Individuals with diabetes who experience sexual dysfunction should immediately notify their physician. Some patients may feel uncomfortable discussing their sexual difficulties with their physician. However, patients should recognize that their physician views sexual dysfunction as a medical condition and has discussed sexual difficulties with countless other patients.

Diagnosing sexual dysfunction begins with a physical examination and a review of the patient's medical history and often the psychiatric history. During these histories, the physician may ask questions about:

• The duration and frequency of the problem
• History of sexual activity
• Sexually transmitted diseases (STDs)
• Current and previous medications
• Smoking and use of alcohol
• Anxiety, stress or depression
• Hormonal conditions
• Pregnancies or prostate problems

A physician will typically check the glucose (blood sugar) of patients with diabetes. Certain laboratory tests may also be performed, depending on the patient’s gender and type of dysfunction. Male patients may also be referred to a urologist or andrologist (specialist in male reproductive health). Female patients may be referred to a gynecologist or urologist.

Tests that may be recommended for men experiencing sexual dysfunction include:

• Prostate exam (digital rectal exam, DRE) and testicular exam.
  
  
• Blood tests. These can reveal conditions such as low levels of testosterone (male hypogonadism) and high levels of a substance called prostate specific antigen (PSA), which may indicate prostate cancer or prostatitis (prostate inflammation caused by infection).
  
  
• Urine tests. These may reveal disorders such as STDs or other infections.
  
  
• Ultrasound. A painless imaging test that can evaluate matters such as the flow of blood to the penis, prostate enlargement or incomplete emptying of the bladder. This test may reveal prostate or bladder-emptying problems. It may also be used to check for signs of atherosclerosis.
  
  
• Culture of prostate discharge.
  
  
• Nerve (sensory) tests. Tests that measure the strength of nerve impulses in a specific region of the body. These tests, such as electromyography (EMG), are particularly useful in evaluating the effects of diabetic neuropathy.

• Nocturnal penile tumescence (NPT). Also called the stamp test or rigidity test, this test determines whether erections occur during sleep, a normal occurrence for most men. If so, the cause of erectile dysfunction is typically mental rather than physical.

Tests that may be recommended for women experiencing sexual dysfunction include:

• Pelvic examination.
  
  
• Urine tests. These may reveal disorders such as STDs or other infections.
  
  
• Blood tests to measure hormone levels.
  
  
• Cultures of vaginal discharge.
  
  
• Nerve tests.
  
  
• Laparoscopy. This minimally invasive surgical procedure, which can help identify the cause of pain during intercourse, allows the physician to view inside the abdomen and reproductive organs, and check for structural abnormalities.