What should be included in a sexual history for the evaluation of erectile dysfunction (ED)?

Updated: Aug 08, 2018
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Even clinicians who are not comfortable dealing with ED should inquire into the sexual aspect of the patient’s health. A simple way to do this is simply to ask, “How’s your sex life? Everything working all right?” This type of inquiry should elicit a clear, quick, direct “Everything’s fine” from the patient. Any other response or even just a delay in answering should suggest potential ED in that patient.

If ED is a possibility, questioning should be aimed at determining which part of the sexual response is abnormal. A clear description of the problem is vital. The following information should be elicited:

  • Whether the patient has difficulty obtaining an erection

  • Whether the erection is suitable for penetration

  • Whether the erection can be maintained until the partner has achieved orgasm

  • Whether ejaculation occurs

  • Whether both partners experience sexual satisfaction

Taking the sexual history also allows the clinician to begin forming an objective opinion regarding the interpersonal relationship between the patient and his sexual partner.

Premature (early) ejaculation generally occurs in men younger than 40 years. This problem can place a great deal of stress on the couple’s relationship. A history of premature ejaculation can be obtained from many men who present in later years with erectile difficulty. Effective treatments, including selective serotonin reuptake inhibitor (SSRI) medications and sex therapy, are available to remedy this condition. (See Premature Ejaculation.)

The sexual history may include specific questions such as the following:

  • Are you ever able to obtain an erection suitable for penetration, even momentarily?

  • Is your ED getting worse or stable?

  • How long have you had trouble attaining or maintaining an erection?

  • How hard is the erection, on a scale of 0-100?

  • Is maintaining the erection a problem?

  • Have you ever had a traumatic sexual experience?

  • Are you able to achieve orgasm and ejaculation?

  • Approximately how long are able to have intercourse before ejaculating?

  • Do you use any type of contraceptives, such as condoms?

  • Do you experience nocturnal or morning erections?

  • Does pain or discomfort occur with ejaculation?

  • Do you have premature (early) ejaculation?

  • Is penile curvature (Peyronie disease) a problem?

  • How frequently do you have sexual activity? Is it typically spontaneous or planned?

  • If your erections were functional, what would be your preferred frequency of intercourse? Do you and your sexual partner agree on this issue?

  • Is adequate foreplay occurring? Is your sexual partner satisfied with the sexual experience?

  • Have you already tried any treatments? If so, what were they? Are you interested in trying a particular treatment first? Are you opposed to trying a particular type of therapy?

  • To what degree do you wish to proceed in determining the cause of the ED? How important is this to you?


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