Sexual dysfunction is one of the most prevalent — and most overlooked — complications of diabetes. Erectile dysfunction affects roughly 52.5% of men with diabetes, while women with type 1 or type 2 diabetes report high rates of desire, arousal, lubrication, orgasm, and pain concerns that consistently exceed those of women without diabetes. Despite this, research shows clinicians rarely initiate these conversations, leaving many patients without diagnosis or treatment.

The 2026 ADA Standards of Care directly address this gap, recommending routine sexual health screening for both men and women with diabetes or prediabetes. For men, this includes asking about ED and low libido, with testosterone testing if hypogonadism is suspected. For women, clinicians should inquire about desire, arousal, and orgasm difficulties — especially when depression, anxiety, or recurrent UTIs are present.

Treatment options span medical, lifestyle, and psychosocial approaches. PDE5 inhibitors work for some men, though response rates are lower in diabetes (~50–60%). Women may benefit from vaginal moisturizers, local estrogen therapy, or flibanserin. A Mediterranean diet, regular exercise, and couples therapy round out a comprehensive biopsychosocial care plan.

Key Takeaways:

• ED may be an early marker of systemic vascular disease — men with diabetes have ~3x the risk compared to those without
• Brief, normalized screening questions can open the door without lengthy clinical workups
• Partner involvement and couples therapy improve relationship satisfaction and diabetes self-management outcomes
• GLP-1 receptor agonists are being studied for potential sexual health benefits, but evidence remains limited

Why it matters: Sexual health directly affects quality of life, emotional well-being, and relationship dynamics — all of which influence how well patients manage their diabetes day to day. Proactively addressing it isn't just compassionate care; it's clinically relevant.