Never Sometimes Most times Always
13. Do you know your average blood sugar level (A1C)?
Yes No
14. Have you ever checked your blood sugar level before or after sexual intercourse?
Yes No
15. If yes, do you experience hypoglycemia (low blood sugar) with this activity?
Yes No
16. Do you feel that diabetes is a cause of your sexual problem?
Yes No
17. Has your sexual problem interfered with your relationship with your partner?
Yes No
18. Has your sexual problem interfered with your job?
Yes No
19. Has your sexual problem interfered with your family?
Yes No
20. Are you feeling depressed over this problem?
Yes No
QUIZ 2:
Have Diabetes-Related Sexual Complications Entered Your Life? (for women)
1. Describe your desire for intercourse.
Poor Fair Stron Very Strong
2. Describe your partner’s desire for intercourse.
Poor Fair Strong Very Strong
3. Are you able to reach orgasm with intercourse?
Never Sometimes Most times Always
4. Are you able to reach orgasm when you are alone?
Never Sometimes Most times Always
5. Do you have a decreased amount of vaginal lubrication?
Never Sometimes Most times Always
6. Is your blood sugar under control?
Never Sometimes Most times Always
7. Do you know your average blood sugar level (A1C)?
Yes No
8. Have you checked your blood sugar before or after sexual intercourse?
Yes No
9. If yes, do you experience hypoglycemia (low blood sugar) with this activity?
Yes No
10. Do you have frequent vaginal and/or bladder infections?
Yes No
11. Is intercourse painful?
Yes No
12. Has your sexual problem interfered with your relationship with your partner?
Yes No
13.