Recognising and diagnosing erectile dysfunction. The chapter lists the key symptoms, from difficulty getting or keeping an erection to reduced sexual satisfaction. It introduces the International Index of Erectile Function (IIEF), a scoring system covering areas such as erectile strength, orgasm and desire, which can help you assess your symptoms before seeing a doctor. It then explains what a medical assessment usually involves: questions about symptoms and medical and sexual history, a physical examination and possibly blood tests, imaging and a review of medications. The importance of early diagnosis, and possible referral to a specialist, is also covered.