Discover Your ED Score & Personalized Treatment Plan
This clinically-validated assessment uses the IIEF-5 (International Index of Erectile Function) combined with advanced hormonal and vascular risk profiling to give you a complete picture of your erectile health.
Root cause analysis: organic vs. psychogenic vs. hormonal
Personalized 5-step treatment recommendations
100% confidential — reviewed by our clinical team
🕐 About 3 minutes · 🔒 HIPAA-protected
Your responses are private. No spam — ever.
Step 1 of 11
Let's start with your contact information
Your results will be reviewed by our clinical team. We may reach out with treatment options.
First Name *
Last Name
Mobile Phone *
We may text your results to this number
Email (optional)
Please enter your first name and phone number.
🔒 HIPAA-protected. We never sell your information.
Step 2 of 11 — IIEF-5 Validated Assessment
How often were you able to get an erection during sexual activity?
Think about the past 4 weeks of sexual activity or attempts.
—
No sexual activity
N/A
1
Almost never or never
1/5
2
A few times (much less than half)
2/5
3
Sometimes (about half the time)
3/5
4
Most times (more than half)
4/5
5
Almost always or always
5/5
Step 3 of 11 — IIEF-5 Validated Assessment
When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
Consider the firmness and rigidity of your erections over the past 4 weeks.
—
No sexual activity
N/A
1
Almost never or never
1/5
2
A few times (much less than half)
2/5
3
Sometimes (about half the time)
3/5
4
Most times (more than half)
4/5
5
Almost always or always
5/5
Step 4 of 11 — IIEF-5 Validated Assessment
When you attempted sexual intercourse, how often were you able to penetrate your partner?
Select the option that best describes your experience over the past 4 weeks.
—
Did not attempt intercourse
N/A
1
Almost never or never
1/5
2
A few times (much less than half)
2/5
3
Sometimes (about half the time)
3/5
4
Most times (more than half)
4/5
5
Almost always or always
5/5
Step 5 of 11 — IIEF-5 Validated Assessment
During sexual intercourse, how difficult was it to maintain your erection after penetration?
Consider how long you were able to maintain firmness during intercourse.
—
Did not attempt intercourse
N/A
1
Extremely difficult
1/5
2
Very difficult
2/5
3
Difficult
3/5
4
Slightly difficult
4/5
5
Not difficult at all
5/5
Step 6 of 11 — IIEF-5 Validated Assessment
When you attempted sexual intercourse, how often was it satisfactory for you?
Consider your overall satisfaction with your sexual experiences over the past 4 weeks.
—
Did not attempt intercourse
N/A
1
Almost never or never
1/5
2
A few times (much less than half)
2/5
3
Sometimes (about half the time)
3/5
4
Most times (more than half)
4/5
5
Almost always or always
5/5
Step 7 of 11 — Advanced Clinical Factors
Do you experience morning erections or spontaneous erections?
Morning erections (NPT — Nocturnal Penile Tumescence) are a key clinical indicator that helps distinguish vascular/hormonal ED from psychological ED. This is one of the most important diagnostic questions.
1
Almost never — I rarely or never wake up with one
2
Rarely — less than once a week
3
Sometimes — once or twice a week
4
Often — several times a week
5
Almost always — most mornings
Step 8 of 11 — Advanced Clinical Factors
How would you rate your sexual desire (libido) over the past 6 months?
Sexual desire is primarily regulated by testosterone. Low libido combined with ED strongly suggests hormonal deficiency — a highly treatable condition that responds well to hormone optimization therapy.
1
Very low or absent — little to no interest in sex
2
Low — noticeably less than before
3
Moderate — average level of desire
4
High — strong sexual desire most of the time
5
Very high — very strong and consistent desire
Step 9 of 11 — Advanced Clinical Factors
How did your erection difficulties first develop?
The onset pattern is a critical diagnostic factor — gradual onset suggests organic causes (vascular, hormonal), while sudden onset often points to psychological or medication-related causes.
1
Gradually over months or years
2
Suddenly within days or weeks
3
After starting a new medication
4
After a stressful event or relationship change
5
I have always had this difficulty (primary ED)
Step 10 of 11
What is your age range?
Age significantly influences ED prevalence and determines which treatment approaches are most effective for you.
A
18–29 years old
B
30–39 years old
C
40–49 years old
D
50–59 years old
E
60–69 years old
F
70 or older
Step 11 of 11
Do you have any of the following conditions or lifestyle factors?
Select all that apply. This helps identify root causes and build your personalized treatment plan.
🔒 HIPAA-compliant — your data is protected and never sold or shared
✅
Assessment Received!
Thank you, . Our clinical team has received your ED assessment and will reach out within 24 hours to discuss your personalized treatment options.
What happens next
📞
A nurse coordinator will call to review your results
📋
A physician will design your personalized treatment plan
💊
Options include oral medications, injections, shockwave therapy & TRT
📧 Send to Dr. J's Clinic
Your ED assessment will be sent securely to info@drjantiagingclinic.com. A member of our team will follow up with you within one business day.
🔒 HIPAA Privacy Notice — This submission contains your protected health information (PHI) and is transmitted securely. Your data will only be accessed by Dr. J Anti-Aging Clinic licensed clinical staff. It will never be sold or shared with third parties. Transmitted under 45 CFR Parts 160 & 164.
