Retrospective Study of 115 Patients with Diabetes Mellitus Complicated by Retrograde Ejaculation

Retrospective Study of 115 Patients with Diabetes Mellitus Complicated by Retrograde Ejaculation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Retrospective Study of 115 Patients with Diabetes Mellitus Complicated by Retrograde Ejaculation Chuan gui Li, Tianzi Zhang, Siqi Li, Hao Li, Chongbo Wang, Huan Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7946195/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Feb, 2026 Read the published version in Basic and Clinical Andrology → Version 1 posted 8 You are reading this latest preprint version Abstract Objective To analyze relationships between age, fertility history, sexual pleasure, disease duration, HbA1c, and erectile hardness in diabetic patients with retrograde ejaculation (RE). Methods A retrospective analysis was conducted on 115 patients with DM and RE who visited Baoding First Central Hospital from January 2020 to June 2025. Data including age, fertility history, sexual pleasure, DM duration, HbA1c, and Erection Hardness Score (EHS) were collected. Patients were divided into type 1 DM group (n = 28) and type 2 DM group (n = 87). Results Among RE patients, 60.87% reported sexual pleasure; 80% had ED. Type 1 DM patients showed higher rates of anorgasmia (64.29% vs 31.03%, P = 0.004) and childlessness (46.43% vs 13.79%, P < 0.01). Type 1 patients were younger (34.11 ± 7.79 vs 41.74 ± 7.65 years, P < 0.01) with longer disease duration (P < 0.01). EHS was significantly lower in patients without sexual pleasure (P < 0.01). Infertile patients were younger (P < 0.01) and had lower EHS (P = 0.035). Lower EHS correlated strongly with anorgasmia (AUC = 0.831). Conclusion Sexual pleasure, fertility, and EHS in diabetic RE patients correlate with disease duration, DM type, and age. Type 1 DM patients present earlier, with higher risks of ED, anorgasmia, and childlessness. Project Support Baoding Science and Technology Bureau Project (No. 2442ZF206); Baoding Key Laboratory of Prostate and Andrological Disease Prevention and Treatment (No. 2363P007) Diabetes Mellitus Retrograde Ejaculation Disease Duration Sexual Pleasure FertilityClassification Code R698 Document Code A Figures Figure 1 Figure 2 Figure 3 Introduction Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia resulting from insufficient insulin secretion or insulin resistance [ 1 ]. Global data show that the prevalence of DM increased from 108 million in 1980 to 422 million in 2014, and currently exceeds 525 million, with a trend toward younger age. Among male DM patients, 35%–50% suffer from ejaculatory dysfunction [ 2 ]. Ejaculation is a complex process requiring coordination of multiple systems, primarily involving contraction of the internal urethral sphincter (to close the bladder neck) and rhythmic contraction of the seminal vesicle and urethral smooth muscles (to expel semen through the urethra). Retrograde ejaculation (RE) refers to the condition where patients can achieve orgasm during intercourse (some retain normal sexual pleasure and ejaculatory movements), but semen refluxes into the bladder. Sperm and fructose can be detected in urine after ejaculation. RE is caused by neuropathy; long-term hyperglycemia damages the nervous system and peripheral vascular system, which may explain why DM patients are prone to RE and anorgasmia. RE accounts for 0.3%–2.0% of all male infertility cases [ 3 ], but its proportion reaches up to 18% among patients initially diagnosed with azoospermia (due to misdiagnosis) [ 4 ]. This severely impairs patients’ sexual experience and fertility. This retrospective study analyzed clinical data of DM patients with RE to provide evidence for preventing further damage and guiding the diagnosis and treatment of DM-associated RE. Subjects and Methods 1.1 Study Subjects A total of 115 male patients with DM and RE, aged 18–60 years, who visited our hospital from January 2020 to June 2025 were included in this retrospective study. Patients were divided into type 1 DM group and type 2 DM group based on DM subtype; erectile hardness was classified into grades I–IV according to EHS. Inclusion Criteria (1) Aged 18–60 years; (2) Married with regular sexual activity. Exclusion Criteria (1) Genital malformation or history of pelvic/neurological surgery; (2) History of mental illness or other unresolved diseases. This study was approved by the Ethics Committee of Baoding First Central Hospital (Ethical Approval No. : Kuai [2024] 170), in accordance with the Declaration of Helsinki. 1.2 Study Methods 1.2.1 Semen Detection Patients abstained from sexual activity for more than 3 days before ejaculation and emptied their bladder urine before ejaculation. They then ejaculated via masturbation, and post-ejaculation urine was collected in a 50-mL plastic specimen cup for testing. RE was diagnosed if > 10 sperm per high-power field or positive fructose was detected [ 5 ]. 1.2.2 DM History and HbA1c Detection Patients’ DM duration was recorded, and venous blood was collected to measure HbA1c (reference range: 4%–6%). 1.2.3 Assessment of Fertility, Sexual Pleasure, and EHS Patients were interviewed to collect data on fertility status and post-ejaculatory sexual pleasure. After being informed of EHS scoring guidelines, patients self-assessed their recent erectile function using the EHS scale. 1.3 Statistical Analysis Statistical analyses were performed using SPSS 29.0, R, and related packages. Categorical data were expressed as (n, %), and continuous data were expressed as (Mean ± SD) or [Median (Q1, Q3)] depending on normality. t-test, one-way analysis of variance (ANOVA), χ² test, and Wilcoxon rank-sum test were used. A P-value < 0.05 was considered statistically significant. Results 2.1 Analysis of General Clinical Data A total of 115 male patients with DM and RE were included. Their general characteristics are shown in Table 1 . Table 1 Grouping of patients with retrograde ejaculation accompanied by diabetes Clinical Parameter Category Number Percentage (%) Age (years) 18–30 16 13.91 31–40 45 39.13 41–50 43 37.39 51–60 11 9.57 DM type Ⅰ 28 24.35 Ⅱ 87 75.65 Orgasm Yes 45 39.13 No 70 60.87 Obstetric history Yes 25 21.74 No 90 78.26 EHS 1 27 23.48 2 36 31.30 3 29 25.22 4 23 20.00 Most patients (≈ 76.52%) were aged 31–50 years. Type 2 DM accounted for 75.65%, significantly higher than type 1 DM. Among RE patients, 60.87% retained sexual pleasure, indicating that RE and anorgasmia are not mutually exclusive. A total of 78.26% of patients had fertility history, including 6 patients who achieved successful pregnancy via assisted reproductive technology (ART) after RE diagnosis. EHS results showed that nearly 80% of patients had erectile dysfunction. 2.2 Clinical Data Differences Between DM Subtypes Clinical data differences between type 1 and type 2 DM groups are shown in Table 2 . Table 2 Research on the Differences of Various Factors among Different Types of Diabetes Clinical Parameter Total Ⅰ Ⅱ P DM type 115 28 87 Orgasm Yes No 45 18 27 0.004 70 10 60 Obstetric history Yes No 25 13 12 < 0.01 90 15 75 EHS 1 2 3 4 27 8 19 0.464 36 11 25 29 5 24 23 4 19 Age (years) 39.88 ± 8.33 34.11 ± 7.79 41.74 ± 7.65 < 0.01 Duration of illness (years) 8(5,11.5) 13.5(7.5,15.25) 7 (5,10) < 0.01 HbA1c 9.4(8.45,10.7) 9.45(8.45,11.32) 9.4(8.45, 10.6) 0.623 Regarding sexual pleasure: The proportion of anorgasmia in type 1 DM patients was significantly higher than that in type 2 DM patients (64.29% vs 31.03%, P = 0.004), with an AUC of 0.666 (Fig. 1). Regarding fertility: The proportion of childlessness in type 1 DM patients was significantly higher than that in type 2 DM patients (46.43% vs 13.79%, P < 0.01), with an AUC of 0.663, suggesting more severe fertility impairment in type 1 DM patients. Regarding erectile function: No significant difference in EHS distribution was observed between the two groups (P = 0.464), with an AUC of 0.584. Regarding age: A significant difference was found between the two groups (type 1 vs type 2: 34.11 ± 7.79 years vs 41.74 ± 7.65 years, P < 0.01), with an AUC of 0.762, consistent with the characteristic early onset of type 1 DM (typically in adolescents or young adults). Regarding disease duration: Type 1 DM patients had significantly longer disease duration than type 2 DM patients (13.5 (7.5, 15.25) years vs 7 (5, 10) years, P < 0.01), with an AUC of 0.732, indicating a correlation between disease duration and anorgasmia/fertility impairment. In contrast, no significant difference in HbA1c levels was observed between the two groups (P = 0.623). Figure 1 Univariate Analysis of Factors Related to Different Types of Diabetes Mellitus 2.3 Analysis of Factors Influencing Sexual Pleasure Differences in clinical factors between patients with and without sexual pleasure are shown in Table 3 . Table 3 Research on the Differences in Various Factors of the Presence or absence of sexual pleasure Clinical Parameter Total No Yes P Orgasm 115 45 75 Obstetric history No Yes 25 10 15 1.00 90 35 55 EHS 1 2 3 4 27 21 6 < 0.01 36 20 16 29 2 27 23 2 21 Age (years) 39.88 ± 8.33 42.44 ± 9.08 38.23 ± 7.41 0.011 Duration of illness (years) 8(5,11.5) 12(10,15) 6(4,8) < 0.01 HbA1c 9.4 (8.45,10.7) 10.3 (8.9,10.8) 9.3(8.33, 10.5) 0.062 EHS differed significantly between patients with and without sexual pleasure (P < 0.01); patients with lower EHS were more likely to have anorgasmia. ROC analysis confirmed that EHS had strong discriminative power for sexual pleasure status (AUC = 0.831, Fig. 2). Age and disease duration also showed significant differences between the two groups (P = 0.011 and P < 0.01, respectively); patients without sexual pleasure were older and had longer disease duration. ROC analysis showed that disease duration had an AUC of 0.860, significantly higher than other univariate indicators, indicating that disease duration is a key risk factor for anorgasmia in RE patients. Figure 2 Univariate Analysis of Factors Influencing Sexual Pleasure 2.4 Analysis of Factors Influencing Fertility Differences in clinical factors between fertile and infertile patients are shown in Table 4 . Table 4 A study on the Differences in various Factors of fertility Clinical Parameter Total No Yes P Obstetric history 115 25 90 EHS 1 2 3 4 27 3 24 0.035 36 7 29 29 5 24 23 10 13 Age (years) 39.88 ± 8.33 32.28 ± 8.34 41.99 ± 7.02 < 0.01 Duration of illness (years) 8(5,11.5) 8(3,14) 8(5,11) < 0.541 HbA1c 9.4(8.45,10.7) 10.5(8.5,12.3) 9.4(8.4, 10.5) 0.064 Age showed a significant difference between fertile and infertile groups (P < 0.01), with infertile patients being younger. ROC analysis confirmed that age had good predictive value for fertility status (AUC = 0.828, Fig. 3), demonstrating strong discriminative power. EHS also differed statistically between the two groups (P = 0.035, AUC = 0.651), indicating that erectile hardness has certain predictive value for fertility, possibly by indirectly affecting ejaculatory function. Although HbA1c did not reach statistical significance (P = 0.064, AUC = 0.622), it suggested that blood glucose control may have a potential impact on fertility. Figure 3 Univariate Analysis of Factors Influencing Fertility Discussion Ejaculation is regulated by the coordination of somatic nerves, sympathetic nerves, and parasympathetic nerves, involving complex neurochemical interactions [ 6 ]. The sympathetic nervous system controls the internal urethral sphincter (for bladder neck closure), while the somatic nervous system regulates pelvic muscles, as well as muscles innervated by the medulla oblongata and sciatic nerve. Key brain centers involved in ejaculation include the medial preoptic area and paraventricular nucleus, both located in the hypothalamus [ 7 ]. Neuropathy is a common sequela of DM, primarily caused by chronic hyperglycemia and insulin resistance impairing the structure and function of neurons and their associated microvascular systems. Neuropathy is thought to result from oxidative stress, neuronal inflammation due to cytokine accumulation, and mitochondrial/cellular dysfunction, ultimately leading to neuronal death [ 8 – 9 ]. DM neuropathy is also attributed to damage to Schwann cells, which are responsible for axonal myelination and optimization of nerve transmission in the nervous system. Studies have shown that hyperglycemia in DM reduces the proliferation and migration of Schwann cells, leading to axonal dysfunction [ 10 ]. Animal studies suggest that this may be due to upregulation of phosphodiesterase type 5 in response to hyperglycemia, resulting in decreased myelin thickness and nerve conduction velocity [ 11 ]. Impaired sympathetic activation during the ejaculatory emission phase can prevent relaxation of the internal urethral sphincter/bladder neck. Human studies have also found atrophy of the internal urethral sphincter in male DM patients with RE; combined with reduced somatic nerve stimulation during ejaculation (i.e., decreased tonic contraction of the bulbospongiosus muscle), this contributes to RE in DM patients. This has been further confirmed in DM rat models [ 12 – 13 ]. DM patients with ED often have abnormal penile somatosensory evoked potentials and bulbospongiosus reflex latency, indicating that DM neuropathy may concurrently affect ejaculatory and penile nerves. Electrophysiological examination of penile nerves may provide reference value for determining the severity of RE and whether it is induced by DM [ 14 ]. In this study, although type 1 DM typically has an earlier onset and longer disease duration, type 2 DM patients accounted for a higher proportion. This is mainly attributed to the higher prevalence of type 2 DM in men, long-term metabolic disorders and insulin resistance, and easy neglect of microangiopathy and autonomic dysfunction—factors that increase the incidence of ejaculatory dysfunction. The finding that many RE patients retain sexual pleasure suggests a potential functional dissociation between orgasm and ejaculatory reflex, or that some RE patients may progress to anorgasmia. The high prevalence of ED and low overall EHS in DM patients with RE indicate that sexual dysfunction in these patients is not limited to ejaculatory disorders but also involves varying degrees of erectile impairment. Type 1 DM patients are more prone to damage to the nerve conduction and regulatory systems for sexual pleasure than type 2 DM patients, which may be related to their earlier onset age and longer disease duration. Additionally, type 1 DM patients have a significantly higher proportion of childlessness, reflecting more severe fertility impairment—possibly associated with more severe RE, extensive cumulative metabolic damage, and hypothalamic-pituitary-gonadal axis dysfunction. Patients without sexual pleasure were older and had longer disease duration, suggesting that disease progression and aging may gradually exacerbate sexual dysfunction through cumulative neural and vascular damage. Anorgasmia in RE patients is a result of multiple factors, mainly influenced by erectile function, disease duration, and age, with blood glucose control possibly playing an auxiliary role. Age is the main factor affecting the fertility status of RE patients, with high predictive value. Clinical evaluation should focus on EHS, age, and disease duration; constructing a multi-factor prediction model using comprehensive indicators is expected to improve the accuracy of sexual pleasure prediction, guide individualized intervention strategies, and enhance patients’ quality of life. However, this study has limitations: the sample size is small, and the number of patients in the type 1 and type 2 DM groups is unbalanced, limiting the statistical power. Future studies should expand the sample size and include multiple centers to provide more reliable evidence for the diagnosis and treatment of DM-associated RE. Pharmacotherapy is the mainstay of RE treatment, primarily focusing on enhancing sympathetic drive to the reproductive tract and bladder neck (e.g., pseudoephedrine) and reducing parasympathetic activity (anticholinergic drugs) to inhibit bladder neck relaxation. Intraurethral injection of collagen at the bladder neck to increase resistance against semen reflux has been reported in the literature [ 15 ]. Additionally, a human study showed that subjects treated with tadalafil for 3 months had improved ejaculatory parameters, possibly due to increased cyclic guanosine monophosphate (cGMP) levels improving external urethral sphincter relaxation and enhancing neurovascular dilation to mitigate microvascular damage to relevant nerves [ 16 ]. Currently, there are no specific drugs for RE beyond the aforementioned medications and commonly used drugs for neurotrophic support and microcirculation improvement. Although RE has a low incidence and accounts for a small proportion of male infertility, it should not be overlooked. When pharmacotherapy is ineffective, low-frequency pulsed ultrasound therapy is an emerging alternative to assisted reproductive technology, which requires further clinical research. Declarations CONFLICT OF INTEREST All authors declare no conflict interests. AUTHOR CONTRIBUTIONS [Author LCG]: Conceptualization, Methodology [Author ZTZ、LH、WCB]: Supervision, Writing – Review & Editing [Author LSQ、WH]: Writing – Original Draft,Data Curation All authors have read and approved the final manuscript. Funding This work was supported by Baoding Science and Technology Bureau Project (No. 2442ZF206) Ethics declarations This study was approved by the Ethics Committee of Baoding First Central Hospital. Each patient signed an informed consent form. References Chinese Society of Endocrinology and Metabolism, Chinese Medical Association; Endocrinologists Branch of Chinese Medical Doctor Association; Endocrine Society of Chinese Medical Association, et al. Guidelines for the Diagnosis and Treatment of Type 1 Diabetes Mellitus in China (2021 Edition) [J]. Chin J Diabetes Mellitus, 2022, 14(11): 1143-1250. (In Chinese) Desai A, Chen R, Cayetano A, et al. 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J Diabetes Investig, 2022, 13: 1945–1957. Mostafa T, Abdel-Hamid IA. Diabetes Mellitus and Male Sexual Dysfunction: An Update [J]. World J Diabetes, 2021, 12(7): 954-974. Chen Y, Chen JH. Progress in Research on Central Neural Mechanisms of Male Ejaculation [J]. Chin J Androl, 2018, 24(11): 963-966. (In Chinese) Gur S, Sikka SC. The Characterization, Current Medications, and Promising Therapeutic Targets for Premature Ejaculation [J]. Andrology, 2015, 3(3): 424-442. Will RG, Nutsch VL, Turner JM, et al. Astrocytes in the Medial Preoptic Area Modulate Ejaculation Latency in an Experience-Dependent Fashion [J]. Behav Neurosci, 2015, 129(1): 68-73. Chéhensse C, Facchinetti P, Bahrami S, et al. The Human Spinal Ejaculation Generator [J]. Ann Neurol, 2017, 81: 35-45. Mazzilli R, Defeudis G, Olana S. The Role of Ejaculatory Dysfunction in Male Infertility [J]. Clin Ter, 2020, 171(6): e523-e527. Peng JX, Li DJ, Liu LY, et al. Comparison of Characteristics Between Chinese Patients with Diabetes Mellitus-Induced Erectile Dysfunction and Non-Diabetes Mellitus-Induced Erectile Dysfunction: A Cross-Sectional Study [J]. Front Endocrinol (Lausanne), 2022, 13: 1096045. https://doi.org/10.3389/fendo.2022.1096045 Xu W, Jiang H, Liu J, et al. Non-Coding RNAs: A New Dawn for Diabetes Mellitus-Induced Erectile Dysfunction [J]. Front Mol Biosci, 2022, 9: 888624. Morelli A, Filippi S, Comeglio P, et al. Physical Activity Counteracts Metabolic Syndrome-Induced Hypogonadotropic Hypogonadism and Erectile Dysfunction in Rabbits [J]. Am J Physiol Endocrinol Metab, 2019, 316(3): E519-E535. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 23 Feb, 2026 Read the published version in Basic and Clinical Andrology → Version 1 posted Editorial decision: Revision requested 21 Dec, 2025 Reviews received at journal 01 Dec, 2025 Reviewers agreed at journal 23 Nov, 2025 Reviewers agreed at journal 19 Nov, 2025 Reviewers invited by journal 09 Nov, 2025 Editor assigned by journal 07 Nov, 2025 Submission checks completed at journal 07 Nov, 2025 First submitted to journal 25 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7946195","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":546186189,"identity":"91dd3d19-5be9-46a4-9b82-85c23d9e93bd","order_by":0,"name":"Chuan gui Li","email":"","orcid":"","institution":"Baoding First Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chuan","middleName":"gui","lastName":"Li","suffix":""},{"id":546186191,"identity":"35563482-29fa-4f18-a6fa-fc82e1b96fab","order_by":1,"name":"Tianzi Zhang","email":"","orcid":"","institution":"City University of 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16:39:19","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":64836,"visible":true,"origin":"","legend":"","description":"","filename":"6527100eb07c473db4102a5f30ea3b191structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7946195/v1/0e9acf1c7c07696950c9a3d2.xml"},{"id":96202165,"identity":"eedd247c-43de-450b-a096-7945f37bc8f6","added_by":"auto","created_at":"2025-11-18 16:39:18","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":73509,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7946195/v1/990bb53a08befbaf208fc033.html"},{"id":96202161,"identity":"7cb7f62f-3f41-4fd0-aa7e-944c01e5fb91","added_by":"auto","created_at":"2025-11-18 16:39:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":117080,"visible":true,"origin":"","legend":"\u003cp\u003eUnivariate Analysis of Factors Related to Different Types of Diabetes Mellitus\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7946195/v1/5ac3c53fe7de6dea7ce7f7d5.png"},{"id":96202166,"identity":"97239cfb-ebe9-4a7b-b09e-32adf95ea27a","added_by":"auto","created_at":"2025-11-18 16:39:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":115433,"visible":true,"origin":"","legend":"\u003cp\u003eUnivariate Analysis of Factors Influencing Sexual Pleasure\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7946195/v1/bfed886bb61968591c8ece82.png"},{"id":96202159,"identity":"e4e9eb67-ff58-46c0-b160-66e47220e0dc","added_by":"auto","created_at":"2025-11-18 16:39:18","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":105256,"visible":true,"origin":"","legend":"\u003cp\u003eUnivariate Analysis of Factors Influencing Fertility\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7946195/v1/2b98bc4962da40701a3a7baa.png"},{"id":103766251,"identity":"03d8c360-4344-4d6f-af52-fb6d7927a7af","added_by":"auto","created_at":"2026-03-02 16:13:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1061227,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7946195/v1/793e2e74-e7b4-4529-b392-eeaa1b0b91fe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Retrospective Study of 115 Patients with Diabetes Mellitus Complicated by Retrograde Ejaculation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDiabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia resulting from insufficient insulin secretion or insulin resistance [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Global data show that the prevalence of DM increased from 108\u0026nbsp;million in 1980 to 422\u0026nbsp;million in 2014, and currently exceeds 525\u0026nbsp;million, with a trend toward younger age. Among male DM patients, 35%\u0026ndash;50% suffer from ejaculatory dysfunction [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEjaculation is a complex process requiring coordination of multiple systems, primarily involving contraction of the internal urethral sphincter (to close the bladder neck) and rhythmic contraction of the seminal vesicle and urethral smooth muscles (to expel semen through the urethra). Retrograde ejaculation (RE) refers to the condition where patients can achieve orgasm during intercourse (some retain normal sexual pleasure and ejaculatory movements), but semen refluxes into the bladder. Sperm and fructose can be detected in urine after ejaculation. RE is caused by neuropathy; long-term hyperglycemia damages the nervous system and peripheral vascular system, which may explain why DM patients are prone to RE and anorgasmia.\u003c/p\u003e\u003cp\u003eRE accounts for 0.3%\u0026ndash;2.0% of all male infertility cases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], but its proportion reaches up to 18% among patients initially diagnosed with azoospermia (due to misdiagnosis) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This severely impairs patients\u0026rsquo; sexual experience and fertility. This retrospective study analyzed clinical data of DM patients with RE to provide evidence for preventing further damage and guiding the diagnosis and treatment of DM-associated RE.\u003c/p\u003e"},{"header":"Subjects and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e1.1 Study Subjects\u003c/h2\u003e\u003cp\u003eA total of 115 male patients with DM and RE, aged 18\u0026ndash;60 years, who visited our hospital from January 2020 to June 2025 were included in this retrospective study. Patients were divided into type 1 DM group and type 2 DM group based on DM subtype; erectile hardness was classified into grades I\u0026ndash;IV according to EHS.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003cp\u003e(1) Aged 18\u0026ndash;60 years; (2) Married with regular sexual activity.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003cp\u003e(1) Genital malformation or history of pelvic/neurological surgery; (2) History of mental illness or other unresolved diseases.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e This study was approved by the Ethics Committee of Baoding First Central Hospital (Ethical Approval No. : Kuai [2024] 170), in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Study Methods\u003c/h2\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e1.2.1 Semen Detection\u003c/h2\u003e\u003cp\u003ePatients abstained from sexual activity for more than 3 days before ejaculation and emptied their bladder urine before ejaculation. They then ejaculated via masturbation, and post-ejaculation urine was collected in a 50-mL plastic specimen cup for testing. RE was diagnosed if\u0026thinsp;\u0026gt;\u0026thinsp;10 sperm per high-power field or positive fructose was detected [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e1.2.2 DM History and HbA1c Detection\u003c/h2\u003e\u003cp\u003ePatients\u0026rsquo; DM duration was recorded, and venous blood was collected to measure HbA1c (reference range: 4%\u0026ndash;6%).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e1.2.3 Assessment of Fertility, Sexual Pleasure, and EHS\u003c/h2\u003e\u003cp\u003ePatients were interviewed to collect data on fertility status and post-ejaculatory sexual pleasure. After being informed of EHS scoring guidelines, patients self-assessed their recent erectile function using the EHS scale.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e1.3 Statistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using SPSS 29.0, R, and related packages. Categorical data were expressed as (n, %), and continuous data were expressed as (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) or [Median (Q1, Q3)] depending on normality. t-test, one-way analysis of variance (ANOVA), χ\u0026sup2; test, and Wilcoxon rank-sum test were used. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Analysis of General Clinical Data\u003c/h2\u003e\u003cp\u003eA total of 115 male patients with DM and RE were included. Their general characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGrouping of patients with retrograde ejaculation accompanied by diabetes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Parameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDM type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eⅠ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eⅡ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e75.65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOrgasm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e60.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eObstetric history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e78.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eEHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMost patients (\u0026asymp;\u0026thinsp;76.52%) were aged 31\u0026ndash;50 years. Type 2 DM accounted for 75.65%, significantly higher than type 1 DM. Among RE patients, 60.87% retained sexual pleasure, indicating that RE and anorgasmia are not mutually exclusive. A total of 78.26% of patients had fertility history, including 6 patients who achieved successful pregnancy via assisted reproductive technology (ART) after RE diagnosis. EHS results showed that nearly 80% of patients had erectile dysfunction.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Clinical Data Differences Between DM Subtypes\u003c/h2\u003e\u003cp\u003eClinical data differences between type 1 and type 2 DM groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResearch on the Differences of Various Factors among Different Types of Diabetes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Parameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eⅠ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eⅡ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDM type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOrgasm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObstetric history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.464\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.88\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.11\u0026thinsp;\u0026plusmn;\u0026thinsp;7.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.74\u0026thinsp;\u0026plusmn;\u0026thinsp;7.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of illness (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(5,11.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.5(7.5,15.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (5,10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHbA1c\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.4(8.45,10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.45(8.45,11.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.4(8.45, 10.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.623\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eRegarding sexual pleasure: The proportion of anorgasmia in type 1 DM patients was significantly higher than that in type 2 DM patients (64.29% vs 31.03%, P\u0026thinsp;=\u0026thinsp;0.004), with an AUC of 0.666 (Fig.\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eRegarding fertility: The proportion of childlessness in type 1 DM patients was significantly higher than that in type 2 DM patients (46.43% vs 13.79%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with an AUC of 0.663, suggesting more severe fertility impairment in type 1 DM patients.\u003c/p\u003e\u003cp\u003eRegarding erectile function: No significant difference in EHS distribution was observed between the two groups (P\u0026thinsp;=\u0026thinsp;0.464), with an AUC of 0.584.\u003c/p\u003e\u003cp\u003eRegarding age: A significant difference was found between the two groups (type 1 vs type 2: 34.11\u0026thinsp;\u0026plusmn;\u0026thinsp;7.79 years vs 41.74\u0026thinsp;\u0026plusmn;\u0026thinsp;7.65 years, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with an AUC of 0.762, consistent with the characteristic early onset of type 1 DM (typically in adolescents or young adults).\u003c/p\u003e\u003cp\u003eRegarding disease duration: Type 1 DM patients had significantly longer disease duration than type 2 DM patients (13.5 (7.5, 15.25) years vs 7 (5, 10) years, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with an AUC of 0.732, indicating a correlation between disease duration and anorgasmia/fertility impairment.\u003c/p\u003e\u003cp\u003eIn contrast, no significant difference in HbA1c levels was observed between the two groups (P\u0026thinsp;=\u0026thinsp;0.623).\u003c/p\u003e\u003cp\u003eFigure 1 Univariate Analysis of Factors Related to Different Types of Diabetes Mellitus\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Analysis of Factors Influencing Sexual Pleasure\u003c/h2\u003e\u003cp\u003eDifferences in clinical factors between patients with and without sexual pleasure are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResearch on the Differences in Various Factors of the Presence or absence of sexual pleasure\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Parameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOrgasm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObstetric history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.88\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.44\u0026thinsp;\u0026plusmn;\u0026thinsp;9.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.23\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of illness (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(5,11.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(10,15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(4,8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHbA1c\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.4 (8.45,10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.3 (8.9,10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.3(8.33, 10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eEHS differed significantly between patients with and without sexual pleasure (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01); patients with lower EHS were more likely to have anorgasmia. ROC analysis confirmed that EHS had strong discriminative power for sexual pleasure status (AUC\u0026thinsp;=\u0026thinsp;0.831, Fig.\u0026nbsp;2).\u003c/p\u003e\u003cp\u003eAge and disease duration also showed significant differences between the two groups (P\u0026thinsp;=\u0026thinsp;0.011 and P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, respectively); patients without sexual pleasure were older and had longer disease duration. ROC analysis showed that disease duration had an AUC of 0.860, significantly higher than other univariate indicators, indicating that disease duration is a key risk factor for anorgasmia in RE patients.\u003c/p\u003e\u003cp\u003eFigure 2 Univariate Analysis of Factors Influencing Sexual Pleasure\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Analysis of Factors Influencing Fertility\u003c/h2\u003e\u003cp\u003eDifferences in clinical factors between fertile and infertile patients are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eA study on the Differences in various Factors of fertility\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Parameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObstetric history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.88\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.28\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.99\u0026thinsp;\u0026plusmn;\u0026thinsp;7.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of illness (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(5,11.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(3,14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(5,11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.541\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHbA1c\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.4(8.45,10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.5(8.5,12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.4(8.4, 10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAge showed a significant difference between fertile and infertile groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with infertile patients being younger. ROC analysis confirmed that age had good predictive value for fertility status (AUC\u0026thinsp;=\u0026thinsp;0.828, Fig.\u0026nbsp;3), demonstrating strong discriminative power.\u003c/p\u003e\u003cp\u003eEHS also differed statistically between the two groups (P\u0026thinsp;=\u0026thinsp;0.035, AUC\u0026thinsp;=\u0026thinsp;0.651), indicating that erectile hardness has certain predictive value for fertility, possibly by indirectly affecting ejaculatory function. Although HbA1c did not reach statistical significance (P\u0026thinsp;=\u0026thinsp;0.064, AUC\u0026thinsp;=\u0026thinsp;0.622), it suggested that blood glucose control may have a potential impact on fertility.\u003c/p\u003e\u003cp\u003eFigure 3 Univariate Analysis of Factors Influencing Fertility\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eEjaculation is regulated by the coordination of somatic nerves, sympathetic nerves, and parasympathetic nerves, involving complex neurochemical interactions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The sympathetic nervous system controls the internal urethral sphincter (for bladder neck closure), while the somatic nervous system regulates pelvic muscles, as well as muscles innervated by the medulla oblongata and sciatic nerve. Key brain centers involved in ejaculation include the medial preoptic area and paraventricular nucleus, both located in the hypothalamus [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNeuropathy is a common sequela of DM, primarily caused by chronic hyperglycemia and insulin resistance impairing the structure and function of neurons and their associated microvascular systems. Neuropathy is thought to result from oxidative stress, neuronal inflammation due to cytokine accumulation, and mitochondrial/cellular dysfunction, ultimately leading to neuronal death [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. DM neuropathy is also attributed to damage to Schwann cells, which are responsible for axonal myelination and optimization of nerve transmission in the nervous system. Studies have shown that hyperglycemia in DM reduces the proliferation and migration of Schwann cells, leading to axonal dysfunction [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Animal studies suggest that this may be due to upregulation of phosphodiesterase type 5 in response to hyperglycemia, resulting in decreased myelin thickness and nerve conduction velocity [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eImpaired sympathetic activation during the ejaculatory emission phase can prevent relaxation of the internal urethral sphincter/bladder neck. Human studies have also found atrophy of the internal urethral sphincter in male DM patients with RE; combined with reduced somatic nerve stimulation during ejaculation (i.e., decreased tonic contraction of the bulbospongiosus muscle), this contributes to RE in DM patients. This has been further confirmed in DM rat models [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDM patients with ED often have abnormal penile somatosensory evoked potentials and bulbospongiosus reflex latency, indicating that DM neuropathy may concurrently affect ejaculatory and penile nerves. Electrophysiological examination of penile nerves may provide reference value for determining the severity of RE and whether it is induced by DM [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, although type 1 DM typically has an earlier onset and longer disease duration, type 2 DM patients accounted for a higher proportion. This is mainly attributed to the higher prevalence of type 2 DM in men, long-term metabolic disorders and insulin resistance, and easy neglect of microangiopathy and autonomic dysfunction\u0026mdash;factors that increase the incidence of ejaculatory dysfunction.\u003c/p\u003e\u003cp\u003eThe finding that many RE patients retain sexual pleasure suggests a potential functional dissociation between orgasm and ejaculatory reflex, or that some RE patients may progress to anorgasmia. The high prevalence of ED and low overall EHS in DM patients with RE indicate that sexual dysfunction in these patients is not limited to ejaculatory disorders but also involves varying degrees of erectile impairment.\u003c/p\u003e\u003cp\u003eType 1 DM patients are more prone to damage to the nerve conduction and regulatory systems for sexual pleasure than type 2 DM patients, which may be related to their earlier onset age and longer disease duration. Additionally, type 1 DM patients have a significantly higher proportion of childlessness, reflecting more severe fertility impairment\u0026mdash;possibly associated with more severe RE, extensive cumulative metabolic damage, and hypothalamic-pituitary-gonadal axis dysfunction.\u003c/p\u003e\u003cp\u003ePatients without sexual pleasure were older and had longer disease duration, suggesting that disease progression and aging may gradually exacerbate sexual dysfunction through cumulative neural and vascular damage. Anorgasmia in RE patients is a result of multiple factors, mainly influenced by erectile function, disease duration, and age, with blood glucose control possibly playing an auxiliary role.\u003c/p\u003e\u003cp\u003eAge is the main factor affecting the fertility status of RE patients, with high predictive value. Clinical evaluation should focus on EHS, age, and disease duration; constructing a multi-factor prediction model using comprehensive indicators is expected to improve the accuracy of sexual pleasure prediction, guide individualized intervention strategies, and enhance patients\u0026rsquo; quality of life.\u003c/p\u003e\u003cp\u003eHowever, this study has limitations: the sample size is small, and the number of patients in the type 1 and type 2 DM groups is unbalanced, limiting the statistical power. Future studies should expand the sample size and include multiple centers to provide more reliable evidence for the diagnosis and treatment of DM-associated RE.\u003c/p\u003e\u003cp\u003ePharmacotherapy is the mainstay of RE treatment, primarily focusing on enhancing sympathetic drive to the reproductive tract and bladder neck (e.g., pseudoephedrine) and reducing parasympathetic activity (anticholinergic drugs) to inhibit bladder neck relaxation. Intraurethral injection of collagen at the bladder neck to increase resistance against semen reflux has been reported in the literature [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, a human study showed that subjects treated with tadalafil for 3 months had improved ejaculatory parameters, possibly due to increased cyclic guanosine monophosphate (cGMP) levels improving external urethral sphincter relaxation and enhancing neurovascular dilation to mitigate microvascular damage to relevant nerves [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Currently, there are no specific drugs for RE beyond the aforementioned medications and commonly used drugs for neurotrophic support and microcirculation improvement.\u003c/p\u003e\u003cp\u003eAlthough RE has a low incidence and accounts for a small proportion of male infertility, it should not be overlooked. When pharmacotherapy is ineffective, low-frequency pulsed ultrasound therapy is an emerging alternative to assisted reproductive technology, which requires further clinical research.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no conflict interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[Author LCG]: Conceptualization, Methodology\u003c/p\u003e\n\u003cp\u003e[Author ZTZ、LH、WCB]: Supervision,\u003cstrong\u003eWriting \u0026ndash; Review \u0026amp; Editing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[Author LSQ、WH]: \u003cstrong\u003eWriting \u0026ndash; Original Draft,Data Curation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Baoding Science and Technology Bureau Project (No. 2442ZF206)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Baoding First Central Hospital. Each patient signed an informed consent form.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChinese Society of Endocrinology and Metabolism, Chinese Medical Association; Endocrinologists Branch of Chinese Medical Doctor Association; Endocrine Society of Chinese Medical Association, et al. Guidelines for the Diagnosis and Treatment of Type 1 Diabetes Mellitus in China (2021 Edition) [J]. Chin J Diabetes Mellitus, 2022, 14(11): 1143-1250. (In Chinese)\u003c/li\u003e\n\u003cli\u003eDesai A, Chen R, Cayetano A, et al. Understanding and Treating Ejaculatory Dysfunction in Men with Diabetes Mellitus [J]. Andrology, 2023, 11: 379\u0026ndash;398.\u003c/li\u003e\n\u003cli\u003eZhao LY, Mao XP, Li XY, et al. Analysis of 7722 Misdiagnosed Cases of Retrograde Ejaculation [J]. Chin J Androl, 2017, 31(4): 41-45. (In Chinese)\u003c/li\u003e\n\u003cli\u003eKhan HL, Bhatti S, Abbas S, et al. Longer Trinucleotide Repeats of Androgen Receptor Are Associated with Higher Testosterone and Low Oxytocin Levels in Diabetic Patients with Premature Ejaculatory Dysfunction [J]. Basic Clin Androl, 2018, 28: 3. https://doi.org/10.1186/s12610-018-0068-0\u003c/li\u003e\n\u003cli\u003eZheng Y, Wu YB, Yu L, et al. Etiology and Sperm Quality Analysis of 36 Patients with Retrograde Ejaculation [J]. Int J Lab Med, 2023, 44(2): 241-243. (In Chinese)\u003c/li\u003e\n\u003cli\u003eBoeri L, Capogrosso P, Ventimiglia E, et al. Sexual Dysfunction in Men with Prediabetes [J]. Sex Med Rev, 2020, 8: 622\u0026ndash;634.\u003c/li\u003e\n\u003cli\u003eKang WH, Sithik MNM, Khoo JK, et al. Gaps in the Management of Diabetes in Asia: A Need for Improved Awareness and Strategies in Men\u0026rsquo;s Sexual Health [J]. J Diabetes Investig, 2022, 13: 1945\u0026ndash;1957.\u003c/li\u003e\n\u003cli\u003eMostafa T, Abdel-Hamid IA. Diabetes Mellitus and Male Sexual Dysfunction: An Update [J]. World J Diabetes, 2021, 12(7): 954-974.\u003c/li\u003e\n\u003cli\u003eChen Y, Chen JH. Progress in Research on Central Neural Mechanisms of Male Ejaculation [J]. Chin J Androl, 2018, 24(11): 963-966. (In Chinese)\u003c/li\u003e\n\u003cli\u003eGur S, Sikka SC. The Characterization, Current Medications, and Promising Therapeutic Targets for Premature Ejaculation [J]. Andrology, 2015, 3(3): 424-442.\u003c/li\u003e\n\u003cli\u003eWill RG, Nutsch VL, Turner JM, et al. Astrocytes in the Medial Preoptic Area Modulate Ejaculation Latency in an Experience-Dependent Fashion [J]. Behav Neurosci, 2015, 129(1): 68-73.\u003c/li\u003e\n\u003cli\u003eCh\u0026eacute;hensse C, Facchinetti P, Bahrami S, et al. The Human Spinal Ejaculation Generator [J]. Ann Neurol, 2017, 81: 35-45.\u003c/li\u003e\n\u003cli\u003eMazzilli R, Defeudis G, Olana S. The Role of Ejaculatory Dysfunction in Male Infertility [J]. Clin Ter, 2020, 171(6): e523-e527.\u003c/li\u003e\n\u003cli\u003ePeng JX, Li DJ, Liu LY, et al. Comparison of Characteristics Between Chinese Patients with Diabetes Mellitus-Induced Erectile Dysfunction and Non-Diabetes Mellitus-Induced Erectile Dysfunction: A Cross-Sectional Study [J]. Front Endocrinol (Lausanne), 2022, 13: 1096045. https://doi.org/10.3389/fendo.2022.1096045\u003c/li\u003e\n\u003cli\u003eXu W, Jiang H, Liu J, et al. Non-Coding RNAs: A New Dawn for Diabetes Mellitus-Induced Erectile Dysfunction [J]. Front Mol Biosci, 2022, 9: 888624.\u003c/li\u003e\n\u003cli\u003eMorelli A, Filippi S, Comeglio P, et al. Physical Activity Counteracts Metabolic Syndrome-Induced Hypogonadotropic Hypogonadism and Erectile Dysfunction in Rabbits [J]. Am J Physiol Endocrinol Metab, 2019, 316(3): E519-E535.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"basic-and-clinical-andrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"andr","sideBox":"Learn more about [Basic and Clinical Andrology](https://bacandrology.biomedcentral.com/)","snPcode":"12610","submissionUrl":"https://submission.nature.com/new-submission/12610/3","title":"Basic and Clinical Andrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Diabetes Mellitus, Retrograde Ejaculation, Disease Duration, Sexual Pleasure, FertilityClassification Code R698 Document Code A","lastPublishedDoi":"10.21203/rs.3.rs-7946195/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7946195/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo analyze relationships between age, fertility history, sexual pleasure, disease duration, HbA1c, and erectile hardness in diabetic patients with retrograde ejaculation (RE).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective analysis was conducted on 115 patients with DM and RE who visited Baoding First Central Hospital from January 2020 to June 2025. Data including age, fertility history, sexual pleasure, DM duration, HbA1c, and Erection Hardness Score (EHS) were collected. Patients were divided into type 1 DM group (n = 28) and type 2 DM group (n = 87).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong RE patients, 60.87% reported sexual pleasure; 80% had ED. Type 1 DM patients showed higher rates of anorgasmia (64.29% vs 31.03%, P = 0.004) and childlessness (46.43% vs 13.79%, P \u0026lt; 0.01). Type 1 patients were younger (34.11 ± 7.79 vs 41.74 ± 7.65 years, P \u0026lt; 0.01) with longer disease duration (P \u0026lt; 0.01). EHS was significantly lower in patients without sexual pleasure (P \u0026lt; 0.01). Infertile patients were younger (P \u0026lt; 0.01) and had lower EHS (P = 0.035). Lower EHS correlated strongly with anorgasmia (AUC = 0.831).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSexual pleasure, fertility, and EHS in diabetic RE patients correlate with disease duration, DM type, and age. Type 1 DM patients present earlier, with higher risks of ED, anorgasmia, and childlessness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProject Support\u003c/strong\u003e Baoding Science and Technology Bureau Project (No. 2442ZF206); Baoding Key Laboratory of Prostate and Andrological Disease Prevention and Treatment (No. 2363P007)\u003c/p\u003e","manuscriptTitle":"Retrospective Study of 115 Patients with Diabetes Mellitus Complicated by Retrograde Ejaculation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-18 16:39:13","doi":"10.21203/rs.3.rs-7946195/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-21T11:19:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-01T11:58:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149203385441736957463255362822129993719","date":"2025-11-23T20:13:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330790496710898236533941652842004410233","date":"2025-11-19T14:15:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-09T11:03:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-07T12:18:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-07T12:15:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Basic and Clinical Andrology","date":"2025-10-25T10:14:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"basic-and-clinical-andrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"andr","sideBox":"Learn more about [Basic and Clinical Andrology](https://bacandrology.biomedcentral.com/)","snPcode":"12610","submissionUrl":"https://submission.nature.com/new-submission/12610/3","title":"Basic and Clinical Andrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ee45580-92c7-4368-b8a4-4fff4ee4a537","owner":[],"postedDate":"November 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T16:10:59+00:00","versionOfRecord":{"articleIdentity":"rs-7946195","link":"https://doi.org/10.1186/s12610-026-00303-7","journal":{"identity":"basic-and-clinical-andrology","isVorOnly":false,"title":"Basic and Clinical Andrology"},"publishedOn":"2026-02-23 15:58:20","publishedOnDateReadable":"February 23rd, 2026"},"versionCreatedAt":"2025-11-18 16:39:13","video":"","vorDoi":"10.1186/s12610-026-00303-7","vorDoiUrl":"https://doi.org/10.1186/s12610-026-00303-7","workflowStages":[]},"version":"v1","identity":"rs-7946195","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7946195","identity":"rs-7946195","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}