Sexual dysfunction is common but can present as a covert problem. Patients expect doctors to ask about sexual functioning, but many doctors have had little education and training about sexuality. Personal attitudes may inhibit skills and influence patient management. Key features in the history are whether the problem is primary or secondary, what else happened around the time the difficulty began, and whether it happens consistently or only in certain circumstances. The way a patient reacts in the consultation with the doctor may shed light on the manner in which she relates to significant others in her sexual life. Physical examination is an important tool. It not only establishes the physical findings, but, if carefully observed, can also reveal as much non-verbal material as the history. Investigations are rarely needed and should be guided by the history, not ordered routinely. Treat each patient as an individual with a unique problem.
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