Perhaps the most difficult aspect of treatment in this scenario is the necessary first part: discovering that each member of the couple has a sexual problem. Too often, a patient is completely absorbed with his or her own troubles to notice that his or her partner has a problem, too! At first glance, this seems difficult to comprehend: how can you be unaware that your partner has a sexual problem? A little review will convince you that it is not that uncommon.
First, when one half of a couple has a sexual problem, one of the first things that happens -- even when the problem is not primarily a loss of sexual desire -- is that the frequency of intercourse drops. It is difficult to evaluate your partner's functional status when you have sex once a month or less. Second, it is easy to assume that your partner's problem with arousal or disinterest in having sex is a secondary reaction to your own sexual difficulty, not a primary problem of your partner. Third, some sexual difficulties, such as erectile dysfunction, can be episodic at first and thus may not occur at every encounter. Other times, a person will have sex just to please his or her partner without being particularly interested in sex.
For these reasons, every new patient evaluation includes a fair amount of time spent questioning the patient about his or her partner to learn about the partner's level of sexual desire and ease of arousal, as well as any difficulties with orgasm or problems with sexual pain. Only after these issues are explored can you be sure that a comprehensive evaluation has been done.