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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.

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