Diagnostic Evaluation: IIEF, Nocturnal Tumescence, Doppler

IIEF Questionnaire and Quantification of Erectile Function

In the clinical sexological eva luation of erectile dysfunction, the International Index of Erectile Function—either in its full form or in the abbreviated IIEF-5 version—is the primary standardized psychometric tool.

This self-administered instrument quantifies erectile function, satisfaction during intercourse, orgasmic function, sexual desire, and the patient’s overall satisfaction.

Through specific questions regarding the firmness, maintenance, and confidence in erections, the total score categorizes the disorder as mild, moderate, or severe.

Its rigorous implementation helps establish a numerical baseline for comparing the severity of the dysfunction, objectively measuring the effectiveness of therapeutic interventions, and reducing biases stemming from subjective perception.

It also serves as a catalyst for the patient to express intimate aspects of his erotic experience, integrating subjective perception with the clinical diagnosis.

Recording of Nocturnal Penile Tumescence and Rigidity

The nocturnal penile tumescence and rigidity test, using continuous sensors, assesses involuntary episodes of erection occurring during deep sleep phases.

Physiologically, a healthy man experiences three to five erectile events per night, each lasting between twenty and thirty minutes.

The diagnostic utility of this technique lies in its ability to differentiate between psychogenic and organic etiologies.

When the recording shows nocturnal erections that are normal in frequency, rigidity, and duration, it confirms that vascular, neurological, and tissue integrity is preserved, pointing to psychological, environmental, or relational causes.

Conversely, an abnormal or absent recording indicates an underlying organic condition, such as vascular, metabolic, or neurological disorders.

Thus, the test provides crucial physiological evidence when the patient’s medical history is ambiguous or when there are doubts regarding an organic component.

Dynamic Penile Doppler Ultrasound and Vascular Evaluation

Dynamic penile Doppler ultrasound, performed by pharmacologically inducing a vasculogenic erection with intracavernosal vasoactive agents, is the objective test par excellence for hemodynamic diagnosis.

This medical procedure allows for direct assessment of the hemodynamic integrity of the cavernous arteries and the physiological competence of the veno-occlusive system.

The clinician measures key vascular parameters such as peak systolic velocity and end-diastolic velocity.

An adequate peak systolic velocity rules out arterial insufficiency, while a reduced end-diastolic velocity confirms that the venous trap mechanism is functioning properly.

If the systolic velocity falls below normal thresholds, arterial insufficiency is confirmed.

If the diastolic velocity remains abnormally elevated following vasoactive stimulation, venous leakage or veno-occlusive dysfunction is accurately diagnosed.