Males with diabetes mellitus have an increased prevalence of erectile dysfunction. Some of the organic causes have been studied in corpus cavernosum strips isolated from men undergoing penile prosthesis implantation. Defects in endothelium-dependent and nerve-mediated vascular smooth muscle relaxation have been found [1]. Similar deficits were noted for alloxan-diabetic rabbits [2] and recently diminished neurogenic erections were reported in streptozotocin-diabetic rats [3]. The nitric oxide (NO) systems of corpus cavernosum endothelium and nerve supply are crucial for smooth muscle relaxation and erectile Diabetologia (1999) Summary Diabetes mellitus is associated with impotence in animal models and patients. Raised reactive oxygen species contribute to diabetic neurovascular deficits, which are amenable to antioxidant treatment. Our aim was to examine the effects of streptozotocin-induced diabetes in rats and long-term treatment with the antioxidant, a-lipoic acid, on responses of an in vitro corpus cavernosum preparation. Diabetes duration was 8 weeks and preventive and reversal (4 weeks untreated diabetes, 4 weeks of treatment) studies were done. Four and 8 weeks of diabetes caused an about 41 % reduction in endothelium-dependent nitric oxide mediated relaxation to acetylcholine in phenylephrine-precontracted cavernosum. This deficit was prevented (93.9 ± 7.1 %) by treatment with a-lipoic acid; reversal studies showed 64.9 ± 19.5 % correction. Neither diabetes nor treatment with a-lipoic acid altered endothelium-independent relaxation to the nitric oxide donor, sodium nitroprusside. Stimulation of corpus cavernosum autonomic innervation caused noradrenergic-mediated contractions that were unaffected by diabetes or a-lipoic acid. Non-adrenergic, non-cholinergic nerve responses, largely dependent on nitric oxide, were seen after phenylephrine precontraction in the presence of atropine and guanethidine. Non-adrenergic, non-cholinergic stimulation caused frequency dependent relaxation to a maximum of about 40 %. Diabetes reduced this to about 25 %, however with preventive a-lipoic acid treatment, non-adrenergic, noncholinergic relaxation was in the nondiabetic range. In the reversal a-lipoic acid treated diabetic group, its deficit was corrected by 52.1 ± 14.6 %. Thus, diabetes reduces endothelium and non-adrenergic, noncholinergic nerve nitric oxide-mediated relaxation of corpus cavernosum smooth muscle, which is likely to be the organic base for impotence. Prevention and partial correction by a-lipoic acid emphasises the importance of reactive oxygen species and suggests a potential therapeutic approach. [Diabetologia (1999) 42: 343±350]