Dear Dr G,

I am a 32-year-old man who is married for two years.

The sex life with my wife was simply awesome for the first year. Like most men who get complacent after getting married, I lost focus on my health. I stopped going to the gym and my waistline started expanding, almost exponentially.

Six months ago, I started getting problems with regular infections and frequent urination. Finally, the dreaded diagnosis of diabetes landed on my laps. Initially, I was coping well with the medications and glucose monitoring. After a while, disaster struck. The morning erections started diminishing.

The Wilting Willy in the bedroom followed shortly. The family physician told me erectile dysfunction is commonly associated with diabetes. I was glad he prescribed me the blue pills and that really nurtured my sex life back to its former glory. Three weeks ago, another disaster struck in the bedroom – I have no ejaculation at all.

These days, I have no ejaculation, almost to the extent of faking an orgasm. My doctor told me I suffer from retrograde ejaculation, most likely related to diabetes. Sadly, I was also told nothing can be done.

In conjunction with the recent World Diabetes Day, I am hoping to put Dr G on the spot about diabetes and retrograde ejaculation. Can you tell me how does diabetes cause retrograde ejaculation? Is it reversible? My wife and I would like to start a family, how do we overcome this obstacle?

I hope Dr G can give me good news for a happy ending.

Please help.

Bitter Sweet

The inability to ejaculate is a condition caused by two possible medical problems. An ejaculation occurs when there is a complete absent of ejaculation due to obstruction. On the other hand, retrograde ejaculation is caused by the emission of semen which travels backwards into the bladder upon orgasm.

The ability of men to ejaculate is determined by the meticulous coordination of the bladder neck sphincter closing tightly, allowing the muscular contraction to propel the semen forward through the penis. The nerve destructive nature of diabetes results in the interference of the ejaculatory reflex.

This in turn renders the inability of the bladder neck to close tightly, resulting the backwards repulsion of the ejaculate into the bladder. Retrograde ejaculation is usually characterised by cloudy urine following orgasm, and the definitive diagnosis is microscopic detection of spermatozoa in the post ejaculatory urine samples.

The true prevalence of retrograde ejaculation is unknown. Five percent of non-diabetic men aged 50 to 80 reported dry orgasm. Studies also revealed approximately 34% of men with diabetes aged 35 to 55 experience retrograde ejaculation. The figure is thought to be significantly higher in poorly controlled diabetic individuals.

Diabetes is a major public health concern in Malaysia, resulting in major chronic complications and premature death. The National Health and Morbidity Survey reported diabetic prevalence of 14.9% in 2006, which jumped to 20.8% in 2011. This translates to 2.8 million individuals being affected by the disease. The increase in the prevalence is projected to rise significantly, in parallel with the increase prevalence of overweight and obesity.

When a healthy young man suffers from diabetes and retrograde ejaculation, the neuronal and vascular destruction will lead to more disastrous catastrophe in the future, including blindness and renal failure.

Nov 14 marks World Diabetes Day, focusing on the detrimental effects of the disease. In fact, this is the day when Frederick Banting first conceived the idea leading to the discovery of insulin. Each year, different-themed campaigns highlight aspects of the disease and its complications. The theme this year emphasises the impact of family and diabetes. Although the marvel of IVF technology can overcome the obstacles of the lost sperm, Dr G’s advice is the sexual dysfunction of diabetic sufferers can be managed with the stringent control of sugar intake.

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