Erectile dysfunction in diabetes: a cardiometabolic marker and clinical opportunity

Erectile dysfunction (ED) is a common complication of diabetes, affecting more than half of men with the condition. Beyond its impact on quality of life, ED is increasingly recognised as an early manifestation of endothelial dysfunction and a marker of underlying cardiometabolic and cardiovascular disease. Despite this, sexual symptoms remain underreported and under-recognised in routine diabetes care. ED in diabetes is multifactorial, arising from vascular, neurological, hormonal and psychological mechanisms. Early identification provides an opportunity for cardiovascular risk assessment and metabolic optimisation. Clinical evaluation includes a focused sexual history, assessment of contributing comorbidities, targeted investigations and appraisal of cardiovascular risk. Management involves optimisation of metabolic health, evidence-based use of phosphodiesterase type 5 inhibitors and consideration of psychological and relational factors, with escalation to second-line therapies or specialist referral indicated for treatment-refractory symptoms or suspected endocrine or cardiovascular disease. Recognising ED in men with diabetes as a clinically meaningful marker of systemic disease supports more integrated approaches to men’s health.

Erectile dysfunction; Diabetes mellitus; Cardiometabolic risk; Men’s health; Phosphodiesterase type 5 inhibitors

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