Diabetes and Erectile Dysfunction: Causes & Treatment

Diabetes and Erectile Dysfunction: Understanding the Link and Your Treatment Options

Published: 13 October 2026

Diabetes and erectile dysfunction (ED) are closely connected: men with diabetes are up to three times more likely to experience erection problems than those without [1][2]. High blood sugar levels can damage the blood vessels and nerves that control erections, making it harder to achieve or maintain one. The good news is that ED in men with diabetes is treatable, and understanding the link is the first step toward finding a solution that works for you.

Why does diabetes and erectile dysfunction occur together?

Diabetes affects your body's ability to regulate blood sugar (glucose). Over time, persistently high glucose levels can damage the small blood vessels and nerves throughout your body, including those in the penis [1][2]. Erections depend on a healthy blood supply: when you're sexually aroused, blood flows into the penis and is held there under pressure. If the blood vessels are narrowed or damaged by diabetes, not enough blood can reach the penis to create a firm erection.

Nerve damage (diabetic neuropathy) also plays a role. The nerves that signal the blood vessels to relax and allow blood flow can become less responsive, making it difficult for an erection to start or be maintained [2]. Both type 1 and type 2 diabetes can cause these changes, and the risk increases the longer you've had diabetes and the less well-controlled your blood sugar has been.

Other factors common in men with diabetes—such as high blood pressure, high cholesterol, obesity, and reduced testosterone—can also contribute to ED [10]. Psychological factors, including anxiety or low mood related to managing a long-term condition, may add to the problem. It's a complex picture, but each element can be addressed.

How is erectile dysfunction assessed in men with diabetes?

If you're experiencing erection problems and you have diabetes, it's important to see your GP or diabetes specialist [1][2]. They will want to understand how long you've had ED, how often it happens, and whether you can still get morning erections (which can help distinguish physical from psychological causes). They'll also review your diabetes control, including your recent HbA1c (a measure of average blood sugar over the past few months) and any complications such as neuropathy or cardiovascular disease.

Your doctor will check your blood pressure, cholesterol, and may arrange blood tests to measure testosterone, kidney function, and other markers [2]. They'll ask about your current medicines, as some drugs (including certain blood-pressure tablets and antidepressants) can contribute to ED. A full medication review is essential, because interactions between ED treatments and your diabetes or heart medicines must be carefully managed.

This assessment helps identify any reversible causes and ensures that any treatment you're offered is safe and appropriate for your overall health. If you're using an online pharmacy like Cured Pharmacy, a UK-registered prescriber will review your medical history and current medicines during the online consultation before any prescription is issued.

What tests might be arranged?

Your GP may order blood tests to check your HbA1c, lipid profile, testosterone, thyroid function, and kidney health [2]. In some cases, they might refer you to a specialist (urologist or endocrinologist) for further investigation, especially if ED is severe, started suddenly, or doesn't respond to initial treatment. Specialist tests can include ultrasound scans of penile blood flow or nerve-conduction studies, though these are not routinely needed for most men.

Lifestyle measures to improve diabetes and erectile dysfunction

Improving your diabetes control is one of the most effective ways to reduce ED [2]. Better blood-sugar management can slow or even partly reverse damage to blood vessels and nerves. Aim to keep your HbA1c within the target range agreed with your diabetes team, monitor your blood glucose regularly, take your diabetes medicines as prescribed, and attend all your diabetes reviews.

Losing weight if you're overweight, eating a balanced diet rich in vegetables, whole grains, lean protein, and healthy fats, and reducing processed foods and added sugars can all improve both diabetes and erectile function [1][2]. Regular physical activity—at least 150 minutes of moderate exercise per week—helps lower blood sugar, improves circulation, and boosts mood and energy. Even a 5–10% weight loss can make a meaningful difference to erections.

Stopping smoking is crucial: smoking damages blood vessels and makes ED worse [1]. Limit alcohol to no more than 14 units per week, as heavy drinking can worsen both diabetes control and erectile function. Managing stress, getting enough sleep, and talking openly with your partner about ED can also help reduce performance anxiety and improve your overall wellbeing.

Oral medicines for diabetes and erectile dysfunction

The first-line treatment for ED in men with diabetes is usually a tablet from the group called PDE5 inhibitors [1][2]. These include sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra). They work by relaxing the blood vessels in the penis, allowing more blood to flow in when you're sexually aroused. They do not cause an automatic erection—you still need sexual stimulation—and they do not cure ED, but they can help you achieve and maintain an erection sufficient for sex.

Sildenafil is taken about one hour before sex and lasts around four hours [3]. Tadalafil can be taken on-demand (at least 30 minutes before sex, with effects lasting up to 36 hours) or as a lower daily dose [4]. Vardenafil works in 25–60 minutes [5], and avanafil is the fastest-acting, often effective within 15–30 minutes [6][11]. Your prescriber will help you choose the best option based on your lifestyle, other medicines, and how well-controlled your diabetes is.

Men with diabetes may need a higher dose or may find that PDE5 inhibitors are slightly less effective than in men without diabetes, but they still work well for many [2]. It's important to try a medicine on several occasions (at least four to eight attempts) before deciding it doesn't work, as response can improve with repeated use.

How do I get a prescription?

All PDE5 inhibitors are prescription-only medicines. At Cured Pharmacy, you complete an online consultation that is reviewed by a UK-registered prescriber. They will check your diabetes control, current medicines (especially for your heart, blood pressure, and any other conditions), and overall health to ensure the treatment is safe for you. If approved, your medicine is dispensed by our GPhC-registered pharmacy and delivered discreetly to your door.

Important safety considerations for men with diabetes

PDE5 inhibitors are generally safe for men with diabetes, but certain combinations are dangerous and must be avoided [3][4][5][6]. Never take a PDE5 inhibitor if you use nitrate medicines (such as GTN spray, isosorbide mononitrate, or isosorbide dinitrate) for angina, or nicorandil, or riociguat. The combination can cause a severe and potentially life-threatening drop in blood pressure. Do not use recreational drugs called 'poppers' (amyl or alkyl nitrites) with these tablets.

If you take an alpha-blocker for prostate symptoms or high blood pressure (such as doxazosin, tamsulosin, or alfuzosin), there is a risk of dizziness or low blood pressure when combined with a PDE5 inhibitor [3][4]. You should be stable on the alpha-blocker and start on the lowest dose of the ED medicine; your prescriber will check this is safe. Some medicines that affect how your liver breaks down drugs—such as ritonavir, cobicistat (in some HIV treatments), ketoconazole, itraconazole, or clarithromycin—can raise PDE5 inhibitor levels and require dose adjustments or may mean certain PDE5 inhibitors are not suitable [3][4][5][6][12].

Other blood-pressure medicines can add to the blood-pressure-lowering effect of PDE5 inhibitors, which is usually manageable but must be declared during your consultation [3][4]. Grapefruit juice can increase drug levels and should be avoided. If you take any other prescribed or over-the-counter medicines, herbal remedies, or supplements, always tell your prescriber—they will check every medicine for interactions. Do not stop or change any prescribed medicine without advice from your doctor or pharmacist.

What if tablets don't work or aren't suitable?

If PDE5 inhibitors are not effective, not tolerated, or contraindicated, other options are available [2][7]. Alprostadil is a medicine that can be applied as a cream into the opening of the penis (Vitaros) or injected into the side of the penis (Caverject). It works by directly relaxing the blood vessels and can produce an erection within 5–15 minutes, without the need for sexual stimulation. These are prescription treatments and require training from a healthcare professional.

Vacuum erection devices (VEDs) are mechanical pumps that draw blood into the penis; a constriction ring is then placed at the base to maintain the erection [1][2]. VEDs are available without prescription and can be effective, though some men find them cumbersome. In more severe cases, or when other treatments have failed, a referral to a urologist for consideration of a penile implant may be appropriate.

Psychological support, including psychosexual counselling or cognitive behavioural therapy (CBT), can be helpful if anxiety, depression, or relationship issues are contributing to ED [1][2]. Your GP can refer you to a specialist service. Combining medical treatment with lifestyle changes and psychological support often gives the best results, particularly for men managing a long-term condition like diabetes.

When should I see my GP?

Always see your GP if you develop new or worsening ED, especially if you have diabetes [1]. ED can be an early warning sign of cardiovascular disease, and addressing it may improve your overall health. Your GP can also review your diabetes control, adjust your medicines if needed, and refer you for specialist input if appropriate. If you experience chest pain during sex, an erection lasting more than four hours, or sudden loss of vision or hearing, seek urgent medical help.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 13 October 2026]
2. National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 13 October 2026]
3. Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 13 October 2026]
4. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 13 October 2026]
5. Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 13 October 2026]
6. Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 13 October 2026]
7. Joint Formulary Committee. (n.d.). Alprostadil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/alprostadil/ [accessed 13 October 2026]
8. Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., & McKinlay, J. B. (1994). Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. Journal of Urology, 151(1), 54–61. https://pubmed.ncbi.nlm.nih.gov/8254833/ [accessed 13 October 2026]
9. National Institute for Health and Care Excellence. (2014). Erectile dysfunction: avanafil (ESNM45). https://www.nice.org.uk/advice/esnm45 [accessed 13 October 2026]
10. Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [accessed 13 October 2026]

Information on this page is for educational purposes only and is not medical advice. Prescription treatments require clinical assessment by a UK-registered prescriber. Always consult a qualified healthcare professional before starting or changing any medication.