Silence, stigma, and sexual health: experiences of sexual dysfunction among men living with diabetes in Ghana

Abstract

BACKGROUND: Erectile dysfunction (ED) is a common but under-discussed complication among men living with diabetes (MLWD), particularly in African contexts where sexual health is culturally sensitive. Despite major psychosocial and relational consequences, ED is often inadequately addressed within routine diabetes care. This study explored perceptions, impacts, and management practices related to sexual weakness among MLWD, alongside healthcare providers' experiences managing the condition in Ghana. METHODS: We conducted an exploratory qualitative study across five public healthcare facilities in four regions of Ghana. In-depth interviews were conducted with 26 MLWD and 14 healthcare providers involved in diabetes care. Participants were purposively recruited, and data were analysed using thematic analysis supported by ATLAS.ti. RESULTS: Participants attributed sexual weakness to multiple causes, including diabetes-related complications, medication effects, and spiritual factors. Divergent explanatory models between patients and providers shaped management decisions and care-seeking. Many men reported using herbal remedies, aphrodisiacs, energy drinks, and spiritual interventions, often delaying biomedical care. Sexual weakness was associated with distress, reduced confidence, and relationship strain, and disclosure was selective, shaped by stigma, secrecy, and trust. Providers expressed concern about misconceptions, unregulated treatment use, and structural constraints within overcrowded diabetes clinics that limited meaningful engagement on sexual health.