Rybelsus (semaglutide) is an oral GLP-1 receptor agonist licensed in the UK for treating type 2 diabetes in adults. Whilst erectile dysfunction is a common concern among men with diabetes, it is important to understand the relationship between this medication and sexual health. Erectile dysfunction is not a listed adverse reaction of semaglutide in the UK Summary of Product Characteristics, and there is no consistent evidence that Rybelsus causes erectile difficulties. This article examines the evidence, explores the link between diabetes and erectile function, and provides guidance on managing sexual health whilst taking Rybelsus.
Summary: Rybelsus (semaglutide) does not cause erectile dysfunction and is not listed as an adverse reaction in UK regulatory guidance.
- Rybelsus is a GLP-1 receptor agonist used to treat type 2 diabetes by stimulating insulin secretion and slowing gastric emptying.
- Erectile dysfunction is not a listed adverse reaction of semaglutide in the UK Summary of Product Characteristics.
- Men with type 2 diabetes have higher rates of erectile dysfunction due to vascular damage, neuropathy, and cardiovascular risk factors.
- Improved glycaemic control through medications like Rybelsus may help preserve vascular and nerve function over time.
- First-line treatments for erectile dysfunction in men with diabetes include PDE5 inhibitors such as sildenafil, which is available on NHS prescription.
- Men experiencing persistent erectile difficulties should discuss concerns with their GP for comprehensive assessment and appropriate treatment options.
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What Is Rybelsus and How Does It Work?
Rybelsus (semaglutide) is an oral medication licensed in the UK for the treatment of type 2 diabetes mellitus in adults. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of a naturally occurring hormone that helps regulate blood sugar levels.
The mechanism of action of Rybelsus involves several complementary pathways. Firstly, it stimulates insulin secretion from the pancreas in a glucose-dependent manner, meaning it only triggers insulin release when blood sugar levels are elevated. This reduces the risk of hypoglycaemia when used alone, although the risk increases when Rybelsus is combined with sulfonylureas or insulin—dose reduction of these agents may be necessary. Secondly, semaglutide suppresses glucagon secretion, a hormone that raises blood glucose, thereby preventing excessive glucose production by the liver. Additionally, Rybelsus slows gastric emptying, particularly in the early stages of treatment, which helps moderate the rise in blood sugar after meals and can contribute to feelings of satiety.
According to the UK Summary of Product Characteristics (SmPC), Rybelsus is indicated when diet and exercise alone are insufficient to control blood glucose. It may be used as monotherapy only when metformin is considered inappropriate due to intolerance or contraindications, or as add-on therapy in combination with other antidiabetic agents such as metformin, sulfonylureas, or insulin. The medication is taken once daily on an empty stomach, with up to 120 mL of water, and must be swallowed whole. Patients should wait at least 30 minutes before consuming any food, beverages, or other oral medications to ensure optimal absorption. The usual starting dose is 3 mg once daily for 30 days, then increased to 7 mg once daily; if additional glycaemic control is needed, the dose may be increased to 14 mg once daily after at least 30 days on the 7 mg dose.
Common adverse effects reported with Rybelsus include gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and abdominal discomfort, particularly during the initial weeks of treatment. These effects often diminish over time as the body adjusts to the medication. Important safety warnings include the risk of acute pancreatitis (patients should be advised to seek immediate medical attention if they experience persistent severe abdominal pain), gallbladder disease (including cholelithiasis and cholecystitis), dehydration-related acute kidney injury (particularly in patients with gastrointestinal side effects), and the need for careful monitoring of diabetic retinopathy in patients with pre-existing retinopathy, especially those on insulin.
According to the UK SmPC and the Medicines and Healthcare products Regulatory Agency (MHRA), erectile dysfunction is not a listed adverse reaction of semaglutide. Patients are encouraged to report any suspected side effects via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.
Understanding Erectile Dysfunction in Type 2 Diabetes
Erectile dysfunction (ED) is a common complication affecting men with type 2 diabetes, with prevalence rates significantly higher than in the general population. Men with diabetes are more likely to experience erectile difficulties, often presenting at a younger age than men without diabetes.
The relationship between diabetes and erectile dysfunction is multifactorial. Chronic hyperglycaemia (persistently elevated blood sugar) can damage both the blood vessels and nerves that are essential for achieving and maintaining an erection. This process, known as diabetic vasculopathy and neuropathy, impairs blood flow to the penis and disrupts the nerve signals required for normal erectile function. Additionally, diabetes is frequently associated with other cardiovascular risk factors—including hypertension, dyslipidaemia, and obesity—which independently contribute to endothelial dysfunction and reduced penile blood flow. Obesity-related hypogonadism (low testosterone) is also common in men with type 2 diabetes and may improve with weight loss.
Psychological factors play an important role. The emotional burden of living with a chronic condition, concerns about sexual performance, relationship stress, and symptoms of anxiety or depression can all exacerbate erectile difficulties. Furthermore, certain medications used to manage diabetes-related complications and cardiovascular risk may contribute to sexual dysfunction. Common culprits in UK primary care include thiazide diuretics, some beta-blockers (particularly older non-selective agents), and selective serotonin reuptake inhibitors (SSRIs) or serotonin-noradrenaline reuptake inhibitors (SNRIs). A medication review with your GP or pharmacist can help identify and address any contributing factors.
It is crucial to recognise that erectile dysfunction is not a listed adverse reaction of semaglutide in the UK SmPC, and there is no consistent evidence that Rybelsus causes ED. In fact, improved glycaemic control achieved through effective diabetes management—including the use of medications like Rybelsus—may help preserve vascular and nerve function over time, potentially reducing the risk of developing or worsening ED. Men experiencing erectile difficulties should be encouraged to discuss these concerns openly with their healthcare provider, as effective treatments are available and early intervention can improve both sexual function and overall quality of life.
Managing Sexual Health While Taking Rybelsus
Maintaining sexual health is an important aspect of overall wellbeing for men with type 2 diabetes, and this remains true for those taking Rybelsus. Optimal diabetes control is the cornerstone of preserving erectile function, as good glycaemic management helps protect the blood vessels and nerves that are vital for sexual health. Patients should work closely with their healthcare team to achieve and maintain individualised HbA1c targets as recommended by NICE guideline NG28, typically aiming for 48 mmol/mol (6.5%) for adults on lifestyle measures or a single drug not associated with hypoglycaemia, or 53 mmol/mol (7.0%) for those on drugs associated with hypoglycaemia or on multiple therapies. Targets should be individualised based on factors such as hypoglycaemia risk, comorbidities, and patient preferences.
Lifestyle modifications play a significant role in managing both diabetes and erectile dysfunction. Regular physical activity—at least 150 minutes of moderate-intensity aerobic exercise per week, as recommended by the UK Chief Medical Officers' Physical Activity Guidelines—improves cardiovascular health, enhances insulin sensitivity, and can directly benefit erectile function by improving blood flow. Maintaining a healthy body weight through balanced nutrition reduces insulin resistance, cardiovascular risk factors, and may improve testosterone levels in men with obesity-related hypogonadism. Smoking cessation is particularly important, as tobacco use significantly impairs vascular function and is a major modifiable risk factor for ED. Limiting alcohol consumption is also advisable, as excessive intake can contribute to both erectile difficulties and poor diabetes control.
If erectile dysfunction persists despite good diabetes management and lifestyle measures, several evidence-based treatment options are available. Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil, tadalafil, vardenafil, and avanafil are first-line pharmacological treatments. Generic sildenafil is widely available on NHS prescription for men with diabetes experiencing ED. Other PDE5 inhibitors (branded sildenafil, tadalafil, vardenafil, avanafil) are subject to Selected List Scheme (SLS) restrictions in England, but diabetes qualifies as an approved indication; local formulary policies may vary. These medications are generally safe for men with diabetes, but there are important contraindications and cautions: they are absolutely contraindicated in men taking nitrates (e.g., glyceryl trinitrate, isosorbide mononitrate) or nicorandil due to the risk of severe hypotension. They should be avoided in men with unstable cardiovascular disease, recent myocardial infarction or stroke (typically within 6 months), significant hypotension, and used with caution in men taking alpha-blockers due to additive blood pressure-lowering effects. Sildenafil is also available as a pharmacy (P) medicine from community pharmacists following a suitability assessment.
Other treatment options include vacuum erection devices (which may be provided on the NHS), alprostadil preparations (intracavernosal injections or intraurethral pellets), psychosexual therapy, or referral to specialist services for more complex cases. Your GP can discuss which option is most suitable for your individual circumstances.
Patients should be reassured that Rybelsus itself does not cause erectile dysfunction, and continuing the medication as prescribed is important for long-term diabetes management and the prevention of complications that could worsen sexual health.
When to Speak to Your GP About Erectile Dysfunction
Erectile dysfunction should never be dismissed as an inevitable consequence of ageing or diabetes. It is a medical condition that warrants professional assessment, as it may signal underlying cardiovascular disease or inadequate diabetes control. Men experiencing persistent difficulties achieving or maintaining erections sufficient for satisfactory sexual activity should arrange a routine appointment with their GP or diabetes specialist nurse.
During the consultation, your healthcare provider will typically conduct a comprehensive assessment including a detailed medical and sexual history, review of current medications, and evaluation of cardiovascular risk factors. Physical examination may include blood pressure measurement, assessment of peripheral pulses, and examination for signs of hypogonadism. Blood tests are often arranged to check HbA1c, lipid profile, and morning (9–11 am) total testosterone levels, as hormonal imbalances can contribute to erectile difficulties. If testosterone is low, the test should be repeated to confirm the result, and further tests such as luteinising hormone (LH), follicle-stimulating hormone (FSH), prolactin, and sex hormone-binding globulin (SHBG) may be considered. Your GP may also assess your cardiovascular risk using tools such as QRISK and address modifiable risk factors.
Emergency medical attention is required if erectile dysfunction is accompanied by:
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Chest pain or severe breathlessness during sexual activity, which may indicate cardiac disease—call 999 or attend A&E immediately
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Priapism (a painful erection lasting more than 4 hours)—seek urgent medical care immediately as this is a urological emergency
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Acute penile trauma or suspected penile fracture (sudden pain, swelling, bruising, and loss of erection during intercourse)—seek urgent medical care
Non-urgent concerns that should be discussed with your GP at a routine appointment include:
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Sudden onset of ED, particularly if associated with new medication
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Penile deformity (e.g., Peyronie's disease) or pain during erection
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Loss of morning erections combined with other symptoms of low testosterone (fatigue, reduced libido, mood changes, loss of muscle mass)
Your GP can provide appropriate referral pathways if specialist input is needed, such as to urology, endocrinology, or psychosexual medicine services, in line with NICE Clinical Knowledge Summaries (CKS) guidance on erectile dysfunction. They can also review your diabetes medications, including Rybelsus, to ensure optimal management and address any concerns about potential side effects. Remember that open communication about sexual health is an essential part of comprehensive diabetes care, and healthcare professionals are accustomed to discussing these sensitive issues in a supportive, non-judgemental manner. Early intervention often leads to better outcomes and improved quality of life for both patients and their partners.
Frequently Asked Questions
Can Rybelsus cause problems with erections?
No, Rybelsus (semaglutide) does not cause erectile dysfunction and is not listed as an adverse reaction in UK regulatory guidance. In fact, improved blood sugar control achieved with Rybelsus may help protect the blood vessels and nerves essential for erectile function over time.
Why do men with type 2 diabetes experience erectile dysfunction?
Men with type 2 diabetes experience higher rates of erectile dysfunction due to chronic high blood sugar damaging blood vessels and nerves required for erections. Additional factors include cardiovascular risk factors, obesity-related low testosterone, psychological stress, and certain medications such as older beta-blockers and thiazide diuretics.
Can I take Viagra or sildenafil whilst on Rybelsus?
Yes, PDE5 inhibitors such as sildenafil can be safely taken alongside Rybelsus for men with diabetes experiencing erectile dysfunction. However, they are absolutely contraindicated if you take nitrates (such as GTN spray or isosorbide mononitrate) or nicorandil due to the risk of severe low blood pressure.
Will better blood sugar control improve my erectile function?
Optimal diabetes control helps preserve the blood vessels and nerves vital for erectile function and may reduce the risk of developing or worsening erectile dysfunction. Achieving individualised HbA1c targets, typically 48–53 mmol/mol as recommended by NICE, alongside lifestyle measures such as regular exercise and maintaining a healthy weight, can directly benefit sexual health.
What should I do if I develop erectile dysfunction after starting Rybelsus?
Arrange a routine appointment with your GP or diabetes specialist nurse for a comprehensive assessment including medication review, cardiovascular risk evaluation, and blood tests such as HbA1c and testosterone levels. Your GP can discuss evidence-based treatment options including PDE5 inhibitors, which are available on NHS prescription for men with diabetes, and provide appropriate referrals if specialist input is needed.
Are there any diabetes medications that can cause erectile problems?
Certain medications used to manage diabetes-related complications may contribute to erectile dysfunction, including thiazide diuretics, older non-selective beta-blockers, and some antidepressants such as SSRIs or SNRIs. A medication review with your GP or pharmacist can help identify any contributing factors, but Rybelsus itself is not associated with erectile dysfunction.
The health-related content published on this site is based on credible scientific sources and is periodically reviewed to ensure accuracy and relevance. Although we aim to reflect the most current medical knowledge, the material is meant for general education and awareness only.
The information on this site is not a substitute for professional medical advice. For any health concerns, please speak with a qualified medical professional. By using this information, you acknowledge responsibility for any decisions made and understand we are not liable for any consequences that may result.
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