Patient History

It helps to remember that in many ways a sexual problem is no different from any other medical problem and that the line of questioning follows the same principles:

1. Clarification of the problem. Can you tell me more about that? 
2. How long has the problem been present? Is it primary (lifelong) or secondary (following a period of “normal” sexual functioning)? If secondary, what else was going on in her life at the time? 
3. Is it present in all situations (global) or only in certain situations (situational)? 
4. How has it changed over time? Has it gotten better, worse, or stayed the same? 
5. If the problem is dyspareunia, then the same line of questioning should be followed as one does for any pain, including exact location, when it comes on and when it leaves, radiation, aggravating and alleviating factors, etc. 
6. Is there anything that makes the situation better? For example, does her libido improve when on holidays? Anything make it worse? For example, is there any relationship to timing in the menstrual cycle, or to a specific life event such as a new job or the death of a parent? 
7. How is this affecting her relationship? Are they still sexually active, perhaps in noncoital ways, or have they ceased sexual activity altogether? Do they still show physical affection or does she avoid this for fear it may lead to sex? What is her partner’s reaction to the situation? 
8. If the problem has been going on for a long time, it is important to ask what made her decide that now is the time to do something about it. (Has her partner threatened to leave? Is she very uncomfortable discussing sexual matters and has only come because the situation has finally reached a point where she and/or the partner find it intolerable?) 
9. A general medical history and review of systems is important, particularly in a new patient. 
10. Does the partner have any sexual difficulties? 
11. What are her and her partner’s thoughts on possible causes for the problem? What have they tried? 
12. Has she seen anyone else about this and if so, what was suggested and what was the outcome?

It is not unusual for a woman to present with problems in more than one component of the sexual response cycle. In that case, it is crucial to determine what came first. For example, is she not interested in sex because it hurts or does it hurt because she is not interested and so does not lubricate?