A retrospective clinical analysis of 115 men diagnosed with diabetes mellitus complicated by retrograde ejaculation has revealed that this ejaculatory disorder rarely occurs as an isolated reproductive impairment, functioning instead as part of a severe composite neurovascular syndrome. Conducted by researchers at the Department of Andrology within Baoding First Central Hospital, the investigation demonstrated that 80.0 percent of the cohort suffered from complete retrograde ejaculation, 54.8 percent experienced moderate-to-severe erectile dysfunction, and 39.1 percent reported total anorgasmia. The findings challenge the conventional clinical paradigm that treats retrograde ejaculation predominantly as a solitary cause of male infertility, establishing that the condition is intertwined with widespread sexual dysfunction. Crucially, multivariate modeling demonstrated that the progressive deterioration of sexual function in these patients is primarily governed by the chronicity of diabetes exposure and long-term metabolic instability, as measured by glycated hemoglobin, rather than by patient age, lifestyle habits, or circulating androgen concentrations.
Retrograde ejaculation represents a specific form of ejaculatory dysfunction wherein semen is propelled backward into the urinary bladder during orgasm because the bladder neck fails to achieve physiological closure. In the diabetic population, this mechanical failure is primarily attributed to diabetic autonomic neuropathy that damages the sympathetic innervation governing internal urethral sphincter contraction. While retrograde ejaculation accounts for less than two percent of male infertility cases across the general population, its identification is frequently complicated by misdiagnosis as azoospermia due to the complete absence of forward semen emission. In the examined cohort, 92 of the 115 men, representing 80.0 percent of the sample, exhibited complete retrograde ejaculation with zero antegrade ejaculate volume, while 20.0 percent retained partial emission. However, the study established that this failure of the spinal ejaculation generator does not manifest in isolation, frequently occurring alongside profound erectile failure and sensory blunting, thereby composing a devastating triple dysfunction.
The investigation was designed as a single-center retrospective study spanning clinical admissions from January 2020 through June 2025 at Baoding First Central Hospital. The protocol received formal ethical approval from the Ethics Committee of Baoding First Central Hospital under approval number Kuai 2024 170 and complied with the Declaration of Helsinki, with informed consent obtained from all participants. Eligible participants were males aged 18 to 60 years with confirmed Type 1 or Type 2 diabetes mellitus who were married or in stable relationships with regular sexual activity. Initial clinical screening identified 210 potential participants, who were subsequently evaluated against explicit exclusion criteria. Patients were excluded if they possessed a history of pelvic, urethral, or prostate surgery such as transurethral resection of the prostate, used medications affecting ejaculation including alpha-blockers and antidepressants, exhibited severe genitourinary malformations, or presented with clinically significant psychiatric disorders or untreated systemic diseases.
To confirm the diagnosis of retrograde ejaculation, all patients underwent standardized semen and urinalysis protocols following a required sexual abstinence period of two to seven days. Patients were instructed to void and empty their bladders before masturbation, after which post-ejaculatory urine was immediately collected and centrifuged. Diagnosis was established upon detecting more than ten spermatozoa per high-power field or a positive fructose test in the centrifuged urine. Antegrade semen samples were evaluated using computer-aided sperm analysis per the World Health Organization Laboratory Manual for the Examination and Processing of Human Semen, sixth edition. Semen parameters were categorized by fifth centile reference limits, defining oligozoospermia as sperm concentration under 16 million per milliliter, asthenozoospermia as progressive motility under 30 percent, and teratozoospermia as normal forms under 4 percent. Laboratory quality control included daily internal calibration using commercial latex beads and external quality assessment organized by the National Center for Clinical Laboratories.
Erectile capacity was measured using the validated Erection Hardness Score, classifying patients into mild or normal function (scores 3 to 4) and moderate-to-severe dysfunction (scores 1 to 2), defined as inability to achieve vaginal penetration. Orgasmic function was recorded through self-reported presence or absence of orgasmic sensation, identifying total anorgasmia. Psychological status was screened via standardized clinical interviews or validated questionnaires to record binary presence of anxiety or depression. Demographic and metabolic records captured age, body mass index, diabetes type, disease duration, smoking, alcohol, and venous glycated hemoglobin. Statistical analyses were performed with SPSS version 29.0 and R software, employing Shapiro-Wilk tests for normality, independent sample t-tests for continuous data presented as mean plus or minus standard deviation, and Chi-square or Fisher exact tests for categorical proportions. Pearson correlation coefficients evaluated associations between duration and hardness scores, while logistic regression models estimated adjusted odds ratios with 95 percent confidence intervals.
The study cohort comprised 115 diabetic men presenting with a mean age of 39.88 ± 8.33 years and a mean body mass index of 26.13 ± 3.82 kg/m², indicating a slightly overweight average across the cohort. Patients diagnosed with Type 2 diabetes represented 74.8 percent of the sample, while 25.2 percent had Type 1 diabetes. Despite their relatively young age, participants exhibited substantial chronic disease burden, characterized by an average diabetes duration of 8.49 ± 4.65 years and poor glycemic control with mean glycated hemoglobin of 9.80 ± 1.98 percent, well above the recommended clinical target. Potential lifestyle risks were notable, with 42.6 percent reporting cigarette smoking and 35.7 percent regular alcohol consumption. Additionally, 39.1 percent screened positive for anxiety or depression. Mean serum testosterone was 19.12 ± 3.61 nmol/L, confirming that extensive functional deficits occurred in a eugonadal state, ruling out primary hypogonadism.
Detailed evaluation confirmed that only 20.0 percent of patients maintained normal erectile function with an Erection Hardness Score of 4, while 80.0 percent suffered from erectile dysfunction, including 54.8 percent with moderate-to-severe impairment. Total anorgasmia affected 39.1 percent of the cohort despite retrograde ejaculation. Stratification by psychological health revealed that patients experiencing comorbid anxiety or depression demonstrated a distinct density shift toward lower hardness scores. Disease duration emerged as a decisive determinant of erectile failure, displaying a strong negative correlation with hardness scores (r = -0.71, P < 0.001). Patients with long diabetes duration (8 years or more) exhibited significantly lower mean hardness scores than those with shorter duration (1.80 ± 0.76 vs. 3.07 ± 0.93, P < 0.001). Clinically, moderate-to-severe erectile dysfunction rose from 28.6 percent in the short-duration group to 79.7 percent in the long-duration cohort, even though current glycated hemoglobin and testosterone levels did not differ significantly.
A subgroup analysis stratified by diabetes type revealed a clinical paradox between clinical profile and functional outcomes. Patients with Type 1 diabetes were significantly younger than those with Type 2 diabetes (33.59 ± 8.15 vs. 42.00 ± 7.29 years, P < 0.001) and exhibited significantly higher serum testosterone levels (20.56 ± 3.33 vs. 18.63 ± 3.59 nmol/L, P = 0.013). Yet, despite these demographic and hormonal advantages, Type 1 patients experienced worse functional outcomes. The rate of total anorgasmia in Type 1 diabetes was more than double that of Type 2 diabetes (65.5% vs. 30.2%, P = 0.002). Moderate-to-severe erectile dysfunction was also higher in Type 1 diabetes (65.5% vs. 51.2%, P = 0.260). This younger but sicker phenotype is driven by a significantly longer disease duration (11.55 ± 5.84 vs. 7.45 ± 3.66 years, P < 0.001), underscoring that cumulative duration of diabetes, rather than patient age, dictates neurovascular damage.
Evaluation of modifiable lifestyle parameters showed that cigarette smoking had a detrimental effect on metabolic stability, with smokers exhibiting significantly higher glycated hemoglobin levels than non-smokers (10.26% vs. 9.46%, P = 0.032). While smokers also presented with lower mean hardness scores (2.27 vs. 2.53), this difference was not statistically significant (P = 0.186), and alcohol consumption showed no significant correlations with erectile or hormonal parameters. To isolate independent predictors of moderate-to-severe erectile dysfunction, a multivariate logistic regression model was constructed adjusting for age, diabetes duration, glycated hemoglobin, hormonal status, and lifestyle factors. In this adjusted model, diabetes duration was the strongest independent predictor, with each additional year increasing severe dysfunction risk by 70 percent (OR 1.70, P < 0.001). Age remained an independent predictor (OR 1.23, P < 0.001), and glycated hemoglobin emerged as a potent predictor (OR 1.70, P = 0.004), whereas smoking, alcohol, and psychological distress lost significance.
These findings demonstrate that retrograde ejaculation in diabetic men reflects extensive systemic neurovascular damage rather than an isolated fertility challenge. Because ejaculation requires coordinated signaling from the spinal ejaculation generator, autonomic injury disrupting bladder neck closure almost invariably coincides with cavernosal nerve impairment and orgasmic sensory deficits. While spontaneous conception is obstructed by retrograde propulsion of semen into the bladder, optimized protocols for sperm retrieval from post-ejaculatory urine offer viable assisted reproductive pathways. Several study limitations were noted, including the retrospective single-center design, a sample size of 115 patients, reliance on self-reported orgasm and psychological symptoms, and the lack of advanced neurophysiological testing such as bulbocavernosus reflex latency measurements. The authors concluded that clinicians managing diabetic men with retrograde ejaculation must adopt a comprehensive approach, screening for comorbid erectile dysfunction, anorgasmia, and psychological distress, recognizing that disease duration and metabolic stability are the primary determinants of progressive sexual failure.
Subject of Research: Clinical characteristics and risk factors of sexual dysfunction in diabetic retrograde ejaculation
Article Title: Retrospective study of 115 patients with diabetes mellitus complicated by retrograde ejaculation
Article References: Li, C., Wang, H., Li, S., Zhang, T., Li, H., & Wang, C. (2026). Retrospective study of 115 patients with diabetes mellitus complicated by retrograde ejaculation. Basic and Clinical Andrology, 36(1), Article 5. https://doi.org/10.1186/s12610-026-00303-7
Image Credits: AI Generated
DOI: 10.1186/s12610-026-00303-7
Keywords: Diabetes Mellitus, Retrograde Ejaculation, Erectile Dysfunction, Anorgasmia, Autonomic Neuropathy, Glycated Hemoglobin, Type 1 Diabetes, Andrology, Retrospective, patients, diabetes, mellitus
News Source: Ophelia Keating. (November 7, 2026). Study Links Diabetic Retrograde Ejaculation to Severe Erectile Dysfunction and Anorgasmia. Scienmag.
