Reverse flow of semen into the bladder instead of exiting through the urethra during an ejaculation is termed as Retrograde ejaculation (RE). It is emerging as one of the main causes of male infertility. Long-standing diabetes or poorly controlled diabetes, damaging the nerves and muscles that control the bladder neck during an ejaculation is the main cause of retrograde ejaculation in diabetics.
Preventing RE by measures taken early in the course of diabetes to reverse diabetes or have tight control on sugar levels is the best.
How do you Know that you have (RE) Retrograde ejaculation
- Dry Ejaculation: The most common symptom is experiencing an orgasm with little or no semen being ejaculated (a “dry” orgasm).
- Cloudy Urine After Ejaculation: After ejaculation, the urine may appear cloudy because the semen is mixed with the urine in the bladder.
- Reduced Fertility: While retrograde ejaculation does not affect sexual performance or the ability to achieve orgasm, it can lead to infertility because semen is not released outside the body.
How Diabetes leads to RE
Autonomic Neuropathy: Diabetes, especially when poorly controlled, can lead to autonomic neuropathy, which damages the nerves that control the muscles of the bladder and reproductive organs. The sphincter at the bladder neck, which should tighten during ejaculation to prevent semen from entering the bladder, becomes weak or uncoordinated. As a result, semen flows backward into the bladder rather than out through the penis.
High blood sugar levels can damage small blood vessels and nerves, reducing the function of the muscles that control the opening and closing of the bladder neck. Over time, uncontrolled diabetes increases the risk of retrograde ejaculation.
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Diagnosis
Retrograde ejaculation is usually diagnosed by examining the urine after ejaculation. If semen is present in the urine, it confirms the diagnosis.
Treatment Options
- Tight control of Blood Sugar level :
- This can be done through a combination of lifestyle changes( Regular exercise and diet ), anti diabetic medication or Insulin to keep sugar levels under control. Monitoring blood sugar levels by regular blood test like FBS, PPBS, HBA1C, Urine microalbuminuria . This can put a halt to the progression of nerve damage cause by diabetes, although it may not reverse existing nerve damage.
- Metabolic surgery: When lifestyle changes, anti diabetic medication, and/or Insulin fail to controlling blood sugar, Metabolic surgery has proved to not only control, but even reverse type 2 diabetes.
- Medications:
- Medications that help strengthen the bladder neck muscles by increasing the tone of the bladder neck can be of help.
- Fertility Treatments:
- When infertility is the issue, reproductive techniques like sperm retrieval from the urine after ejaculation followed by Intrauterine insemination (IUI) or In vitro fertilization (IVF) may be options.
Take home message
Preventing and avoiding RE is better, as retrograde ejaculation caused by diabetes may not always be fully reversible.
