Erectile
Dysfunction (ED)

Diagnosis, severity levels and what to do now

You know something isn't right. The erection has become unreliable, the pressure is rising, the issue is weighing on you. The first and most important step now is not a prescription — but a precise diagnosis. Because whoever knows what's going on can act in a targeted way.

This page explains how erectile dysfunction is defined and classified, how the severity level is determined — and what a thorough medical evaluation looks like, one that goes beyond a quick prescription.

Erectile dysfunction — have it evaluated by a specialist now

30–45 minute initial consultation, complete hormone panel, individual findings report. Nationwide via telemedicine.

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What is erectile dysfunction —
the medical definition

The term sounds more complicated than it is. Erectile dysfunction (ED) — also called impotence, although this term is largely avoided in medicine — describes the repeated inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse.

The severity levels of erectile dysfunction

Not every case of ED is equally severe. The classification into severity levels helps the doctor choose the treatment strategy — and gives the patient a realistic picture of where he stands.

Severity level	IIEF-5 Score*	Description	Typical picture
No ED	22–25	Normal erectile function	Erection regularly firm, without problems
Mild	17–21	Occasional difficulties	Erection sometimes softer, but usually holds
Mild–Moderate	12–16	More frequent difficulties	Erection often unreliable, penetration sometimes difficult
Moderate	8–11	Significant impairment	Erection mostly insufficient, penetration often not possible
Severe	1–7	No sufficient erection	Little or no erection achievable or sustainable

* IIEF-5: International Index of Erectile Function — validated questionnaire for assessing erectile function. Score from 5 questions, maximum 25 points. Explained further down on this page.

The three criteria of the ED diagnosis (WHO / EAU guideline)

① Duration: The problems have existed for at least 3 months.

② Frequency: They occur in more than half of sexual situations.

③ Distress: The situation burdens the man and/or the partnership.

All three criteria must be met before speaking of erectile dysfunction.
Occasional erection problems without these criteria are not a disease.

Important: The ED diagnosis says nothing yet about the cause. It is the first step — which must be followed by a thorough investigation of the cause.

The IIEF-5 questionnaire: How the severity level is measured

The IIEF-5 questionnaire: How the severity level is measuredThe IIEF-5 (International Index of Erectile Function, short version) is the internationally most widely used instrument for the standardized assessment of erectile function. It consists of 5 questions that are answered on a scale from 1 to 5 — maximum 25 points.

At AndroKlinik, the IIEF-5 is part of the medical history form that you receive by link before the initial consultation. This way, the doctor already has a structured assessment before the conversation begins.

Here is a preview of the five questions — for orientation:

Question (simplified)	Almost never	Rarely	Sometimes	Mostly	Almost always
How often are you able to get an erection?	○	○	○	○	○
How often is your erection firm enough for penetration?	○	○	○	○	○
How often can you maintain the erection during sexual intercourse?	○	○	○	○	○
How difficult is it to maintain the erection until the end?	○	○	○	○	○
How often is sexual intercourse satisfying for you?	○	○	○	○	○

Note: The IIEF-5 is a screening instrument — not a definitive diagnosis. The classification is always made in the context of the overall findings by the doctor.

Discuss your IIEF-5 score directly with the specialist

You fill out the questionnaire in advance — the doctor is already prepared for the initial consultation.

Book a consultation now

The diagnostic process: What happens at AndroKlinik

A thorough ED diagnostic evaluation is more than a questionnaire and a prescription. It is a systematic investigation of the cause — because the treatment depends on the cause. That is the difference between a 5-minute conversation and a real andrological evaluation.

#	Diagnostic step	What is examined
1	Medical history form (in advance by link)	Symptoms, duration, frequency, IIEF-5 score, medications, pre-existing conditions, lifestyle, relationship situation, sleep — all recorded in a structured way before the conversation
2	Initial video consultation (30–45 min.)	In-depth medical history, targeted follow-up questions, erection type analysis (morning? situation-dependent?), psychological factors, partnership context
3	Complete hormone panel	Testosterone total + free, SHBG, LH, FSH, PSA, estradiol, TSH, blood count, glucose, lipids — blood draw close to home at the partner laboratory
4	Differential diagnosis	Vascular, hormonal, neurogenic and psychological causes are systematically weighed against each other — based on medical history + laboratory results
5	Findings evaluation (video, 48h)	The specialist explains your laboratory values, identifies the probable cause(s), and presents an individual therapy plan
6	Therapy plan & e-prescription	Written plan with recommendations: lifestyle, dietary supplements, P-Shot, shockwave, TRT or other options — depending on findings and preference

Organic or psychological? This is how the doctor distinguishes

The most important diagnostic fork in the ED evaluation: Is the cause primarily in the body — or primarily in the head? In practice, the answer is often: both. But there are reliable clinical indications.

Indications of an organic main cause:

Gradual onset over months or years
Morning erections are absent or have become significantly weaker
Erection remains unreliable even during masturbation
Relevant risk factors present: diabetes, high blood pressure, smoking, obesity
Age over 50, testosterone deficiency detectable in the laboratory
No clear situation dependency

Indications of a psychological main cause:

Sudden onset — often after a specific trigger
Morning erections present and firm
Erection during masturbation succeeds, but not with the partner
Pronounced performance anxiety or fear of failure
Under 40, no relevant physical risk factors
Temporal connection with professional or private stress, separations, traumas

In practice: Even if the main cause is organic, most men develop a psychological component over time — performance anxiety, withdrawal, self-observation. Both levels must be taken into account in the therapy plan.

Further diagnostics –
When they make sense

In most cases, medical history + laboratory results are sufficient for a well-founded therapy decision. In certain situations, further examinations make sense — especially when surgical treatment is being considered or the standard therapy does not work.

Further diagnostics — when and what

Penile duplex sonography (color Doppler):
Measures blood flow in the erectile body arteries — in cases of suspected vascular ED
Nocturnal penile tumescence measurement (NPT):
Objective measurement of nocturnal erections — differentiation organic vs. psychological
Neurological examination:
In cases of suspected neurogenic cause (diabetic neuropathy, spinal cord problem)
Psychological consultation:
In cases of a clearly psychological main cause or when organic treatment is not sufficient
Endocrinological consultation:
In cases of complex hormone findings beyond testosterone

These examinations are coordinated at AndroKlinik as needed and referred to the right specialists.

Erectile dysfunction as an early warning signal
Why the diagnosis goes beyond the erection

An important aspect that is rarely brought up in a 5-minute consultation: Erectile dysfunction is often not just a sexual problem — it is a window into a man's vascular and hormonal health.

Newly occurring vascular ED is statistically associated with an increased risk of heart attack in the following years

Penile arteries (1–2 mm in diameter) react earlier to arteriosclerosis than coronary arteries (3–4 mm)

ED can precede type 2 diabetes mellitus by years

Testosterone deficiency, which contributes to ED, has independent effects on bone density, musculature and heart health

What this means for your diagnosis

At AndroKlinik, cardiovascular markers are a standard part of the evaluation panel.
An ED diagnosis is the occasion for a comprehensive health assessment — not just a prescription.
Many men discover, during the ED evaluation, high blood pressure or diabetes requiring treatment for the first time.

Now have it carefully evaluated — not just treated

Initial consultation + complete panel + individual therapy plan. 48 hours until the findings.

Book a consultation now

Frequently asked questions about the diagnosis of erectile dysfunction

How long does the diagnosis take at AndroKlinik?

From booking to the complete findings usually takes 5–7 days: medical history form directly after booking, initial consultation within 1–2 working days, blood draw at the partner laboratory, findings evaluation within 48 hours after receipt of the laboratory values.

Can I fill out my IIEF-5 score myself and bring it along?

Yes — and it is even helpful. At AndroKlinik, the IIEF-5 is an integral part of the medical history form that you receive before the conversation. If you have already filled it out, the doctor is directly informed at the initial consultation.

What if I am ashamed to talk about it?

That is the most common reason why men wait too long. Via video consultation, many men speak considerably more openly — no waiting room, no one across from you whom you know. Our doctors are specialized in these conversations and conduct them daily. Shame is normal — but it is no reason not to seek help.

Do I have to go to the clinic for the physical examination?

For the initial diagnosis, in most cases no — medical history, IIEF-5, hormone status and differential diagnosis can be fully carried out by telemedicine. If a physical examination (e.g. penile duplex sonography) is medically indicated, this will be discussed and coordinated during the conversation.

Is erectile dysfunction curable?

That depends on the cause. In cases of a psychological main cause, complete remission is very possible. In cases of vascular or hormonal cause, ED is in many cases very treatable — erectile function improves significantly and sustainably when the underlying cause is addressed. In cases of severe organic ED with long courses, there are today also surgical solutions (penile implant) that enable a complete restoration of sexual function.

All treatment options for erectile dysfunction

You now know your findings — or know how they are obtained.

On the next page, you will learn which treatment options exist: from lifestyle and PDE-5 inhibitors through P-Shot and shockwave therapy to the penile implant.

Treatment of erectile dysfunction

Start now with the right diagnosis

Specialist evaluation — discreet, complete, nationwide via telemedicine.

About the author

Dr. med. Timo A. Spanholtz
Specialist for Plastic and Aesthetic Surgery - Specialist for men's health and intimate surgery

Dr. Spanholtz is founder and chief physician of AndroKlinik. With many years of clinical experience in men's health, andrology and reconstructive urology, he accompanies patients from the entire German-speaking region.

Learn more

Erectile
Dysfunction (ED)

Diagnosis, severity levels and what to do now

Erectile dysfunction — have it evaluated by a specialist now

What is erectile dysfunction —
the medical definition

The severity levels of erectile dysfunction

The three criteria of the ED diagnosis (WHO / EAU guideline)

The IIEF-5 questionnaire: How the severity level is measured

Here is a preview of the five questions — for orientation:

Discuss your IIEF-5 score directly with the specialist

The diagnostic process: What happens at AndroKlinik