Diagnosis of sexual dysfunction begins by asking the patient's sexual activity as a whole. In addition to asking for symptoms, the doctor will ask about the patient's activities and disease history, including if there have been events or traumas in the past.

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The doctor will then perform a physical examination, including an examination of physical changes that may affect sexual activity. During the physical examination, the doctor will examine the genital organs. Blood tests may be done to check hormone levels or other suspected causes, including:
- blood sugar levels
- Estrogen and testosterone levels.

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• Blood sugar checks are needed to determine the presence of diabetes mellitus. Diabetes mellitus can cause nerve and blood vessel injury related to sexual dysfunction. High levels of sugar in the blood can damage the natural function of blood vessels, so that a person cannot get an erection optimally.

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Blood sugar examination is taken through a vein that can be checked at several times, namely blood sugar while, fasting blood sugar, and blood sugar 2 hours post prandial.

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• Estrogen examination is an examination using a blood sample taken from a vein in the arm to measure the concentration of the three components of estrogen, namely estrone, estradiol, and estriol in the blood. Estrogens are a group of steroids that are responsible for the development and function of the reproductive organs, as well as the formation of secondary sex characteristics in women. Together with other hormones such as progesterone, it helps regulate the menstrual cycle, is involved in the growth of the breasts and uterus, and helps maintain a healthy pregnancy. Although considered the primary sex hormone for women, it is also found in men and plays a role in bone metabolism and growth in both sexes. Lack of the hormone estrogen can cause sexual dysfunction.

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• Testosterone examination is an examination carried out to measure the level of the hormone testosterone in the blood. Testosterone level tests aim to diagnose medical conditions caused by too much or too low testosterone levels in the blood.

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Testosterone is a male reproductive hormone produced by the testes. During a man's puberty, this hormone makes the voice louder, triggers the growth of penis and chest hair, helps in muscle building and sperm production, triggers libido (sex drive). Whereas in women, testosterone is produced in small amounts in the ovaries. This hormone plays a role in maintaining hormonal balance and regulating other body functions. There are two types of testosterone blood tests, namely the free testosterone test and the total testosterone test. As the name implies, a total testosterone test will measure the overall amount of this hormone, both bound and free testosterone. While the free testosterone index test only assesses the amount of free testosterone. Low testosterone levels can lead to sexual dysfunction.

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• Furthermore, ultrasound examination (Doppler), to check the flow of blood around the organs. Ultrasound examination is useful to see the smooth flow of blood in the penis, in order to stiffen, the penis requires sufficient blood flow. Therefore vascular disease (eg atherosclerosis) can cause impotence.

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Bibliography

1. The Indonesian Ministry of Health. Guidelines for Classification and Diagnosis of Mental Disorders in Indonesia III. Jakarta: Ministry of Health RI Directorate General of Medical Services. 1993
2. Elvira SD, Hadisukanto G. Textbook of Psychiatry. Jakarta: FKUI publishing body. 2013
3. Sadock BJ, Sadock VA. Human Sexuality. Muttaqin H, Sihombing RNE, Editor. Kaplan & Sadock Textbook of Clinical Psychiatry. 02th ed. Jakarta : EGC; 2010. p. 298
4. Maramis FM, Maramis AA. Normal and Abnormal Sexuality Edition 2. Surabaya : Airlangga University Press. 2009. p. 343-65
5. Maslim, R. Diagnosis of Mental Disorders, PPDGJ-III Brief Reference. Edition 1. Jakarta : PT. Noah Jaya. 2001. Pg. 96-97; 111-15.
6. Anurogo D. Understanding Disparity. Jakarta: Surya University. 2013. Vol. 40 No.7.
7. Avasthi, et al. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian J Psychiatry. 59(Suppl 1), pp. S91–S115.
8. Pastuszak, A. (2014). Current Diagnosis and Management of Erectile Dysfunction. Curr Sex Health Rep. 6(3), pp. 164–176.

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Author: dr. Fida Alawiyah (Medical Consultant Doctor PRAMITA Clinical Laboratory Jl. Sultan Abdurrahman No. 9A Pontianak)