Exploring sexual health challenges in men with type 2 diabetes-related erectile dysfunction: a qualitative study

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease that is frequently associated with erectile dysfunction (ED). This complication adversely affects sexual function, quality of life, marital relationships, and psychological well-being. Despite its high prevalence, sexual health issues remain overlooked, especially with respect to diabetes management. This qualitative study explored sexual health challenges from the perspective of Iranian men with T2DM and ED. METHODS: Using conventional content analysis, semistructured interviews were conducted in 2025 with 19 purposively selected men experiencing T2DM-related ED from Shariati Hospital. Data analysis followed the approach of Graneheim and Lundman. Trustworthiness was ensured through member checking and intercoder reliability (Kappa = 0.82). RESULTS: The participants’ average age was 49.8 ± 8.2 years. Most were middle-aged (51.8%), married (89.5%), and had been living with diabetes for less than 10 years (78.9%). Educational and occupational backgrounds varied widely. Qualitative analysis identified the main theme of “silent distress,” which included four categories: (1) Shaming and embarrassment in the disclosure ED: Fear of social disgrace and cultural constraints prevented discussion of the ED; (2) Fragmentation of sexual identity: ED reduced sexual self-confidence, caused feelings of humiliation, and damaged masculine identity. (3) Threat to marital life: Participants worried about spousal rejection and potential relationship breakdown. (4) Inadequate sexual healthcare services: Major barriers include a lack of awareness among patients and physicians about the diabetes-ED connection, the absence of sexual counseling during visits, and a lack of private clinical environments. CONCLUSION: ED in men with T2DM causes significant psychosocial distress, creating a cycle of “silent distress.” This situation is worsened by cultural barriers (stigma preventing disclosure), educational gaps (insufficient patient/provider awareness), and structural issues (lack of private counseling). Key solutions include integrating sexual counseling into routine diabetes care; training healthcare teams to address sexual health proactively; establishing confidential clinical environments; and launching public awareness campaigns to reduce stigma. These strategies are essential not only for improving quality of life but also for breaking the cycle of silent distress and possibly enhancing adherence to diabetes treatment. TRIAL REGISTRATION: Not applicable.