Abstract
BACKGROUND: Erectile dysfunction (ED) is the inability to achieve or sustain an erection adequate for satisfactory sexual activity. The prevalence of ED varies widely among diabetic patients worldwide, mainly due to disparities in healthcare access and diabetes management between low-income and high-income countries. ED significantly impacts the quality of life for affected men, potentially leading to frustration, despair, and sometimes separation from an intimate partner. This study aimed to assess the prevalence, severity patterns, and factors associated with erectile dysfunction among diabetic men attending clinics in three selected sites in Western Uganda. METHODS: The clinic-based cross-sectional study was conducted involving 236 diabetic men from three clinics: Fort Portal Regional Referral Hospital, Hoima Regional Referral Hospital, and Kampala International University (KIU) Teaching Hospital in Western Uganda from June to September 2024. The number of patients was proportionally assigned depending on the number of diabetic men receiving care at the selected facilities. For each clinic, the patients were enrolled consecutively. The IIEF-5 questionnaire was used. Descriptive statistics and bivariate and multivariable logistic regression were done with SPSS version 20.0. RESULT: The prevalence of erectile dysfunction was 79.2%, whereby 21.95%, 36.4%, 22.4% and 19.3% had mild, mild to moderate, moderate, and severe erectile dysfunction, respectively, at 95% CI. Multivariable logistic regression identified increasing age, HbA1c (aOR = 2.44, 95%CI:1.067–5.569, p = 0.035), fasting blood sugar (aOR = 2.50, 95%CI:1.106–5.657, p = 0.028), and BMI (aOR = 15.1833, 95%CI: 1.168–19.739) to be significantly associated with ED. No behavioural characteristic was associated with ED. CONCLUSION: The prevalence of erectile dysfunction was very high. Increasing age, obesity, and inadequate control of blood sugar were significantly associated with ED. Future studies should focus on qualitative data and causal and therapeutic interventions. We also recommend routine screening and timely addressing of blood sugars. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12902-025-02048-2.