There are several ways diabetes can affect a man sexually – a key one being erection problems. And this is because diabetes and erectile dysfunction are physically linked.
So is there a best ED treatment for men with diabetes? In short yes – men with diabetes can take Viagra, but there are other options that might be slightly better suited to them.
Diabetes has been linked to a range of sexual problems in men, including low libido, ejaculation and – most commonly – erectile dysfunction.
The main reason is physical: vascular blood flow and nerve transmissions are vital for erections to happen, and diabetes can interfere with both of these functions. But there’s a psychological element too. If you’ve got diabetes, you might be more aware of these potential problems – even if they aren’t happening yet – which could lead to psychological ED.
Diabetes can cause erectile dysfunction by interfering with your internal ‘plumbing’. Over time, glucose deposits can build up in blood vessels, and it’s this that has an adverse effect on blood flow and makes it harder to get an erection.
There’s another way that diabetes can lead to ED too. Over time, severe cases of diabetes can lead to nerve damage, and affect the communications that control erectile function. When men become aroused, signals from the brain help blood vessels near the penis to widen, so blood can get through and ‘fuel’ an erection. With diabetes-induced nerve damage, this process can become inhibited, and stop erections from happening.
If you’ve got diabetes, there are ways you can treat erectile dysfunction and stop it from getting worse. One is to stick to your diabetes treatment plan – this will help to prevent your diabetes from progressing, causing further damage to blood vessels and making ED symptoms worse.
Another is to eat a healthy diet and exercise regularly. Doing this can help to improve your diabetes control, but also has the added effect of improving vascular health (which can contribute towards better erections).
And then there are treatments that can help increase blood flow to the penis, such as Viagra. While these don’t treat the instigating cause, they can help to tackle the problem of ED itself.
According to Diabetes UK, men with diabetes are three times more likely to develop erectile dysfunction. Studies into how common erectile dysfunction is in diabetic men have suggested prevalences of 52% , and in men with type 2 diabetes specifically, 66% and 59%. A paper published by the American Diabetes Association suggested a prevalence of between 35-75%, compared with 26% in the general population.
So we know there’s a strong correlation between ED and diabetes, which indicates a higher risk. But the exact extent of the risk is debatable, because other factors (many of which can be present alongside diabetes) can contribute towards erectile dysfunction too. It’s rarely possible to single out diabetes as the sole contributing factor.
It’s thought that diabetes can cause ejaculation problems by interfering with nerve transmissions from the brain. When men are aroused, ejaculation occurs when pleasure signals are sent back and forth between the penis and neuroreceptors. Severe diabetes can cause nerve damage, which interferes with this process – causing loss of sensation and, in a man, less ejaculatory control.
Studies have suggested that men with diabetes are more likely to have acquired premature ejaculation than men without diabetes.
How we source info.
When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.
If you’ve got diabetes, the best pill to treat erectile dysfunction can depend on a few factors, including whether you’re on blood pressure lowering treatment, and how severe your ED is.
Several ED pills, including sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) have been shown in clinical studies to be effective at treating ED in men with diabetes.
But if you’re taking other medications to treat diabetes or associated metabolic disease, it’s more likely you’ll be recommended vardenafil.
Vardenafil has been found to be well-tolerated in men with impotence associated with diabetes. But because it’s a potent drug in comparison to other treatments, it can be more effective at lower doses; the median or starting dose of vardenafil for example is 10mg, compared to 50mg if you’re using sildenafil. So because you don’t need as much of it to treat ED symptoms, the risk of side effects with vardenafil is thought to be lower.
There is a trade-off for this though – vardenafil tends to be a more expensive option than sildenafil, and the branded version (Levitra) tends to be pricier (than Viagra) too. So when choosing a treatment, this is another factor that could influence your decision.
Oral treatments are the preferred first choice for men with diabetes but, if these don’t work, alprostadil is another option. This is often given in the form of an injection (like Caverject or Viridal) but you can get it as a cream too (Vitaros). It’s shown to be well-tolerated and effective in men with diabetes.
Sildenafil, which is also known by the branded name Viagra, is a safe treatment for diabetic men with erectile dysfunction to use. One study into the use of the drug in just over 100 men with ED and diabetes found that 55% were able to have at least one successful sexual intercourse’ after using it (compared to 15.6% in the placebo group).
Another study analysing sildenafil use in just over 250 men with diabetes and ED reported improved erections in 56% of participants (compared with 10% in the placebo group).
So if you have diabetes, Viagra can be an effective treatment for you. But if you have diabetes and Viagra doesn’t quite work well enough or gives you side effects, you might be recommended a different treatment, like Vardenafil (Levitra), rather than a higher dose of sildenafil. This is because higher doses of ED drugs like sildenafil pose a higher risk of side effects or interactions with other treatments.
There are certain patient criteria in the UK that, if met, mean that someone with erectile dysfunction is entitled to branded treatment on an NHS prescription (which is free if you’re entitled to free treatment).
One is that if you have diabetes and erectile dysfunction, you can get an NHS prescription for Viagra. To access the treatment, you’ll need to make an in-person appointment with your GP. They can normally prescribe Viagra without referring you to a specialist if you have diabetes.
Because diabetes can cause damage to blood vessels and the nervous system, it’s not always possible to fully reverse erectile dysfunction related to it. Sometimes, you might need to use ED treatment long-term to counter the problem.
But it is possible to prevent diabetes and any erectile dysfunction symptoms associated with it from getting worse, by controlling your blood sugar and following your diabetes treatment plan.
Some men who have diabetes and intermittent erectile dysfunction may find that their symptoms pass if they follow a healthier diet and get plenty of exercise. If you have diabetes and think you might be experiencing ED though, it’s worth seeing a doctor so they can make sure your diabetes is well-controlled – as well as give you advice and treatment recommendations for your ED symptoms.
How we source info.
When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.
Cream that you apply to the tip of the penis and works from 5 minutes.
Small pellet you insert into the tip of the penis, that works from 10 minutes.
A bit of everything. 3 different tablets you can try to see which one works best for you.
Lower dose pill. Better option if you're older or have a pre-existing condition like diabetes.
Like Viagra, but cheaper and works in the same way. Non-branded version of the original ED drug.
Non-branded version of Levitra. Works in the same way, but cheaper.
Rebranded version of Viagra that comes in one dose (50mg) and doesn't need a prescription.
Injectable treatment that's very similar to Caverject. Works from 5 minutes and lasts up to 1 hour.
Long-lasting tablet treatment for ED. Effective after 30 minutes.
Diabetes UK. (n.d.). Diabetes and sexual problems – in men. [online] [Accessed 27 Feb. 2023].
Kouidrat, Y., Pizzol, D., Cosco, T., Thompson, T., Carnaghi, M., Bertoldo, A., Solmi, M., Stubbs, B. and Veronese, N. (2017). High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies. Diabetic Medicine, 34(9), pp.1185–1192.
Parmar, R.S., et al. (2022). Prevalence of erectile dysfunction in Type 2 diabetes mellitus (T2DM) and its predictors among diabetic men. Journal of Family Medicine and Primary Care, [online] 11(7), pp.3875–3879.
Chu, N.V. and Edelman, S.V. (2001). Diabetes and Erectile Dysfunction. Clinical Diabetes, [online] 19(1), pp.45–47.
Majzoub, A., Arafa, M., Al-Said, S., Dabbous, Z., Aboulsoud, S., Khalafalla, K. and Elbardisi, H. (2016). Premature ejaculation in type II diabetes mellitus patients: association with glycemic control. Translational Andrology and Urology, [online] 5(2), pp.248–254.
Basu, A. and Ryder, R.E.J. (2004). New Treatment Options for Erectile Dysfunction in Patients with Diabetes Mellitus. Drugs, 64(23), pp.2667–2688.
Keating, G.M. and Scott, L.J. (2003). Vardenafil. Drugs, 63(23), pp.2673–2703.
Heaton, J., et al. (2001). Intracavernosal alprostadil is effective for the treatment of erectile dysfunction in diabetic men. International Journal of Impotence Research, 13(6), pp.317–321.
Escobar-Jiménez, F. (2002). Eficacia y seguridad del sildenafilo en varones con diabetes mellitus tipo 2 y disfunción eréctil. Medicina Clínica, 119(4), pp.121–124. Impotence Research, 13(6), pp.317–321.
Rendell, M.S., Rajfer, J., Wicker, P.A., Smith, M.D. and for the Sildenafil Diabetes Study Group (1999). Sildenafil for Treatment of Erectile Dysfunction in Men With Diabetes. JAMA, 281(5),
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