Erectile Dysfunction: Classification

The causes of erectile dysfunction are divided into an organic and a nonorganic, psychogenic genesis. However, it is always difficult to establish a causal pathogenesis, because even purely organic forms always lead to a psychological co-reaction, which affects the self-esteem of the man and leads to personality changes (Popken 2002). Another classification of erectile dysfunction is the following (after Lizza and Rosen, 1999):

Organically induced erectile dysfunction.

  • Vascular
  • Arterial
  • Venous
  • Mixed
  • Neurigen
  • Anatomical
  • Endocrine

Psychogenic erectile dysfunction.

  • Generalized type
    • Lack of sexual interest
    • Primary libido deficiency
    • Age-related decrease in sexual interest
    • Generalized disability
    • Chronic disorders of intimate relations
  • Situational type
    • Partner-related
    • Situation-related
    • Conflict-related

International Index of Erectile Function (IIEF)

The International Index of Erectile Function (IIEF) is a widely used multidimensional self-examination tool for assessing male sexual function. It is recommended as the primary endpoint for erectile dysfunction (ED) clinical trials and for diagnostic assessment of ED severity. The following questions refer to possible erectile dysfunction in the past 4 weeks. Each question allows only one answer.

How often were they able to get an erection during sexual activity1? Points
No sexual activity 0
Almost never/never 1
A few times (much less than 50%) 2
Sometimes (about 50%) 3
Most of the time (much more than 50%) 4
Almost always/always 5
If you had erections during sexual stimulation2, how often were your erections hard enough for penetration?
No sexual activity 0
Almost never/never 1
A few times (much less than 50%) 2
Sometimes (about 50%) 3
Most of the time (much more than 50%) 4
Almost always/always 5
If you attempted to have sexual intercourse3, how often were you able to penetrate your partner?
Did not try sexual intercourse 0
Almost never/never 1
A few times (much less than 50%) 2
Sometimes (about 50%) 3
Most of the time (much more than 50%) 4
Almost always/always 5
During sexual intercourse, how often were you able to maintain your erection after penetrating your partner?
Did not try sexual intercourse 0
Almost never/never 1
A few times (much less than 50%) 2
Sometimes (about 50%) 3
Most of the time (much more than 50%) 4
Almost always/always 5
During intercourse, how difficult was it to maintain your erection until intercourse was completed?
Did not try sexual intercourse 0
Extremely difficult 1
Very difficult 2
Difficult 3
Somewhat difficult 4
Not difficult 5
How would you rate your confidence in getting and keeping an erection?
Very low 1
Low 2
Medium 3
High 4
Very high 5
Total score

1 Sexual activity: includes sexual intercourse, caresses, foreplay, and masturbation (self-satisfaction).2 Sexual stimulation: Includes situations such as making love to the partner, looking at erotic pictures, etc. 3 Sexual intercourse: Is defined as vaginal penetration of the partner (penetration into the partner). Interpretation

Total score 6-10 11-16 17-21 22-25 26-30
Strength of erectile dysfunction severe moderate light to moderate mild none

A score of less than 26 is likely to indicate erectile dysfunction if symptoms persist for an extended period (at least 3 months).