Diabetes mellitus (DM) is one of the most common and serious non-communicable disease affecting the lives and wellbeing of individuals with the disease, families, and societies at large. In 2019, approximately 463 million (9.3%) people were living with diabetes, and it was estimated that, by 2045, the prevalence will rise to 10.9% (700 million) (1). Its complications have major and long-lasting impacts at different levels (2). One of the most common and underestimated complications among DM is erectile dysfunction (ED) (3). According to the National Institutes of Health Consensus Development Conference, ED is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance (4). ED is two to three times more common among individuals with DM than those without DM (5, 6).

The global prevalence of ED was 3%–76.5% (7). There is a great variation in the prevalence of ED among male patients with DM. On the basis of different epidemiological data, its prevalence was 52% (3). Different studies were carried out in different parts of the world, where the prevalence of ED among patients with DM ranges from 6.8% in Ethiopia to 95% in South Africa (8–21). In Africa, its general prevalence among patients with DM was 71.45% (22). Different studies on the prevalence of ED among patients with DM in some parts Ethiopia were carried out, and the prevalence was from 6.8% to 85.5% (8, 11, 19, 21, 23–25).

Although the number of people living with diabetes is rising in Ethiopia, there are only few studies on the complications of DM particularly ED. ED has a significant impact on the individual both physically and psychologically. It can also impair the quality of life of the patients, as well as their partners and families in general (5, 26). Factors including depression, older age, low educational status, poor quality of life, lack of regular physical activity, longer duration of DM, history of cardiovascular disease, cigarette smoking, hypercholesterolemia, poor glycemic control, obesity, taking beta blockers, and comorbidity were stated as the determinant factors for ED in patients with DM in different studies (8, 9, 11, 13, 16–19, 21, 23–25, 27).

ED is a treatable condition. If effective care and management including lifestyle modification, psychosexual therapy, and pharmacotherapy is applied, then it can be cured for up to 95% of cases (28). However, talking about sexual practice and experience is a very sensitive issue in Ethiopia where it is considered as a shameful act. This makes the diagnosis and treatment of ED difficult. The poor culture of openly discussing the sexual health problem among the community may mask the real magnitude of the problem in the population with diabetes. No study on ED in the eastern part of the country was carried out, and knowing its current magnitude and determinant factors may be important for early detection, managing the problem, and improving the quality of life of the patients. Thus this study aimed to assess the magnitude of ED and associated factors among patients with diabetes attending follow-up at a public hospital, Harar, Eastern Ethiopia.

The current study assessed the magnitude and factors associated with ED among male patients with diabetes attending follow-up at HFCSH. The study found that an overall magnitude of ED was 83.8%. The finding is comparable with studies conducted in China (14), King Saudi University-Medical City in Saudi Arabia (14), and Bahirdar in Ethiopia (24), which showed ED prevalence of 79.1%, 80.5%, and 85.5%, respectively. However, The finding is comparable with studies conducted in Iran, 59.5% (20); Srilanka, 68% (16); Jamaica, 64% (17); Tanzania, 55.1% (15); Jimma, Ethiopia, 6.8% (21); and Central and Northwestern of Tigray, Ethiopia, 69.9% (19). This inconsistency might be due to sociocultural difference among the study population that talking about sexual issue is not such embarrassing in Iran, Srilanka, and Tanzania as it is in our country, so the population in those studies might get diagnosed and treated accordingly before the study was conducted; different data collection methods and tools to determine the magnitude of ED might be the other reason for the discrepancy that the study that was conducted in the Jimma, Ethiopia, used card review, but this study used interview.

The result of the present study presented that age was significantly associated with ED. Adult male patients with diabetes who were more than 60 years old were 2.9 times more likely to experience ED than those in the age category of 18–30 years, and those participants who were in the age of 46–59 years were 2.56 times more likely to have ED that those who those in the age category of 18–30 years. This current finding is consistent with studies conducted in Turkey (9) and Dessie in Ethiopia (8), where male patients with diabetes whose age were greater than 60 years were more likely to experience ED than those who were less than 60 years old. Old age was also associated with ED among male patients with diabetes in Mizan-Tepi University Teaching Hospital and Tepi General Hospital, Ethiopia (23), and Jimma Medical Center, Southwest Ethiopia (11), where the prevalence was higher among patients greater than 40 years of age than those who were less than 40 years old. Older age was also associated with ED in a study conducted in Bahir-dar Ethiopia where both age group 45–59 and >60 years were associated with ED (24).

Glycemic control is another independent predictor in the present study that exhibited significant association with ED. Adult male patients with diabetes who had poor glycemic control were 2.14 times more likely to experience ED compared to those who had good glycemic control. This is consistent with studies carried out in Italy (10) and Saudi Arabia (9), which revealed a significant association of ED with poor glycemic control. However, in the studies conducted in Turkey (13), Northern Srilanka (16), southwest Ethiopia (23), and Jimma Medical Center Ethiopia (11), there was no association found between ED and glycemic control among adult male patients with diabetes. This variation might be due to differences among the study population, the methodology used, time of study, and diverse population culture.

The overall finding of the current study revealed a high magnitude of ED among male patients with diabetes. Majority of the participants experienced mild to moderate ED. Health institutions and healthcare providers should include assessment and management of ED as part of routine medical care in diabetic follow-up clinics. Patients who are of old age and who had poor glycemic control require special attention in screening for ED.

The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.

Ethical clearance was obtained from Institutional Health Research Ethical Review Committee (IHRERC) of the College of Health and Medical Science of Haramaya University. The ethical and supportive letters were submitted to Hiwot Fana Comprehensive Specialized Hospital, and consent was obtained from hospital administrator before data collection. A brief introductory orientation was given to the study participants prior to data collection, and written informed voluntary consent was obtained. Moreover, to maintain privacy, the names of the patients were not written on the questionnaire, and patients were interviewed alone in a separate room.

All the authors had made significant contribution in idea generation, study design, analysis, and interpretation. They participated in drafting and reviewing the manuscript. All authors contributed to the article and approved the submitted version.