Unhappy Endings

Dear Dr G,

I am 52-year-old man who is reasonably fit and healthy but was diagnosed with diabetes two years ago.

I saw how diabetes affected my elderly mother over the past two decades, and am determined to keep myself healthy with medication to reduce the risk of complications.

I understand that diabetes can cause erectile dysfunction due to hardening of the blood vessels.

Thankfully, I am able to maintain an active sex life and my erectile rigidity remains solid.

However, I am encountering sexual dysfunction of a different nature – in recent months, I have noticed the volume of my ejaculate is getting less and less.

In fact, on a few occasions, there was no noticeable ejaculation upon climax. My wife even thinks I am faking an orgasm!

Can you tell me why am I running out of semen?

I read somewhere diabetes can cause backward inflow of ejaculation or have I simply run dry?

How do I get a proper diagnosis for this?

Yours truly,
Backward Bernard

Diabetes mellitus is a metabolic disease that causes high blood sugar levels.

Type I diabetes is essentially a medical condition characterised by the acute diminished production of insulin following the destruction of cells in the pancreas. Type II diabetes, which is a lot more common, has a gradual onset and tends to affect older adults.

Although its exact mechanisms are different, the medical complications faced by sufferers are usually the same.

Diabetes can affect many aspects of overall health. The common destructions of organs in diabetic patients include neuropathy (nerves), retinopathy (retina), vasculopathy (blood vessels), cardiomyopathy (heart) and nephropathy (kidneys). Therefore, patients with poorly-controlled diabetes are likely to face severe medical problems such as stroke, heart attack, blindness and renal failure.

Erectile dysfunction (ED) is also a common sexual dysfunction brought on by diabetes and usually treated by physicians. In fact, on many occasions, many patients who visit doctors with complaints of erectile dysfunction are diagnosed with diabetes for the first time!

Apart from ED, another sexual dysfunction faced by diabetic patients is retrograde ejaculation or a “dry orgasm”. Diabetic neuropathy can destroy the parasympathetic nerve system responsible for the contraction of relevant muscles to ensure the propulsion of semen forward. Sufferers will notice a diminishing amount of ejaculate and some even experience a lessening in the intensity of the orgasm.

Then again, this may have no correlation with diabetes at all. The use of certain type of medications such as alpha blockers can result in the relaxation of the bladder, causing backflow of the ejaculate. Lastly, retrograde ejaculation also commonly affects older men with an enlarged prostate, as loosened prostatic valves can impair the intricate control of ejaculate.

Sexual dysfunction is associated with guilt and sufferers tend to reflect on the “damage” caused by too much sex or masturbation in the past. However, the reality is there is no evidence to suggest too much ejaculation in one’s youth or past can result in semen “drying up”.

A diagnosis of retrograde ejaculation can be easily established with a microscopic examination of the urine immediately after sexual climax, where the presence of sperm can confirm the diagnosis.

The detrimental impact of uncontrolled diabetes is well recognised as well as its effect on many bodily functions, including sexual health. Although the incidence of retrograde ejaculation is not as well documented as ED in diabetic patients, its psychological impacts should not be underestimated.

The bad news is there is no effective treatment available to reverse retrograde ejaculation. The good news is that the sperm in the urine often remains “alive and kicking” and still suitable for procreation.

The English novelist and poet, Charlotte Bronte famously advised: “I try to avoid looking forward or backward, and try to keep looking upward.”

When no treatment is effective to propel the semen forward, he agrees with Bronte and says: “No point looking forward or backwards when nothing can be done, simply keep healthy and enjoy looking upwards!”