Sexual dysfunctions, especially erectile dysfunction, are common in diabetics and arise from a variety of vascular and neurologic derangements. While PDE5i do not work as well in diabetics as in other populations, they still represent a good first-line treatment. If their use is unsatisfactory, intracorporal injections and implantable prosthesis are excellent alternatives. Vacuum devices represent another viable alternative, although satisfaction is generally not as high. Beyond erectile difficulties, men may complain of ejaculatory symptoms which arise from neuropathy of sympathetic nerves. Additionally, female sexual dysfunctions may be underreported in diabetics but further clinical advances may lead to increased hope and more efficacious treatments for these disorders.