Diabetes epidemic has hit the world hard but it has hit India the hardest in the world all over. Diabetes is associated with complications of small arteries and large arteries which are respectively called micro and macrovascular disease. 

Erectile dysfunction (ED) is a macrovascular complication associated with Diabetes. In general population, ED affects 50% population above 40 years of age. In elderly diabetics, the prevalence is much higher. 

It’s known that diabetes affects arteries and nerves due to high sugar levels in the blood. These are most common pathologies behind ED. The nerve supply to blood vessels carrying blood to genital is affected and also arteries carrying blood to genitals are narrowed due to long-standing diabetes. 

Other than high sugar mental stress is a major reason for ED. Nowadays a lot of young IT professionals come with very high blood sugars and also ED. Diabetes doesn’t produce ED very early but stresses due to job, sedentary lifestyle, alcohol consumption, late night parties take a toll on sex life. 

Premature evacuation (PE), Delayed ejaculation are some of the other forms of sexual dysfunction in males with diabetes. PE is mostly seen in young individuals and delayed ejaculation is seen in elderly persons. 

Psychiatrical illnesses like depression are very common in diabetes or any other chronic ailments. Depression is a common cause of ED. Treatment with some of the antidepressants cause delayed ejaculation. 

In my practice rarely patients come and divulge their sexual problems. As a doctor, I’ll always initiate a discussion by asking as to how’s your sex life. Almost 75-80% patients then confess to having some sort of sexual dysfunction including loss of libido due to work pressure or marital disagreements. 

Early morning election in such people gives a clue that mostly ED is because of mental stress origin and not pathological. 

It is important on part of doctors to rule out ED caused by drugs. Some BP medication too causes ED. Low levels of testosterone can cause low libido and ED. 

After carefully investigating the cause of sexual dysfunction it is possible in most of the cases to give remedies for the same. Most important part of sexual dysfunction management is a good open non-judgemental discussion between the patient and the doctor.