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Please fill out The Decreased Sexual Desire Screening (DSDS) Form
7
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1
Name
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First Name
Last Name
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2
Email
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example@example.com
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3
In the past was your level of sexual desire or interest good & satisfying to you?
YES
NO
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4
Has there been a decrease in your level of sexual desire or interest?
YES
NO
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5
Are you bothered by the decreased level of sexual desire or interest?
YES
NO
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6
Would you like your level of sexual desire to increase?
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7
What factors do you feel may be contributing to your current decrease in sexual desire or interest?
An operation, depression,injuries,,or other medical injuries
Medication, drug, or alcohol you are currently taking
Pregnancy, recent childbirth, menopausal symptoms
Other sexual issues you may be having (pain or decreased arousal)
Your partner's sexual problems
Dissatisfaction with your relationship or partner
Stress or fatigue
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