Sexological diagnosis

The realization of each person's sexual desire depends on his or her knowledge of sexuality, previous experiences, emotional attitudes, personality traits, interpersonal relations, trauma, the state ofiasomatic health, the intensity of external stimulation, the internalization of cultural patterns and social norms, the ability to provide intimacy and many other factors. Their mutual coordination, can ensure the proper course of the sexual activity undertaken. The correct course has such an activity that leads to a steady increase in sexual tension, up to the threshold of discharge, after which orgasm with its mental and physical attributes is achieved.

Weakened or disturbed sexual function is, in the vast majority of cases, only an incidental symptom of disturbed partnerships, excessive stress on the nervous system or somatic conditions. Many sexual dysfunctions have their significant causes in the distant past of the patient's life, sometimes in childhood, and current situations that seem to play the role of causes of the disorder are only a trigger system. Therefore, in the process of sexological diagnosis, it is of great importance to correctly reconstruct the patient's biography, which would allow to catch possible socio-cultural determinants of the symptom, repressed traumas, improperly resolved family relationships.

The onset of sexual dysfunction can involve any of the stages of the sexual response cycle: desire, arousal, orgasm and refraction (a sense of mental and physical fulfillment). Problems can arise at any age and can be caused by various factors: psychogenic, somatic or sociocultural.

Depending on the cause, we divide them into two groups:

I. Psychosexual dysfunctions,

II. Symptomatic sexual dysfunction in the course of:

- diseases and physical conditions,

- mental illnesses,

- past injuries and surgical procedures,

- medication intake,

- ingested chemical compounds other than drugs.

The considerable number of factors determining the onset of sexual arousal and factors controlling the course of sexual activity of both physiological and psychological nature, and the fact that each of them has a kind of veto right, deciding at the appropriate moment to interrupt or distort the sexual response, is the reason why the clinician must consider each of them as a possible, decisive cause of the sexual disorder with which the sufferer reports to the sexologist's office.

The goals of the diagnostic procedure in the sexologist's office are:

1. Making a clinical diagnosis or description of a sexual problem,

2. Determine the etiology ( cause ) of the sexual disorder or dysfunction,

3. Selection and proposal of an appropriate treatment method.

In the process of sexological diagnosis, the role of the sexologist is to obtain results that allow the drafting of diagnostic hypotheses, concerning:

1. Mechanisms biological and psychological mechanisms involved in the formation and functioning of a given disorder sexual activities, 

2. The role of the patient's personality in the formation and functioning of a particular sexual dysfunction,

3. The impact of a specific sexual dysfunction on the patient's personality and interpersonal relationships,

4. Mental dysregulation accompanying or underlying the sexual dysfunction in question,

5. Psychological characteristics of the patient person that can have a significant impact on the effectiveness of therapeutic management.

Determining the etiology of dysfunction involves differential diagnosis of psychogenic and somatogenic sexual dysfunctions.

PSYCHOLOGICAL DIAGNOSTICS

1. psychosexual history - includes in its scope all biological, psychological and social aspects of the patient's past life and development, with particular emphasis on past sexual experiences and preferences and current sexual life:

1.1 Family home,

1.2 Psychosocial development,

1.3 Sexual development,

1.4 Erotic experiences,

1.5 Marriage relationship (current partnership arrangement),

1.6 The origin, dynamics and accurate description of the sexual problem,

1.7 Sexual behavior.

2 Test studies

2.1 MMPI

2.2 Other selected test studies ( to be decided by the clinician)

3. psychological observation - refers to the behavior of the patient person during the sexological subject examination, as well as interactions occurring between the patient person and the partner/partner during joint visits to the sexologist.

MEDICAL DIAGNOSTICS

1. sexological interview

1.1 A thorough description of the sexual problem by the patient person,

1.2 Description of the problem by the patient's partner(s).

2 Medical history:

2.1. past illnesses, surgeries, injuries,

2.2. current medical conditions,

3.3. medications taken,

4.4. addictions.

3 Physical examination:

3.1. andrology,

3.2. gynecological,

3.3. neurological,

3.4. other specialized consultations (psychiatric, cardiology, endocrinology)

4 Laboratory tests:

4.1. glucose levels, sugar curve,

4.2. endocrine system assessment

- Free and total testosterone,

- FSH, LH, prolactin,

- cortisol, SHBG,

- ovulation cycle assessment,

- Other necessary determinations of hormone levels, functional tests.

4.3 Semen testing

5. other selected diagnostic tests:

- EEG,

- CT, MRI,

- ULTRASOUND,

- Exercise ECG.

The results obtained in the course of the diagnostic processes ( psychological and medical) make it possible to carry out a multidimensional evaluation of the sexual problem and stop proposing an appropriate method of treatment.