Diabetic neuropathy


	Denervation of the genitourinary system can cause a number of symptoms, including bladder dysfunction, retrograde ejaculation, erectile dysfunction, and painful intercourse (dyspareunia) due to lack of vaginal lubrication.

	Bladder dysfunction should be diagnosed with a cystometrogram. The inability to sense a full bladder can lead to bladder infections and urinary incontinence which can be treated by having the patient participate in a strict voluntary urination schedule. Catheterization can be performed in advanced cases.

	Retrograde ejaculation is caused by a dysfunction in internal and external sphincter closure during ejaculation, and patients may present with cloudy urine postcoitally. This symptom can be successfully treated with antihistamines.

	Erectile dysfunction can be caused by a number of factors other than diabetic neuropathy, and an attempt to discover the cause of impotence must be made prior to treatment. Sildenafil has been used successfully in treating men with impotence due to neuropathy.

	Finally, painful intercourse, most common in diabetic women, is usually due to decreased libido, depression, and reduced vaginal lubrication. Treatment for sexual dysfunction in women includes use of vaginal lubricants and estrogen creams.