General practice management of type 2 diabetes

Sexual problems – Men
☰ Table of contents

Clinical context

Erectile dysfunction is a common problem for men with diabetes.

Men with diabetes are four times more likely to develop erectile dysfunction than men without diabetes. The prevalence in men aged >40 years with diabetes may be as high as 50% and incidence increases by approximately 10% per annum. Men with diabetes are also affected by erectile dysfunction at an earlier age, with occurrence approximately a decade earlier.257,258

Erectile dysfunction may be acute or chronic during periods of high blood glucose. Failure to achieve erection may be due to psychological causes, macrovascular disease or pelvic autonomic neuropathy.

An organic cause is more likely when there are other macrovascular or microvascular complications.

In addition, as a population/group/cohort, men with diabetes (types 1 and 2), have been shown to have lower testosterone levels than men without diabetes. This may contribute to reduced libido and aggravate or exacerbate erectile dysfunction.


In practice

It is important to enquire about erectile dysfunction in the annual review.

Differentiate organic and psychological erectile dysfunction by taking a detailed history such as spontaneous early morning erections, anorgasmia and lack of libido.

Assessment of severity and management of psychological (anxiety and depression) and physical symptoms.

Psychological therapies such as supportive counselling for patients with organic erectile dysfunction and behavioural therapy for psychogenic erectile dysfunction are useful.259

Phosphodiesterase inhibitors are useful and side effects are generally mild. Concomitant use of vasodilating nitrates are contraindicated due to life-threatening hypotension.

The help of a urologist who specialises in erectile dysfunction should be sought for those considering penile injection with vasoactive agents such as prostaglandin E1 (alprostadil), surgical treatments, vacuum devices, penile prostheses or implants  may help.

Potential CVD risk of engaging in and resuming sexual activity needs to be discussed

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  2. Gandaglia G, Salonia A, Passoni N, Montorsi P, Briganti A, Montorsi F. Erectile dysfunction as a cardiovascular risk factor in patients with diabetes. Endocrine 2013;43(2):285–92.
  3. Smith IA, McLeod N, Rashid P. Erectile dysfunction – When tablets don’t work. Aust Fam Physician 2010;39(5):301–05.