Assessment

In evaluating male patients with hypoactive sexual desire, the clinician should routinely obtain a total and free testosterone level and consider procuring a prolactin level. In both male and female patients, a thorough medical and pharmacological history should be elicited. This strategy will identify temporal relationships between the dysfunction and the onset of endocrinological disease, medication use, medical treatment, or substance abuse.

Sexual desire is assessed by enquiring into the patient's quality and quantity of sexual imagery in daytime fantasies and night dreams, desire to engage in sexual behaviour both alone and with a partner, and frequency of sexual activity, alone or with a partner. For DSM-IV and ICD-10, the individual's life context must be considered, namely age, health, and partner status.

Psychological and relational factors that require assessment include:

1. quality of the relationship;

2. feelings about the partner, e.g. positive regard, anger, or loss of respect;

3. impact of extramarital liaisons;

4. sexual orientation incompatibility between the self and partner;

5. history of childhood or adult sexual trauma;

6. negative parental transferences and current or prior history of affective disorder;

7. life circumstances that result in negative emotions, e.g. business failures, death of relatives.

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