This study examined prospectively the prevalence and type of sexual dysfunction in a well-characterized group of 160 insulin-treated (Type 1) diabetics during a 6-year period. Of the original sample, 101(76%) participated in the follow-up study and were considered representative of the original consecutive sample. In this study each patient was his/her own control. Prevalence and type of sexual dysfunction was similar to reports from the first investigation and similar to prevalences from other studies. At both examinations a significantly higher prevalence of sexual dysfunction was recorded among diabetic men with signs of peripheral neuropathy. A group of diabetic patients had recovered from their sexual problems in the intervening period without any therapeutic procedures and without any changes in their diabetic status. Psychosocial events seemed to be major factors. Recovery was seen even in patients having peripheral and/or autonomic neuropathy. Although a significant correlation of peripheral neuropathy and erectile dysfunction in diabetic men was demonstrated, many patients with peripheral and/or autonomic neuropathy were without any sexual concerns. Reported sexual dysfunction was significantly correlated to clinical assessment of disease-acceptance and prevalence of somatopsychological reactions to the disease. Of importance in optimal diabetes therapy and in sexual dysfunction research in diabetics is the integration of emotional and behavioral aspects without forsaking the somatic factors. In routine diabetes control sexual aspects should be incorporated in the overall counseling of the diabetic patient or the diabetic couple.