Ejaculatory dysfunction in men with diabetes mellitus

Table 3 Possible pathophysiological mechanisms underlying ejaculatory dysfunctions in diabetes mellitus (human studies)

Ref.	Possible cause	Outcome
Premature ejaculation
Culha et al[88]	Anxiety	Among PE patients with DM, 15% had anxiety
Culha et al[88], Khan et al[89]	Depression	Among PE patients with DM, 16.9% had depression
		Depression score Significantly higher among diabetic-related PE patients
Khan et al[89], Malavige et al[90]	Genetic and racial factors	Long tri-nucleotide repeats of the androgen receptor are related to the lowest IELT (PE)
		Asian men reported higher diabetic PE than European counterparts
El-Sakka[91]	Diabetic condition, duration of MD	> 10 yr of diabetes were 2.7 times as likely to report diabetic-related PE
	Poor glycemic control	Poor glycemic control were 9.6 times as likely to report PE
El-Sakka[91], Majzoub et al[92]	Having diabetic-related -erectile dysfunction (ED) and Cardiovascular diseases	Significant association between PE and cardiovascular diseases
Malavige et al[93], Malavige et al[90]		ED showed a significantly higher incidence of PE
Olamoyegun et al[94]		ED was strongly associated with PE odds ratio = 4.4
El-Sakka[91]	Having diabetic –related neuropathy	It is not associated with PE
Khan et al[89]	Total serum testosterone	Significantly higher among type 2 diabetic-related PE patients
Owiredu et al[95]		It correlates negatively with short IELT among type 2 DM
Bellastella et al[96]		No significant difference in type 1 diabetes
Delayed ejaculation and anejaculation
Corona et al[97]	Depression	Severe depressive symptoms are associated with ejaculatory problems in DM
Ellenberg et al[25] , La Vignera et al[27] , Dinulovic et al[98]	Progressive autonomic neuropathy of the sympathetic nerves	Denervation leads to weak or loss of VD and SV peristaltic movements
Dunsmuir et al[99], Condorelli et al[100]		Abnormal inflammatory responses lead to alteration of the VD and SV peristaltic movements
La Vignera et al[101] , Pop-Busui et al[102]		Delayed /poor emission
		Absent emission
Haddad et al[26], Culver et al[103]	Calcification of vas deferens and seminal vesicles	Loss of their ability to contract as the smooth muscle is replaced by fibrotic, calcified tissue
Tsuno et al[104]		Delayed/poor emission
Hylmarova et al[29] , Corona et al[81]	Hypogonadism	No association between serum testosterone levels and ejaculation time in men self-reporting DE including diabetic patients
Paduch et al[82], Gianatti et al[105]
Morgentaler et al[106]		T replacement is not associated with improvement in DE or AE
Burke et al[107], Corona et al[108]	Low sexual desire	DM is significantly associated with low sexual desire
Corona et al[109]		DE and AE are associated with low sexual desire
Retrograde ejaculation
Klebanow et al[110]	Diabetic neuropathy (T10-L3)	Intact vasal and seminal vesicle contraction but incomplete simultaneous bladder neck closure leads to partial RE
Greene et al[111]		Intact vasal and seminal vesicle contraction and simultaneous complete lack of bladder neck closure leads to complete RE
Koyanagi[112]	External urethral sphincter relaxation dysfunction (triple parasympathetic-sympathetic-somatic innervation)	Lack of active external urethral sphincter relaxation leads to disruption of antegrade ejaculation
Cao et al[113]

AE: Anejaculation; DE: Delayed ejaculation; DM: Diabetes Mellitus; EL: Ejaculation latency; ED: Erectile dysfunction; PE: Premature ejaculation; SV: Seminal vesicle; VD: Vas deferens.