Recommended Care
• A detailed history and examination should be conducted in an unintimidating private setting with structured interviews by encouraging discussion regarding sexual concerns in both men and women with diabetes.
• Appropriate language considering the patient’s age and culture should be used to make the patient comfortable.
• Psychological and social disturbances if any, should be discussed in an empathetic manner.
• Promotion of lifestyle changes to reduce the associated risk factors should be encouraged in patients with diabetes of both sexes.
Men
• Adult men with diabetes should be screened with a detailed sexual function history for ED as early as when they are diagnosed with diabetes.
• Detection of ED and evaluation of the response to treatment should be performed by validated questionnaires such as IIEF or Sexual Health Inventory for men.
• PDE-5 inhibitors may be offered as a first-line therapy for the treatment of ED in men with diabetes as they improve the quality of life of the patients and are associated with low side-effects.
• Symptoms of hypogonadism including lack of interest in sex and ED should be investigated further with a screening for serum testosterone concentration in the morning. Testosterone replacement may be beneficial in men with diabetes with symptomatic hypogonadism.
Women
• To identify whether a diabetic woman has sexual dysfunction, eliciting a detailed history in a compassionate manner and examination is the first step.
• Several self-reported validated questionnaires such as Female Sexual Function Index, the Female Sexual Distress (FSD) Scale, the Brief Index of Sexual Functioning for Women, and the Derogatis Interview for Sexual Function have been developed to assess FSD.
• Currently, the therapeutic recommendations for FSD include maintaining a healthy lifestyle, achieving an optimal glycemic control, genitourinary infection control, resolving psychosocial issues.
• Treatment with water-based vaginal lubricants, hormone replacement therapy, clitoral therapy device, genital infection control therapy are recommended.
• Treatment strategies with dehydroepiandrosterone supplementation, estrogen or androgen replacement, flibanserin (serotonin 1A receptor agonist and a serotonin 2A receptor antagonist) and PDE-5 inhibitors are investigated, however, currently there is limited evidence for their use.