Clinical Case Presentation Checklist for Sexologists
Clinical case discussions are a cornerstone of training and professional development in sexology. Whether in supervision, workshops, or congress presentations, the way a case is structured profoundly shapes the quality of clinical reasoning and collective learning.
However, many case presentations risk oversimplifying sexual dysfunction by falling into a false dichotomy: organic vs psychological causes. In reality, sexual functioning is rarely explained by a single factor. Biological vulnerabilities, psychological processes, relational dynamics, and sociocultural influences interact continuously. Effective case formulation, therefore, requires a biopsychosocial perspective that recognizes how these elements influence one another over time.
One particularly useful framework in sexual medicine is the distinction between predisposing, precipitating, and maintaining factors:
- Predisposing factors increase vulnerability to sexual dysfunction (e.g., personality traits, medical conditions, cultural beliefs about sexuality).
- Precipitating factors trigger the onset of symptoms (e.g., stressful life events, medication changes, relationship conflicts).
- Maintaining factors perpetuate the problem once it has emerged (e.g., avoidance behaviors, performance anxiety, maladaptive couple dynamics).
When clinicians present cases clearly and systematically, they enable colleagues to evaluate the clinical reasoning process, identify missing elements in the assessment, and refine treatment strategies.
The following checklist is designed as a practical guide for sexologists preparing a case presentation.
-
Case Presentation Clarity
☐ Patient demographics (age, gender, orientation)
☐ Relationship status and duration
☐ Partner information (age, health, sexual functioning)
☐ Cultural or religious context
☐ Presenting complaint clearly defined
Important question
Is the presenting complaint described from the patient’s perspective, or from the clinician’s interpretation?
-
Symptom Timeline
☐ Onset of symptoms
☐ Precipitating events
☐ Symptom progression over time
☐ First occurrence vs current severity
☐ Temporal relationship with life events or medications
Key rule
In sexual medicine, the timeline often reveals the diagnosis.
-
Sexual Function Domains Assessed
☐ Sexual desire (spontaneous/responsive)
☐ Arousal (erection / lubrication / subjective arousal / body awareness)
☐ Orgasm or ejaculation
☐ Pain during sex
☐ Sexual satisfaction
Check whether symptoms are:
☐ Lifelong vs acquired
☐ Generalized vs situational
☐ Fluctuating over time
-
Medical Assessment
☐ Relevant medical conditions
☐ Hormonal status
☐ Neurological factors
☐ Cardiovascular risk factors
☐ Medication review (especially antidepressants, antipsychotics, antihypertensives)
-
Psychiatric Assessment
☐ Depression
☐ Anxiety disorders
☐ OCD or compulsive behaviors
☐ Trauma history
☐ Substance use
Important question
Is the psychiatric condition contributing to the sexual problem, or is the sexual difficulty generating psychological distress?
-
Medication Review
☐ SSRIs / SNRIs
☐ Antipsychotics
☐ Mood stabilizers
☐ Hormonal medications
Evaluate:
☐ Timing of medication introduction vs symptom onset
☐ Possible iatrogenic sexual dysfunction
-
Relationship Assessment
☐ Relationship satisfaction
☐ Communication patterns
☐ Sexual expectations
☐ Conflict patterns
☐ Intimacy outside sexual activity
Key point
Many sexual dysfunctions are couple-system problems, not individual disorders.
-
Behavioral and Sexual Practices
☐ Masturbation habits
☐ Pornography use
☐ Sexual frequency
☐ Sexual repertoire
☐ Sexual scripts and expectations
☐ Avoidance behaviors
-
Predisposing, Precipitating, and Maintaining Factors
A strong clinical formulation should identify how different factors interact.
Predisposing factors
☐ Biological vulnerabilities (hormonal conditions, chronic illness)
☐ Psychological traits (anxiety sensitivity, perfectionism)
☐ Early sexual learning or sexual trauma
☐ Cultural or religious beliefs about sexuality
☐ Relationship history
Precipitating factors
☐ Stressful life events
☐ Relationship conflicts
☐ Medication changes
☐ Medical events or surgery
☐ Sexual performance experiences (e.g., erectile failure, rapid ejaculation)
Maintaining factors
☐ Performance anxiety and cognitive focus on performance
☐ Avoidance of sexual activity
☐ Negative couple interaction patterns
☐ Reinforcing sexual scripts or expectations
☐ Persistent fear of symptom recurrence
Key point
This formulation helps explain why the problem emerged and why it persists.
-
Diagnostic Formulation
Check whether your diagnostic hypothesis has:
☐ Identified primary vs secondary dysfunction
☐ Considered biological, psychological, relational, and sociocultural contributors
☐ Evaluated medication effects
☐ Integrated the biopsychosocial formulation
Key point:
How do biological, psychological, and relational factors interact in this specific case?
-
Treatment Plan Evaluation
Does the treatment plan include:
☐ Psychoeducation
☐ Behavioral interventions
☐ Psychological treatment
☐ Medication management
☐ Partner involvement
Important question
Does the treatment plan address the mechanisms maintaining the dysfunction, or only the symptoms?
-
Outcome Monitoring
☐ Clear treatment goals
☐ Objective measures (e.g., erection quality, IELT, FSFI)
☐ Subjective measures (e.g., satisfaction with the results, less distress)
☐ Follow-up timeline
Key point:
Monitoring progress allows clinicians to evaluate whether the treatment hypothesis was correct or needs adjustment.
Final Reflection
When discussing a case, colleagues can ask:
- What is the primary mechanismof the dysfunction?
- What evidence supportsthis formulation?
- What alternative explanations might exist?
Clinical excellence in sexology does not emerge from identifying a single cause, but from understanding how multiple factors converge in a patient’s sexual life.
Sexual dysfunctions rarely arise from isolated biological or psychological causes. Instead, they reflect the interaction of medical conditions, emotional processes, relational dynamics, sexual learning, and sociocultural influences. A structured case presentation helps clinicians capture this complexity and prevents premature conclusions.
Using a systematic checklist encourages clearer thinking, more precise diagnosis, and more targeted treatment planning. It also improves the educational value of case discussions in supervision, training programs, and professional conferences.
Ultimately, the goal is not only to present a case clearly but to demonstrate the clinical reasoning process behind assessment and treatment decisions. By adopting a biopsychosocial framework and carefully considering predisposing, precipitating, and maintaining factors, sexologists can better understand the mechanisms underlying sexual dysfunction and design interventions that truly address the needs of their patients.
