will make an appropriate diagnosis on the basis of a detailed clinical history accompanied by a complete physical examination and pertinent blood analyses.

ED may be classified by the degree of rigidity achieved in the erection and its interference with sexual activity. For this purpose, we have questionnaires to evaluate erectile function, the most notable of which is the IIEF 5 (a sexual health questionnaire for men), which is the most widely used (table I). Thus, we classify ED in four groups: severe (5-7), moderate (8-11), mild to moderate (12-16) and mild (17-21). A score of 22 to 25 indicates good erectile function.

In the initial evaluation of ED, it is important that the patient be accompanied by his partner, since her/his presence helps us greatly to understand the patient’s psychosocial environment and the perspective the partner may have on the sexual problem.


Erectile Dysfunction Test (IIEF-5)

1. How do you rate your confidence that you could get and keep an erection?
1. Very low 2. Low 3. Moderate 4. High 5. Very High
2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
1. Almost never or never 2. Much less than half the time 3. About half the time 4. Much more than half the time 5. Almost always or always
3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?
1. Almost never or never 2. Much less than half the time 3. About half the time 4. Much more than half the time 5. Almost always or always
4. During sexual intercourse how difficult was it to maintain your erection to the completion of intercourse?
1. Extremely difficult 2. Very difficult 3. Difficult 4. Slightly difficult 5. Not difficult
5. When you attempted sexual intercourse, how often was it satisfactory for you?
1. Almost never or never 2. Much less than half the time 3. About half the time 4. Much more than half the time 5. Almost always or always

The IIEF-5 score is the sum of the ordinal responses to the five items. Thus, the score can range from 5 to 25.

22 – 25 No ED
12 – 21 Mild ED
8 – 11 Moderate ED
5 – 7 Severe ED


The complementary studies that are most widely used for the diagnosis of ED include colour Doppler echography with intracavernous injection of alprostadil. This is an echographic test that is carried out in the doctor’s office and consists in evaluating the erection mechanism. For this purpose, after injection of a vasoactive substance called alprostadil (Caverject®) into the corpus cavernosum, the diameter of the cavernosal arteries is measured, along with the peak systolic blood velocity (PSV), the end diastolic blood velocity (EDV) and the index of resistance (IR).

A PSV greater than 35 cms shows adequate arterial perfusion (figure X), while a PSV of less than 25 cms reveals inadequate delivery of arterial blood and that a good erection will not be achieved. If the ED is secondary to so-called venoocclusive disease, we will find a good PSV but an EDV greater than 5 cms.

An IR greater than 0.9 is associated with a normal vascular mechanism, while an IR less than 0.75 correlates with veno-occlusive disease. This study allows us to know very precisely the cause and degree of ED present in the patient.

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Hospital Quirón Teknon
Dr. Jose Mª Gil-Vernet

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C/ Vilana, 12
08022 Barcelona

T. +34 93 393 31 95
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