Erectile Dysfunction

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee

Gerald Brock MD, FRCSC William Harper MD, FRCPC

  • Key Messages
  • Recommendations
  • Figures
  • Highlights
  • Full Text
  • References

Key Messages

  • Erectile dysfunction (ED) affects approximately 34% to 45% of adult men with diabetes, has been demonstrated to negatively impact quality of life among those affected across all age strata and may be the earliest sign of cardiovascular disease.
  • All adult men with diabetes should be regularly screened for ED with a sexual function history. Those with ED should be investigated for hypogonadism.
  • The current mainstay of therapy is phosphodiesterase type 5 inhibitors. They have been shown to have major impacts on erectile function and quality of life, with a low reported side effect profile, and should be offered as first-line therapy to men with diabetes wishing treatment for ED.

Highlights of Revisions

  • The recommendation regarding the use of phosphodiesterase type 5 (PDE5) inhibitors has been expanded to include scheduled use.


  1. 1.All adult men with diabetes should be regularly screened for ED with a sexual function history [Grade D, Consensus].
  2. 2.Men with diabetes and ED should be investigated for hypogonadism [Grade D, Level 4 (1-4)].
  3. 3.A PDE5 inhibitor, if there are no contraindications to its use, should be offered as first-line therapy to men with diabetes and ED in either an on-demand [Grade A, Level 1A (5-11)] or scheduled-use [Grade B, Level 2 (11,12)] dosing regimen.
  4. 4.Referral to a specialist in ED should be considered for eugonadal men who do not respond to PDE5 inhibitors or for whom the use of PDE5 inhibitors is contraindicated [Grade D, Consensus].
  5. 5.Men with diabetes and ejaculatory dysfunction who are interested in fertility should be referred to a healthcare professional experienced in the treatment of ejaculatory dysfunction [Grade D, Consensus].

ED, erectile dysfunction; PDE5, phosphodiesterase type 5.


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  2. Dhindsa S, Prabhakar S, Sethi M, et al. Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab 2004;89: 5462-8.
  3. Boyanov MA, Boneva Z, Christov VG. Testosterone supplementation in men with type 2 diabetes, visceral obesity and partial androgen deficiency. Aging Male 2003;6:1-7.
  4. Shabsigh R, Kaufman JM, Steidle C, et al. Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. J Urol 2004;172:658-63.
  5. Fonseca V, Seftel A, Denne J, et al. Impact of diabetes mellitus on the severity of erectile dysfunction and response to treatment: analysis of data from tadalafil clinical trials. Diabetologia 2004;47:1914-23.
  6. Rendell MS, Rajfer J, Wicker PA, et al. Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. JAMA 1999; 281:421-6.
  7. Boulton AJM, Selam J-L, Sweeney M, et al. Sildenafil citrate for the treatment of erectile dysfunction in men with type II diabetes mellitus. Diabetologia 2001; 44:1296-301.
  8. Goldstein I, Young JM, Fischer J, et al. Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study. Diabetes Care 2003;26:777-83.
  9. Sáenz de Tejada I, Anglin G, Knight JR, et al. Effects of tadalafil on erectile dysfunction in men with diabetes. Diabetes Care 2002;25:2159-64.
  10. Carson CC, Lue TF. Phosphodiesterase type 5 inhibitors for erectile dysfunction. BJU Int 2005;96:257-80.
  11. Hatzichristou D, Gambla M, Rubio-Aurioles E, et al. Efficacy of tadalafil once daily in men with diabetes mellitus and erectile dysfunction. Diabet Med 2008; 25:138-46.
  12. Buvat J, van Ahlen H, Schmitt H, et al. Efficacy and safety of two dosing regimens of tadalafil and patterns of sexual activity in men with diabetes mellitus and erectile dysfunction: Scheduled Use vs. On-Demand Regimen Evaluation (SURE) study in 14 European countries. J Sex Med 2006;3:512-20.


Reproduced with permission from Canadian Journal of Diabetes © 2013 Canadian Diabetes Association. To cite this article, please refer to For citation.

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