The goal of your initial evaluation with Dr. Guay is to determine the cause of the dysfunction you are experiencing. For men, the issue may be one of decreased libido or sexual desire, ejaculation, or the most common presenting complaint in males, erectile dysfunction (ED). For women, the issue may also be one of decreased libido, problems with sexual arousal, orgasmic dysfunction or insufficient vaginal lubrication.
Erectile dysfunction in men may be caused by psychological or medical conditions. In our clinic, we find that a high percentage of men with ED have underlying medical causes such as diabetes, hypertension or hypercholesterolemia, while some have underlying psychological reasons, and others have a combination of both. In a high percentage of women, organic medical causes underlie sexual dysfunction. Some common causes of sexual dysfunction include:
The Center for Sexual Function at Lahey utilizes a multidisciplinary approach to the diagnosis and treatment of sexual dysfunction. We consider all possible underlying causes, especially multiple medical risk factors that may be triggering or contributing to the condition. Dr. Guay will obtain a detailed medical history, including current medications and a thorough history of your sexual problem (e.g., duration and extent of the dysfunction). A genital examination will be performed, and any other possible contributing factors that are not available from your medical record may be explored. In addition, hormone and other blood tests may be required. If there is a question of psychological versus medical causes of male erectile dysfunction, a nocturnal penile tumescence and rigidity test may be performed with an apparatus that the patient uses in the privacy of his home. For women, results of gynecological exams and tests may be important in determining the underlying cause of a sexual dysfunction.
Besides medical issues, your relationship with your partner is also considered. In fact, partners are encouraged to attend the consultation, if possible. At any stage, if performance anxiety or relationship problems are present, a consultation with a recommended sex therapist is advised. At times, there may be both medical and psychological problems that need to be addressed simultaneously. The treatment approach we use at Lahey has been assembled by the American Association of Clinical Endocrinologists and is available online. A summary of the system of care for the patient and couple is available in the guide's appendix.