Diabetes and erectile dysfunction

How common is erectile dysfunction in men with diabetes?

Very common. A systematic review published in Diabetic Medicine in 2017 pooled the results of 145 studies and found that roughly half of men with diabetes had some degree of erectile dysfunction. That is considerably higher than in men without diabetes of a similar age.

Erectile problems also tend to start earlier in men with diabetes, and they can be more severe. None of this means every man with diabetes will be affected, but it does mean the subject is worth raising rather than avoiding.

Why does diabetes cause erectile dysfunction?

An erection needs three things to work well: healthy blood vessels, working nerves and a supportive hormonal background. Diabetes can affect all three.

• Blood vessels. Over time, raised blood sugar damages the endothelium, the thin inner lining of arteries. That lining is what allows vessels to widen and let blood rush into the penis. When it is damaged, erections become weaker or harder to sustain.
• Nerves. Diabetic neuropathy, the nerve damage that can cause numbness in the feet, can also affect the nerves that trigger an erection.
• Hormones. Type 2 diabetes and obesity are associated with lower testosterone levels in some men, which can reduce desire.
• Company it keeps. Diabetes often comes with high blood pressure, raised cholesterol and excess weight, and some of the medicines used for these can affect erections as well.

Mood matters too. Living with a long-term condition is demanding, and worry or low mood can add a psychological layer to a physical problem, as we explain in can stress really cause erectile dysfunction?

Can erectile dysfunction be a sign of diabetes?

It can. Some men first learn they have diabetes after seeing a doctor about erections. That is why guidelines recommend checking blood sugar as part of a standard assessment.

It is also a signal about the heart. Men with diabetes are already at higher cardiovascular risk, and erectile dysfunction adds to the picture. The Princeton III consensus on erectile dysfunction and cardiovascular disease recommends that men with ED have their heart risk assessed, and men with diabetes are a group where this is particularly relevant. Our article on why erectile dysfunction can be an early health warning explains the link.

Can diabetes-related erectile dysfunction be improved?

Often, yes, although it can take more than one step. The foundations are the same ones that protect the rest of the body:

• keeping blood sugar within the target agreed with your diabetes team;
• managing blood pressure and cholesterol;
• stopping smoking;
• regular physical activity and, where needed, weight loss;
• reviewing medicines with your doctor if you suspect one is affecting erections.

These measures help protect blood vessels and nerves over time. They do not always reverse damage that is already established, which is why treatment for the erection itself is often used alongside them.

What treatments work for men with diabetes?

Men with diabetes are offered the same range of treatments as other men. Tablets such as sildenafil and tadalafil are usually tried first when they are suitable, although men with diabetes may respond less strongly than men without it. Other options include vacuum devices and injections into the penis.

When these do not work well enough or are not acceptable, a penile implant may be considered. Diabetes is taken into account in planning surgery, especially because of the risk of infection, and good blood sugar control beforehand matters. We explain the wider decision in when is a penile implant considered?

When to see a doctor

If you have diabetes and your erections have become less reliable, mention it at your next diabetes review or see a urologist. If you do not have diabetes but have noticed new erectile problems, a blood sugar test is a simple and sensible part of the check-up. Our page on penile implants and diabetes covers the surgical side in more detail.

Questions men also ask

Can erectile dysfunction be the first sign of diabetes?

Sometimes, yes. Because diabetes can damage small blood vessels and nerves before other symptoms appear, a blood sugar test is part of a standard assessment for erectile dysfunction.

Can better blood sugar control reverse erectile dysfunction?

It helps protect blood vessels and nerves and may improve erections in some men, but established damage does not always reverse. Treatment for the erection itself can be used at the same time.

Can men with diabetes have a penile implant?

Many can. Diabetes is taken into account in planning, particularly because of infection risk, and good blood sugar control before surgery is important.

Sources & further reading

1. Diabetic Medicine High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies (opens in a new tab) (2017) Kouidrat Y, et al.
2. European Urology European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction (opens in a new tab) (2021) Salonia A, et al.
3. Journal of Urology Erectile Dysfunction: AUA Guideline (opens in a new tab) (2018) Burnett AL, et al.
4. Mayo Clinic Proceedings The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease (opens in a new tab) (2012) Nehra A, et al.

This article is general health information. It does not replace an individual medical consultation, examination or diagnosis. Read our editorial policy and medical review policy.