ABSTRACT
Before selecting a pharmacological agent for the treatment of any given sexual disorder, one should identify the nature of the presenting sexual problem from a detailed history-taking and thorough physical evaluation and after adequate consideration of results of all pertinent laboratory and, if necessary, special testing procedures. Moreover, if the initial investigation is suggestive of an inciting pharmacological agent or the intake of an addictive drug, a trial of the inciting pharmacological agent or discontinuation of the drug of addiction should be attempted before prescribing an additional agent for the management of the sexual problem. Identification of the presenting problem can also help in directing the subsequent physical and laboratory evaluations as well as in selection of the most suitable therapeutic intervention. For example, patients presenting with hypoactive sexual desire would need to be evaluated for possible underlying hypogonadism, hypothyroidism, or the presence of central nervous system (CNS) disease, and treatment of desire deficiency in these conditions should primarily start with the replacement of the deficient hormone(s) or treatment of the underlying CNS disorder. Similarly, patients with erectile dysfunction (ED), absent or retarded emission, anorgasmia, or painful erection should be surveyed not only for the presence of medical illnesses associated with these sexual problems but also for the adverse sexual effects of drugs used to treat these medical conditions.
