Retrograde ejaculation as an initial presenting symptom of type 2 diabetes mellitus: a case report and literature review

Retrograde ejaculation (RE), known as one of the late complications of diabetes mellitus, is rarely a presenting symptom in the diagnosis of diabetes. A 30-year-old male presented with a progressive decline in ejaculate over 2-month. Lab results revealed a high random blood glucose level (425 mg/dL). A substantial number of sperm were found in the post-ejaculate urine specimens, confirming a diagnosis of RE. Further lab tests revealed an hemoglobin-A1c (HbA1c) of 12.7%, with negative results for antibodies to glutamic acid decarboxylase, insulin antigen-2, insulin receptor and islet cell, consistent with a diagnosis of type 2 diabetes mellitus (T2DM). Insulin glargine and oral anti-hyperglycemic agents were initiated. Also, imipramine and pseudoephedrine were prescribed for 4-week and then discontinued, as no positive effect on ejaculation was seen. At the 36-month follow-up, the patient had a normal glucose level with HbA1c <6.5%. However, RE persisted. RE is commonly seen as a late-stage complication among T2DM. We presented a rare case where RE was the first referred symptom of T2DM and RE persisted even after adequate control of glycemia.

Retrograde ejaculation; Type 2 diabetes mellitus; Complication; Case report

[1] Parnham A, Serefoglu EC. Retrograde ejaculation, painful ejaculation and hematospermia. Translational Andrology and Urology. 2016; 5: 592–601.

[2] Fedder J, Kaspersen MD, Brandslund I, Højgaard A. Retrograde ejaculation and sexual dysfunction in men with diabetes mellitus: a prospective, controlled study. Andrology. 2013; 1: 602–606.

[3] Verrotti A, Prezioso G, Scattoni R, Chiarelli F. Autonomic neuropathy in diabetes mellitus. Frontiers in Endocrinology. 2014; 5: 205.

[4] Mostafa T, Abdel-Hamid IA. Ejaculatory dysfunction in men with diabetes mellitus. World Journal of Diabetes. 2021; 12: 954–974.

[5] Ibragimov AZ, Aliev TA, AbdullaevKI, Mirza-Zade VA. The function of the closure apparatus of the bladder in retrograde ejaculation in diabetics. Urologiia i Nefrologiia. 1990; 3: 65–68.

[6] Gaunay G, Nagler HM, Stember DS. Reproductive Sequelae of Diabetes in Male Patients. Endocrinology and Metabolism Clinics of North America. 2013; 42: 899–914.

[7] Kam J, Tsang VH, Chalasani V. Retrograde Ejaculation: a Rare Presenting Symptom of Type 1 Diabetes Mellitus. Urology Case Reports. 2016; 10: 9–10.

[8] Arafa M, El Tabie O. Medical Treatment of Retrograde Ejaculation in Diabetic Patients: a Hope for Spontaneous Pregnancy. The Journal of Sexual Medicine. 2008; 5: 194–198.