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Key Points ED is a prevalent complication of diabetes, affecting up to 75% of all diabetic men, and is responsible for a decreased quality of life for these patients Diabetic ED has a multifactorial aetiology, although cavernosal endothelial dysfunction is currently recognized as a hallmark of the disease pathophysiology Diabetes-induced hyperglycaemia and oxidative stress increase are responsible for the loss of endothelial cell functionality and integrity Diabetic systemic and cavernosal endothelial dysfunction is maintained owing to the detrimental effects of diabetes on the vascular repair mechanisms of angiogenesis and vasculogenesis Improvements in endothelial health and amelioration of ED might be achieved by tight glycaemic control and treatment with PDE5Is and testosterone supplementation Understanding the molecular pathways involved in endothelial dysfunction will aid in the identification of novel therapeutic strategies to improve endothelial and erectile function in diabetic men Abstract Erectile dysfunction (ED) is a common complication of diabetes, affecting up to 75% of all diabetic men