Ejaculatory dysfunction in men with diabetes mellitus

Table 2 Possible pathophysiological mechanisms underlying ejaculatory dysfunctions in diabetes mellitus (animal studies)

Ref.	Postulated mechanisms	Possible ejaculatory dysfunction
McVary et al[36], Yagihashi et al[49]	Pathologic changes in the nerve supply of seminal tract due to accumulation of AGE increased ROS (sympathetic neuropathy)	Prolongation of EL
Tomlinson et al[50], Longhurst et al[51]	Decreased number of synapses in thoracic ganglia	Reduction of the numbers of ejaculations
Kaschube et al[52], Kamata et al[53]	Axonopathy in postganglionic sympathetic fibers	Disturbed the emission phase
Güneş et al[54], Tsounapi et al[55]	Neuropathic changes in hypogastric nerve and motor pudendal nerve fibers	Disruption of the ejection phase
Tomlinson et al[50], Longhurst et al[51], Kaschube et al[52], Kamata et al[53], Güneş et al[54]	Hypersensitivity (supersensitivity) of seminal tract smooth muscles to exogenous noradrenaline	Reduction of EL
Sakai et al[56], Sakai et al[57]	Hyperactivity of Ca channels in smooth muscles	Reduction of EL
Ebiko et al[37], Yonezawa et al[38]Yagihashi et al[49], Torimoto et al[60]	Sympathetic neuropathy and external urethral sphincter relaxation dysfunction	Disruption of bladder neck closure
		Disruption of AE
Sandrini et al[61], Abraham et al[62]	Changes in serotonergic transmission	Reduction or prolongation of EL
Seethalakshmi et al[71], Wolfe et al[72]	Impaired hypothalamic or pituitary signaling	Decreased sexual performance
Oksanen et al[73], Sudha et al[74]	Deficiency of gonadotropic hormones or blockade of their actions	Decreased sexual performance
Ballester et al[75], Neirijnck et al[76]	Decrease in number and function of Leydig cells	Decreased sexual performance
Neirijnck et al[76]	Defective testicular steroidogenesis	Decreased sexual performance
Kühn-Velten et al[64], Anderson et al[65], Ricci et al[66], Murray et al[67], Cameron et al[68], Ohta et al[69], Nakane et al[70]	Reduced serum levels of LH and testosterone (T)	Decreased sexual performance
McVary et al[36], Minaz et al[48], Steger et al[85], Al-Roujayee et al[86], Kashif et al[87]	Reduced libido	Decreased sexual performance, decreased mount frequency, and reduced EL
Hassan et al[45], Steger et al[77]	Reduced reproductive organ weight	Exact Effects on ejaculation still unknown

AGE: Advanced glycation end products; Ca: Calcium; DE: Delayed ejaculation; EL: Ejaculation latency; FSH: Follicle stimulating hormone; LH: Luteinizing hormone; PE: Premature ejaculation; ROS: Reactive oxygen species; STZ: Streptozotocin; T: Testosterone.