Editorial: Sexual function and dysfunction in men and women with diabetes

Sexual dysfunctions are frequent in men and women with diabetes [1]. Erectile dysfunction (ED) is a 8 common and debilitating complication of diabetes mellitus (DM) affecting up to 75% of men with long-9standing disease [2,3]. The pathophysiology of ED in diabetes is multifactorial, involving endothelial 10 dysfunction, neuropathy, hormonal imbalances, and psychological stressors [2,3]. Recent evidence 11 has broadened the understanding of the intricate mechanisms behind ED, as well as its clinical 12 implications and potential management strategies [2,3]. Glycaemic control, insulin resistance, 13 hypogonadism, obesity, oxidative stress, adipokine imbalance, and inflammation, often present in 14 diabetic patients, synergistically contribute to endothelial damage and compromised penile vascular 15 flow [1,2,4]. The same risk factors responsible for ED lead to early atherothrombosis [4]. In fact, one of 16 the most clinically significant associations highlighted in recent years is the link between ED and 17 cardiovascular disease [4]. Several studies suggest that ED may be an early marker of systemic 18 atherosclerosis and future cardiovascular events in diabetic men [4] The studies presented in this special issue collectively advance our understanding of the complex 70 interplay between diabetes and sexual dysfunction in men and women. They emphasize the 71 multifactorial nature of ED, the significance of personalized medicine, and the need for comprehensive 72 management strategies that address metabolic, hormonal, and psychological aspects.