Here's a step-by-step guideline of how to diagnose and treat sexual dysfunctions.

Assessment of Sexual Dysfunctions

Often requires medical evaluation

• By competent, sensitive physician

Psychosocial evaluations

• Can be complex
• Multiple etiologies
• Distinguishing cause. effect, & their interaction
• Frequently identify co-morbidities
• Sexual and non-sexual
• Medical and psychological
• Within and between partners

Ideally both partners get interviewed

• Together and separately
• Not always possible
• Could itself be diagnostic
• Identified patient is sent in to be “fixed”
• Stories often differ
• Even about objective data
• Often about conceptions of the problem
• Or even if there is a problem

“There are no unaffected partners in sexual dysfunctions” (Bill Masters)

• Resentment
• Anger
• Doubts
• Does she still love me?
• Does he still find me attractive, sexy, appealing?
• Diminished Quality of Life

Sexual dysfunctions vary across several dimensions

• Nature of presenting complaint
• Is this really a sexual problem?
• Length of dysfunction
• Primary vs. Secondary
• Has the person always had the dysfunction or was there ever a period of good functioning?

Sexual dysfunctions vary across several dimensions

• Medical vs. Psychological Etiology
• Frequently difficult to determine
• Particularly if problem is of long duration
• Locus of problem?
• One partner, the other, or both?
• Do both partners see this the same?
• Single or multiple dysfunction(s)
• In one partner or both?
• Relationship, if any, of multiple dysfunctions?

Important to explore

• How each partner understands the problem
• What has the couple has tried to deal with the problem?
• With what success?
• Anything make it better/worse?
• What is the non-sexual relationship like?
• Non-sexual sources of stress
• Health problems?
• Medications?
• Why are they in treatment now?
• What does each hope to get from treatment?
• How willing is each to participate in treatment?
• Strengths, as well as problems
• What competes with sex?
• Time, work, kids
• A detailed description of what the couple typically does sexually
• Maladaptive attitudes, beliefs, behaviors, and expectations
• Each partner’s outside sexual experiences
• Before or during this relationship
• What’s at stake if the problem isn’t resolved?
• Is the problem also a solution?
• Secrets
• Fantasies