Background: Erectile dysfunction in diabetic patients leads to changes of intima, media, and Lumina of arteries resulting in atherosclerosis. Aims of Study:To determine the association between diabetes mellitus and penile Doppler ultrasonography changes in patients with erectile dysfunction. Also, the influence of duration, control of diabetes and diabetes complications on Doppler parameters. Settings and Design: Prospective cohort study, AndrologyMaterial and Methods: Thirty diabetic patients with ED and 10 age matched healthy controls were enrolled. Patients underwent assessment with international index of erectile function score, cavernosal artery ultrasonography during flaccid state for measurement of internal diameter, intima media thickness and arterial wall mass index. Followed by ICI to measure peak systolic velocity, end diastolic velocity and resistive index.Statistical Analysis Used: Mean, standard deviation and Chi-square test by SPSS V.16.Results: Diabetic patients with ED showed statistically significant decrease in IIEF score and PSV, increase in IMT and AWMI compared to controls. Positive correlation between duration of diabetes, blood glucose level and IMT and AWMI, Negative correlation between duration of diabetes and IIEF, PSV and erectile response. Negative correlation between blood glucose level and IIEF, PSV. Negative correlation between IMT, AWMI with IIEF.Conclusions: Diabetic patients with ED have a higher prevalence of atherosclerosis represented as increased IMT and AWMI compared with controls. Diabetes was an independent risk factor associated with atherosclerosis. Cavernosal artery IMT and AWMI interpreted clinically as negative correlation with erectile function domain of IIEF. These new parameters give good prediction for atherosclerosis and could replace more invasive ICI. Key Words: Erectile dysfunction -Intima media thickness -Arterial wall mass index. Key Messages:Ultrasound changes of diabetic patients include; increased IMT, AWMI, decreased PSV. IMT, AWMI are new parameters could be done in flaccid state and give the same level of accuracy considering predicting data for cavernosal arteries pathological changes which affect erectile function and could replace ICI and avoid its side effect.