Diabetes and male sexual function (Part 8)
Diabetes ejaculatory dysfunction
The ejaculation reflex is initiated by cerebral erotic input and by sensory stimulation of the penis. The sensory afferent nerves are the dorsal nerves of the penis. Ejaculation is primarily a sympathetic event. The efferent neural pathways arise from spinal levels T10 to L2 and travel through the sympathetic chain ganglia, the hypogastric plexus anterior to the aorta and the pelvis to the prostate, vas deferens and seminal vesicle. Ejaculatory dysfunction can be caused by medication such as selective serotonin reuptake inhibitors, surgery such as transurethal resection of the prostate or chronic medical . Diabetes is one of the nonsurgical causes of ejaculatory dysfunction. Diabetic neuropathy affects the peripheral sympathetic nerve supply to the bladder neck, thereby interfering with its closure and resulting in ejaculation abnormalities.
Impairment of the sympathetic system results in retrograde ejaculation, that is, the escape of the seminal fluid from the posterior urethra back to the bladder. The diagnosis is made from the patient’s medical history (absence of intermittent emission of semen, orgasm without visible ejaculate) and confirmed by finding sperm in postcoital specimen of urine. The presence of more than 10 to 15 sperm per high power field confirms the presence of retrograde ejaculation. More extensive neuropathy may render buy diabetes drugs men incapable of seminal emission (anejaculation) caused by disruption of the sympathetic nerve supply to the vas deferens.