Diabetes is associated with numerous long-term complications. Many of these, like kidney failure and ischaemic heart disease, are life threatening. Others, such as eye damage and nerve damage, impact heavily on quality of life. But sexual difficulties, which affect both women and men with diabetes, often receive less attention than they deserve, despite the high levels of distress they generate. Mac Robertson looks at the risks for sexual dysfunction in men and women with diabetes and describes the current management options.