Understanding and treating ejaculatory dysfunction in men with diabetes mellitus

Abstract

Diabetes mellitus is a rapidly rising metabolic disorder with important sys-This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Effects of diabetes mellitus on sperm quality and fertility outcomes: Clinical evidence

“…Finally, a recent review investigated the available treatments, and related efficacy, for ejaculatory dysfunctions in DM men. 17 As reported above (see the Introduction section), these dysfunctions can lead to subfertility. In particular, among ejaculatory dysfunctions, the authors focused on retrograde ejaculation and its management in DM infertile men.…”

“…On the other hand, the authors reported that in infertility clinics, especially when pharmacotherapy fails to yield antegrade ejaculation, ART from spermatozoa retrieved from post-orgasmic urine treated or alkalized prior to ejaculation is widely used in patients with retrograde ejaculation. 17 Outcomes of ART using this method demonstrated a pregnancy rate of 24% 79 -34% 80 per cycle and a live birth rate of 28% 79,80 with the Hotchkiss method. Hence, in DM patients with complete retrograde ejaculation, ICSI using spermatozoa retrieved from post-orgasmic alkalized urine can be proposed as an effective and safe option for achieving pregnancy.…”

“…In particular, among ejaculatory dysfunctions, the authors focused on retrograde ejaculation and its management in DM infertile men. 17 They reported that different authors 17 investigated in DM patients the efficacy of pharmacotherapy in converting partial or complete retrograde ejaculation to antegrade ejaculation, and two studies 77,78 evaluated also sperm parameters before and after treatment. These studies 77,78 reported efficacy in converting retrograde to antegrade ejaculation of 38%-60%, higher than that (22%-28%) reported in a previous systematic review, 79 and an improvement in sperm count 77,78 and motility 77 after treatment.…”

“…In addition, DM has been associated with several other complications, such as oral, 7 dermatologic, 8 rheumatic/muscoloskeletal, 9 gastrointestinal 10 and genitourinary 11,12 problems, the latters including a higher risk of urogenital infections than the general population. 12 More recently, DM has been associated with sexual dysfunctions, [13][14][15] and in particular, in male subjects, with erectile 13,14,16 and ejaculatory 17 dysfunctions and hypogonadism. 16,18 Infertility has been recognized as a public health issue by the World Health Organization (WHO), 19 affecting about one out of ten couples of reproductive age.…”

RSSDI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2022

“…Whilst promising findings from large randomized controlled trials (RCTs) have provided strong evidence for the licensed treatment of PE, similar robust studies are needed to accurately elucidate factors predicting EjD in DM, as well as for the development of pharmacotherapies for DE and RE. 850,851 Women • Diabetes-induced neuropathy and vascular dysfunction may be mainly responsible for the FSD and the low Female Sexual Function Index may be associated with BMI.…”