When a man's sexual function declines, all he knows is that he can't perform and wants the problem fixed right away. Treatment follows diagnosis. The medical history and a series of directed questions, followed by a physical exam and some lab tests, are all that is required. Your physician will ask a series of questions to understand when and why you first started to have sexual problems. He will also want to know your general medical history, current medications, and something about your habits. Then he will do a physical exam, obtain a blood sample for some laboratory tests, review the results, and then determine what treatment is best for you. The types of questions your doctor will ask and the physical exam he will perform are outlined in this chapter.
When did your sexual problems begin?
For most men, sexual problems evolve as an insidious stuttering process characterized by intermittent loss and restoration of sexual function over several years. As the condition responsible for the original sexual failure becomes more firmly entrenched, a man struggles to maintain some sexual interest and potency. Eventually, he experiences a complete loss of sexual capabilities.
Sometimes, however, an impotent man may describe a different scenario and give a history of sudden loss of sexual potency that then becomes persistent and unremitting, as in the following case: "I can tell you the exact date and time that the problem happened. It was 11:00 P.M. on my wife's birthday. Four months earlier, on my birthday, sexual function was fine. When her birthday rolled around, I was unable to perform and have been unable to get an erection from that date on."
Psychologic problems are the most likely cause of impotence for this man and other men with similar histories. With the exception of acute penile or spinal-cord trauma, no physical or physiologic process causes a sudden and permanent disappearance of male sexual function.
When was the last time your sexual function was normal?