Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Erectile dysfunction in diabetes mellitus

David K McCulloch, MD
Section Editor
David M Nathan, MD
Deputy Editor
Kathryn A Martin, MD


The inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse is a distressing and common symptom, affecting up to one-third of adult men [1]. The prevalence of erectile dysfunction (ED) increases with age (figure 1), and it is common in men with systemic disorders such as hypertension, ischemic heart disease, or diabetes mellitus.

ED in men with diabetes mellitus will be reviewed here. A general discussion of normal erectile physiology and the treatment of male sexual dysfunction are presented separately. (See "Overview of male sexual dysfunction" and "Treatment of male sexual dysfunction".)


The frequency of erectile dysfunction (ED) in diabetes was evaluated in a survey of 541 men aged 20 to 59 years with diabetes attending a large community diabetes clinic [2]. The prevalence of ED increased progressively with age, from 6 percent in men aged 20 to 24 years, to 52 percent in men aged 55 to 59 years. In addition to increasing age, the main factors associated with ED were peripheral or autonomic neuropathy, retinopathy, long duration of diabetes, and poor glycemic control.

Five years later, new ED had developed in 75 of 275 men [3]. In contrast, only 11 of 128 men (9 percent) who initially had ED regained erectile function; these men were usually younger, had a shorter duration of diabetes, and had features suggesting psychogenic ED when first evaluated. Men in whom ED persisted were more likely to develop retinopathy or neuropathy than men with normal erectile function.

In a similar population study of 1040 Israeli men with diabetes who completed a self-report questionnaire, ED severity increased with diabetes duration, poor glycemic control, diuretic therapy, and presence of microvascular or cardiovascular disease [4]. In addition, observational studies suggest that the presence of ED is a predictor of cardiovascular events in men with diabetes [5,6], as it is for men without diabetes. (See "Overview of male sexual dysfunction", section on 'Association with cardiovascular disease'.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2017. | This topic last updated: Mar 24, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993; 270:83.
  2. McCulloch DK, Campbell IW, Wu FC, et al. The prevalence of diabetic impotence. Diabetologia 1980; 18:279.
  3. McCulloch DK, Young RJ, Prescott RJ, et al. The natural history of impotence in diabetic men. Diabetologia 1984; 26:437.
  4. Kalter-Leibovici O, Wainstein J, Ziv A, et al. Clinical, socioeconomic, and lifestyle parameters associated with erectile dysfunction among diabetic men. Diabetes Care 2005; 28:1739.
  5. Gazzaruso C, Solerte SB, Pujia A, et al. Erectile dysfunction as a predictor of cardiovascular events and death in diabetic patients with angiographically proven asymptomatic coronary artery disease: a potential protective role for statins and 5-phosphodiesterase inhibitors. J Am Coll Cardiol 2008; 51:2040.
  6. Ma RC, So WY, Yang X, et al. Erectile dysfunction predicts coronary heart disease in type 2 diabetes. J Am Coll Cardiol 2008; 51:2045.
  7. De Berardis G, Pellegrini F, Franciosi M, et al. Longitudinal assessment of quality of life in patients with type 2 diabetes and self-reported erectile dysfunction. Diabetes Care 2005; 28:2637.
  8. Giuliano FA, Leriche A, Jaudinot EO, de Gendre AS. Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both. Urology 2004; 64:1196.
  9. Andersson KE, Wagner G. Physiology of penile erection. Physiol Rev 1995; 75:191.
  10. De Berardis G, Pellegrini F, Franciosi M, et al. Identifying patients with type 2 diabetes with a higher likelihood of erectile dysfunction: the role of the interaction between clinical and psychological factors. J Urol 2003; 169:1422.
  11. Buvat J, Lemaire A. Endocrine screening in 1,022 men with erectile dysfunction: clinical significance and cost-effective strategy. J Urol 1997; 158:1764.
  12. Wessells H, Penson DF, Cleary P, et al. Effect of intensive glycemic therapy on erectile function in men with type 1 diabetes. J Urol 2011; 185:1828.
  13. Derosa G, Romano D, Tinelli C, et al. Prevalence and associations of erectile dysfunction in a sample of Italian males with type 2 diabetes. Diabetes Res Clin Pract 2015; 108:329.
  14. McCulloch DK, Hosking DJ, Tobert A. A pragmatic approach to sexual dysfunction in diabetic men: psychosexual counselling. Diabet Med 1986; 3:485.
  15. Rendell MS, Rajfer J, Wicker PA, Smith MD. Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. Sildenafil Diabetes Study Group. JAMA 1999; 281:421.
  16. Goldstein I, Young JM, Fischer J, et al. Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study. Diabetes Care 2003; 26:777.
  17. Sáenz de Tejada I, Anglin G, Knight JR, Emmick JT. Effects of tadalafil on erectile dysfunction in men with diabetes. Diabetes Care 2002; 25:2159.
  18. Vardi M, Nini A. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus. Cochrane Database Syst Rev 2007; :CD002187.
  19. Padma-Nathan H, Hellstrom WJ, Kaiser FE, et al. Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group. N Engl J Med 1997; 336:1.
  20. Linet OI, Ogrinc FG. Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. The Alprostadil Study Group. N Engl J Med 1996; 334:873.
  21. Kearse WS Jr, Sago AL, Peretsman SJ, et al. Report of a multicenter clinical evaluation of the Dura-II penile prosthesis. J Urol 1996; 155:1613.
  22. Garber BB. Inflatable penile prosthesis: results of 150 cases. Br J Urol 1996; 78:933.
  23. Bejany DE, Perito PE, Lustgarten M, Rhamy RK. Gangrene of the penis after implantation of penile prosthesis: case reports, treatment recommendations and review of the literature. J Urol 1993; 150:190.