Objective To observe the clinical effect of dry acupuncture on erectile dysfunction associated with type 2 diabetic autonomic neuropathy. Methods Sixty patients with type 2 diabetic autonomic neuropathy related erectile dysfunction who were admitted from January 2020 to February 2021 were selected as the research objects. According to the random number table, they were divided into drug group (group A) and dry needle group (group B), dry acupuncture and medication group (group C), 30 cases in each group. All patients were treated with diet control and hypoglycemic treatment. Group A was treated with sildenafil, group B was treated with dry acupuncture, and group C was treated with sildenafil + dry acupuncture. All three groups received continuous treatment for 12 weeks, and continued observation for 12 weeks after stopping the treatment. The scores of IIEF-5, clinical efficacy, and TCM symptom scores of the three groups were statistically compared at the time of admission and after the course of treatment. The incidence of adverse reactions in the three groups was recorded. Results After treatment, the difference of IIEF-5 scores among the three groups was statistically significant (P＜0.05), and the IIEF-5 scores of group C and group B were higher than that of group A (both P＜0.05). There was statistical significance in the total effective rate among the three groups (P＜0.05), and the total effective rate of group C and group B was higher than that of group A (P＜0.05). After treatment, scores of sexual desire, ejaculation, impotence, dizziness, tinnitus, emotional depression, lumbar and knee pain and other TCM symptoms in the three groups were decreased, and scores of TCM symptoms in group C and group B were lower than group A, the difference was statistically significant (P＜0.05). 4 weeks after treatment, the sexual satisfaction of both husband and wife increased compared with before, and the difference was statistically significant (P＜0.05) in group C＞group B＞group A. Conclusion Dry needling therapy can treat erectile dysfunction associated with type 2 diabetic autonomic neuropathy and has a good clinical effect and high safety. It is worthy of clinical application.