- How long have you had problems with male sexual symptoms?
Why: to determine if male sexual problems have existed since the onset of adult sexual function (lifelong) or may have been preceded by a period of unimpaired function (acquired). This differentiation is ultimately needed to give proper therapeutic direction.
- What male sexual symptoms do you have?
Why: e.g. impotence, reduced libido, hypersexuality, painful ejaculation, premature ejaculation, foreskin symptoms, genital lump, genital sores, genital itching.
- Sudden or gradual onset of the difficulties?
Why: gradual onset often suggests an organic cause (i.e. due to medical problems) while sudden onset often suggests a psychological cause (i.e. depression, bereavement, stress, fatigue, performance anxiety, anger and relationship problems).
- How often do you have male sexual problems?
Why: to determine if intermittent and situational or total (occurs across all situations). Must determine if the low libido exists under all (generalized) or just some (situational) sexual circumstances. Generally a problem that appears only sometimes (e.g. with one sexual partner but not with another) can be thought of as arising from psychosocial origins.
- Are your male sexual symptoms causing problems to you or your partner?
Why: to determine if any deleterious consequences of the male sexual symptoms. e.g. There is no "right" or "normal" number of times you should want to make love. Desire can wax and wane with circumstances and at different periods in a relationship. High or low sexual desire doesn't have to be a problem at all - unless there is a discrepancy with the desire level of your partner or you are taking risks to your health or reputation.
- Are you in a monogamous relationship?
- If you are not in a monogamous relationship, do you always practice safe sex?
Why: to help determine risk of sexually transmitted diseases.
- If you have erectile dysfunction (impotence), is the problem truly impotence?
Why: i.e. inability to achieve or maintain an erection of sufficient quality for satisfactory sexual intercourse. Some people often mistakenly use the term impotence to mean other sexual problems such as premature ejaculation, failure to ejaculate, pain with ejaculation (may suggest urethral stricture or prostate cancer).
- What is the age of the person with the male sexual problems?
Why: it is normal for older men to notice that it takes longer to achieve an erection, it takes longer to achieve subsequent erections and that the penis is less hard when erect. However, no matter what age you are, if you are physically unable to achieve or maintain an erection sufficient for satisfactory sexual activity you should see your doctor for assessment and treatment. Puberty may be associated with an increased libido. Menopause may be associated with a reduced libido.
- Do you still have early morning erections or are you able to achieve erections and ejaculation with masturbation?
Why: if yes, suggests difficulties may be due to psychological cause rather than a medical cause.
- What is the reaction of your partner to your male sexual symptoms?
Why: worries about a sexual problem can become an important perpetuating factor.
- Does your partner have any problems with sexual desire, sexual response, orgasm or pain?
Why: Sexual function involves a partner and thus any sexual dysfunction is also partner related.
- Does love making make you feel happy and relaxed?
- Do you spend much time on love play/fore play?
- Are you able to communicate with your partner about what turns you on, your sexual requirements, fantasies, likes and dislikes?
- Stress levels?
Why: this is one of the key factors for causing sexual problems. Stress lowers the levels of some male body chemicals and thus may have the effect of reducing sexual desire and reducing the ability to perform when you do try.
- Relationship problems?
Why: problems in a relationship can cause sexual dysfunction. e.g. are you and your partner sexually attracted to each other?, how often do you argue with your partner?, do you talk things over with your partner?, how is your love for your partner?
- Are you able to retract your foreskin?
Why: if not this suggests Phimosis which is the inability to retract the foreskin.
- Have you been circumcised?
Why: tumors of the penis are rarely seen in circumcised men. Paraphimosis does not occur in circumcised men.
- History of trauma or accidents?
Why: spinal cord injury, injury to sex organs or broken bones in the pelvic area may cause nerve damage that interrupts the connection between the nervous system and the penis.
- History of sexual abuse as a child or adult?
- Past medical history?
Why: many male sexual problems are associated with other physical conditions e.g. high blood pressure, stroke, heart disease, diabetes, peripheral vascular disease, multiple sclerosis, hormonal disorders ( hyperthyroidism, hypothyroidism, hypogonadism, high prolactin levels), kidney disease, liver disease, prostate enlargement or cancer, Peyronie's disease, Reiter's disease. Any medical condition that causes fatique or tiredness may potentially cause low libido e.g. glandular fever, flu.
- Past surgical history?
Why: surgery to organs such as prostate, bladder or colon may damage nerves that interrupt the connection between the nervous system and the penis.
- Previous radiotherapy to the pelvis?
Why: may cause male sexual dysfunction.
- Medications?
Why: some medications can cause erection problems as a side effect e.g. diuretics (thiazides), some high blood pressure medications (beta-blockers and aldomet), some cholesterol lowering drugs (statins), some diabetes medications, some antidepressants (tricyclics), cancer treatments, some anti-ulcer medications (cimetidine and zantac), tranquilizers (phenothiazines) and epilepsy medications; SSRI antidepressant may cause difficulty with erection and also difficulty with ejaculation if erection is achieved; some medications are associated with an increased sexual desire including levodopa and danazol; some medications are associated with a reduced sexual desire including clomipramine, fluphenazine, methadone, guanethidine, chlorthalidone, guanedrel, methyldopa, spironolactone, fluoxetine, danazol, digoxin, ethinyl estradiol, ketoconazole and niacin.
- Smoking history?
Why: smoking increases the risk of atherosclerosis and peripheral vascular disease which is a major cause of erectile dysfunction.
- Alcohol history?
Why: alcohol abuse or intoxication may cause sexual dysfunction; alcohol intake may increase sexual desire at low dose.
- Illegal drug history?
Why: substance abuse may cause sexual dysfunction e.g. marijuana, cocaine, amphetamines, heroin; amphetamines may increase sexual desire at low dosage.
- Sexual history?
Why: can indicate risk of sexually transmitted diseases such as genital warts, syphilis and herpes.
- Use of anabolic steroids to build muscle bulk?
Why: may affect sexual function.
- Travel history?
Why: e.g. primary syphilis is rare in urban Australia but must be excluded if suspect this diagnosis, especially if there has been recent sexual contact in South East Asia; Donovanosis is endemic in northern and central Australia; Chancroid is usually only seen following sexual exposure in South East Asia, India or Africa; Lymphogranuloma venereum is usually only seen following sexual exposure in East and West Africa, India, parts of Southeast Asia, South America and the Caribbean.
- Family history?
Why: e.g. high blood pressure, heart disease, stroke, peripheral vascular disease, diabetes, hemochromatosis, depression, bipolar affective disorder.
