My Question

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Name (optional)
email
City / State
Country
Age
Sex	Male Female
Marital Status
Category of Problem
Describe the problem/concern
Since when/how long do you have it
Always present? (If not, when did it begin?)
Does it occur with every partner or with only some?
What in your opinion is the cause of the problem?
Who is affected by this ?
Taking or taken any medications for this problem? Which medicines? How long?
Do you or did you have any other health problems? Since when?
Undergone any surgeries?
Tried self-help? (describe)

Rights: Abhisarika, India