Ayurvedic management of diabetes-induced retrograde ejaculation: A case report

Male infertility stems from both hereditary predispositions and behavioural determinants, with intact ejaculatory mechanisms being critical for reproductive capacity. RE accounts for only 0.3-2% of total infertility cases; it affects 34.6% of diabetic men[i]. Retrograde Ejaculation (RE) is characterized by the retrograde migration of seminal fluid into the urinary bladder rather than antegrade expulsion through the urethra, primarily attributed to impaired bladder neck sphincter competence, frequently secondary to diabetic autonomic neuropathy. Diagnostic confirmation is established through the identification of spermatozoa in post-coital urine specimens in the absence of sperm in the ejaculate[ii].

Present management strategies concentrate on retrieving viable sperm from the bladder for assisted reproductive procedures including IUI and IVF. To protect sperm quality, sodium bicarbonate is used to neutralize the acidic urinary environment. Despite these efforts, success rates remain modest, with approximately 15% of couples achieving pregnancy per treatment cycle[iii].

Ancient Ayurvedic texts recognize conditions like Retrograde Ejaculation as part of Shukra Dosha (disorders of seminal fluid), explaining the problem as an imbalance of vitiation of Kapha and Vata dosha that obstructs the Shukravaha Srotas (reproductive pathways). Treatment focuses on restoring normal bodily function through cleansing, rejuvenation, and specific herbal remedies. Despite this traditional knowledge, there is limited modern research documenting how Ayurvedic treatments work for retrograde ejaculation in diabetic patients.

 

This case report describes the successful treatment of a 33-year-old diabetic man with retrograde ejaculation using a comprehensive Ayurvedic approach. The treatment included Virechan (medicated purgation), Triphaladi Kal Basti (therapeutic enema), and oral herbal medications, which led to natural conception and pregnancy. This case demonstrates how traditional Ayurvedic therapies may offer valuable complementary treatment options for managing reproductive problems in men with diabetes.

A 33-year-old male patient, married for Five years, came to the Panchakarma outpatient clinic seeking help for infertility.  His main concerns included dry orgasms (absence of ejaculation) and noticeably cloudy urine after sexual activity. He was a known case of type 2 diabetes mellitus for 7 years with a sedentary lifestyle. Clinical examination revealed that the patient was obese, weighing 120 kg, with generalized swelling and dry skin. known case of type 2 diabetes mellitus for the past five years. His daily routine was largely sedentary, spending more than 12 hours sitting each day due to his night shift work schedule. He did not engage in any regular exercise and followed a strictly vegetarian diet. This combination of health conditions and lifestyle habits appeared to be contributing factors to his fertility problems.

 

 

 

 

 

 

 

 

 

 

Table No. 1: Treatment Plan with Time line

 

 

Table No. 2: Single Drugs and Formulations Used in Treatment

Drug	Contents
Vaishvanar churna[i]	Saidhava lavana (Rock Salt), Ajawain (Trachyspermumammi), Ajmoda (Apiumleptopyllum), Shunthi (Zingiber officinalis), Haritaki (Terminalia chebula)
Goghrita	Goghrita
Trivrutta Avaleha[ii]	Trivrit (Operculina turpethum), Tamala Patra (Cinnamomum tamala), Twak (Cinnamomum cassia), Ela (Elettaria cardamomum), Madhu (Honey) & Khandsharkara (Rock candy)
Triphadi Taila[iii]	Amalaki (Emblica officinalis), Bibhitak (Terminalia bellerica), Haritaki (Terminalia chebula), Chitrak (Plumbago zeylanica), Nishottar (Operculinater apenthum), Aragwadh (Cassia Fistula), Vacha (Acorus calamus), Guduchi (Tinospora cordifolia), Haridra (Carcuma longa), Ativisha (Aconitum heterophyllum), Murva (Marsdenia tenacissima), Vasa (Adhathoda vasika), Nimb (Azadiracta indica), Saptaparna (Alstonia scholaris), Daruharidra (Berberis aristata), Indrayan (Cirrullus Colocynthis), Pipal (Ficus Religiosa), Yavani (Carum copticum), Kushtha (Sussurea luppa), Pippali (Piper longum), Bilva (Aegle marmelos), Madanphala (Randia dumentorum R. spinasa), Shatapushpa (Anthum graveolens Benth), Surasa, Shweta Surasa (Ocimum sanctum) Phaninjhaka (Origanum majorana), Arjaka (Ocimum basillicum), Bhustruna (Hyptis suaveolens), Sugandhaka (Leucas cephalotes), Sumukha (Brassica juncea), Krisnajiraka (Ocimum basilium), Kutherak (Orthosiphon pallidus), Kasamamarda (Cassia occidentalis), Vidanga (Embelia ribes), Kshavaka (Centipeda minima), Kharapushpa, Surasi (Limonia crenulata), Nirgundi (Vitex nenundo), Kulahal (Mundika (sphaeranthus indicus),  Undurukarnika (Ipomea reniformis chois), Phanji (Clerodendrum serratum), Kakjangha (Ethnopharmacological), Kakmachi (Solanum nigrum), Kayaphal (Myrica escilenta), Bharangi root (Clerodendrum serratum), Mahanimb (Melia azedarah Linn)
Triplaladhi Niruha Solution (Emulsion) [iv]	Triphaladi Kwath [Amalaki (Emblica officinalis), Bibhitak (Terminalia bellerica), Haritaki (Terminalia chebula), Yavani (Carum copticum), Bilva (Aegle marmelos), Vasa (Adhathoda vasika), Kushtha (Sussurea Luppa), Musta (Cyperus rotundus), Pippali (Piper Longum), Madanphala (Randia dumentorum R. spinasa)] Saidhav (Rock Salt) Yavakshar Madhu (Honey) Tila Taila (Sisamum indicum) Gomutra (Cow Urine)
Tab. Shilapravang[v]	Shuddha Shilajatu (Purified Asphaltum punjabianum), Praval Pishti (Calcium carbonate, Magnesium, trace elements), Vanga Bhasma (Tin oxide), Swarna Makshika Bhasma (Calcined Copper pyrite), Mukta Pishti (Calcium Carbonate & Conchiolin), Guduchi Satva (Tinospora cordifolia), Ela (Elettaria cardamomum), Vanshlochana (Bamboo silica), Karpura (Camphor) & Gokshura (Tribulus terrestris)

II.I Outcome Measures:

Clinical improvement was assessed using both subjective and objective parameters:

1.     Reduction in symptoms of dry orgasm and cloudy urine.

2.     Post Ejaculatory Urine Examination

3.     HbA1c levels

 

II.II Results

Table No. 3: Blood Assessment Report for HbA1c

 

Table No. 4: Post Ejaculatory Urine Examination

 

There was a complete resolution of symptoms of dry orgasm, with restoration of antegrade ejaculation, and disappearance of turbid urine after sexual activity.

 

Post-ejaculatory urine examination revealed the absence of spermatozoa after therapy and HbA1c levels showed significant improvement (See the Tables 3 and 4). The outcome was further supported by spontaneous conception in the patient’s spouse, indicating restoration of reproductive function.

This case demonstrates potential therapeutic efficacy of an Ayurvedic protocol in reversing diabetic retrograde ejaculation, with documented restoration of antegrade ejaculation and spontaneous conception alongside substantial improvement in glycemic control.

 

The pathophysiology involves progressive autonomic neuropathy affecting sympathetic nerve fibers from the superior hypogastric plexus, which provide essential α1-adrenergic innervation to the internal urethral sphincter and bladder neck musculature. Chronic hyperglycemia initiates multiple pathological pathways: non-enzymatic glycation forming advanced glycation end products, polyol pathway activation with sorbitol accumulation causing osmotic stress, and microvascular insufficiency compromising vasa nervorum perfusion leading to nerve ischemia and demyelination . Concurrently, elevated free fatty acids promote ectopic lipid accumulation in peripheral nerves, generating toxic intermediates (diacylglycerols, ceramides) that impair insulin signalling and trigger Toll-like receptor 4-mediated neuroinflammation with release of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6). Excessive fatty acid oxidation overwhelms mitochondrial capacity, producing reactive oxygen species that damage mitochondrial DNA and impair ATP production. The net effect is impaired noradrenergic neurotransmission at the bladder neck, preventing adequate sphincter contraction during ejaculation and permitting retrograde semen flow .

 

The treatment protocol addressed these derangements through three interventions. Virechan (therapeutic purgation) likely yielded metabolic correction by reducing systemic inflammatory burden, enhancing pancreatic β-cell function, and modulating gut microbiota composition with improvements in insulin sensitivity .

 

The Triphaladi Kala Basti constituted the core neuroprotective component, delivering Triphala-containing medicated enemas rectally. Triphala's polyphenolic compounds (gallic acid, ellagic acid, chebulinic acid) demonstrate potent antioxidant activity, reducing malondialdehyde levels in nerve tissues while enhancing endogenous antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase), thereby interrupting lipid peroxidation and restoring redox homeostasis . Additionally, Triphala exhibits anti-inflammatory effects by inhibiting pro-inflammatory cytokine production and reducing macrophage/lymphocyte infiltration into peripheral nerves, limiting demyelination and preserving nerve fiber integrity . Furthermore, Triphala promotes neural repair through enhanced nerve growth factor expression, Schwann cell proliferation, and remyelination of damaged fibers, with experimental studies documenting 18-22% improvements in motor nerve conduction velocity . The rectal administration route bypasses hepatic first-pass metabolism, enhancing bioavailability of thermolabile phytochemicals, while the alternating lipid-based (Anuvasan) and aqueous-based (Niruha) enema pattern optimizes absorption of both lipophilic and hydrophilic compounds .

 

Shilapravang contributed through fulvic acid-mediated mitochondrial function enhancement, improved microcirculation to vasa nervorum , and pro-androgenic effects supporting ejaculatory function restoration .

 

The cumulative effect likely restored adequate α1-adrenergic signalling at the internal urethral sphincter, re-establishing antegrade ejaculatory function as objectively confirmed by absent spermatozoa in post-coital urine and subsequent spontaneous conception.

 

However, significant methodological limitations preclude definitive conclusions. As an uncontrolled single-case observation without randomization, or comparison group, or spontaneous improvement, cannot be excluded. The multicomponent protocol prevents isolation of individual therapeutic contributions, and absence inflammatory biomarkers (hs-CRP, IL-6, TNF-α), oxidative stress parameters (malondialdehyde, antioxidant enzymes), free fatty acid levels, or neuroimaging represents critical gaps.

 

Despite these limitations, this case provides enough evidence to justify further research. Future studies should use randomized controlled trials with clear measurements like semen analysis, urine tests after intercourse, and pregnancy rates. These studies should also check how the treatment works by measuring nerve function, inflammation markers, and changes in body fat. Longer follow-up periods are needed to see if benefits last and to monitor safety. Since current medications for diabetic nerve damage have limited success and diabetes affects millions worldwide, properly studying this Ayurvedic approach could reveal new treatment options for diabetic nerve problems beyond just ejaculation issues.

 

IV.         LIMITATIONS AND FUTURE DIRECTIONS

This case study suggests Ayurvedic treatments (Virechan, Triphaladi Kal Basti, and Tab. Shilapravang) may effectively treat retrograde ejaculation through detoxification and metabolic mechanisms. However, single case limitations necessitate rigorous clinical trials with larger cohorts, standardized protocols, and mechanistic studies to validate efficacy. An integrative approach combining evidence-based evaluation of traditional Ayurvedic therapies with modern medical science could potentially expand therapeutic options for patients with retrograde ejaculation and related metabolic disorders

The integrated Ayurvedic protocol of Virechan, Triphaladi Kal Basti, and Tab. Shilapravang administration provides a multifaceted therapeutic approach addressing both metabolic dysregulation in Madhumeha (Type 2 DM) and associated neurogenic ejaculatory dysfunction. This patient-specific intervention targets pathophysiological mechanisms underlying retrograde ejaculation, potentially offering an alternative therapeutic modality for diabetes-related reproductive complications.

 

VI.         PATIENT’S PERSPECTIVE

The patient reported significant emotional relief following successful conception, stating that confirmation of pregnancy brought a sense of joy and gratitude. He noted improvement in psychological well-being and quality of life after resolution of infertility. The Ayurvedic intervention was perceived as beneficial in addressing both the physiological condition and its associated psychological impact.

VII.        PATIENT’S CONSENT

The patient consented to the publication of this case. the treatment gap in youth mental health care.

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[1] Kam J, Tsang VH, Chalasani V. Retrograde Ejaculation: A Rare Presenting Symptom of Type 1 Diabetes Mellitus. Urol Case Rep [Internet]. 2016 Jan 1 [cited 2025 Jan 4];10:9. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5090193/

 

[1] Jung J, Ahn HK, Huh Y. Clinical and Functional Anatomy of the Urethral Sphincter. Int Neurourol J [Internet]. 2012 Sep [cited 2025 Jan 23];16(3):102. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3469827/

 

[1] View of VAISHVANARA CHURNA – STANDARDIZATION, EVALUATION AND COMPARATIVE OVERVIEW OF PHARMACOGNOSTIC AND PHARMACEUTICAL PROPERTIES [Internet]. [cited 2025 Jan 11]. Available from: https://ijapr.in/index.php/ijapr/article/view/1446/1117

 

[1] View of Management of Shukrakshaya (Oligospermia) by implementing traditional Ayurveda treatment: A case report [Internet]. [cited 2025 Jan 11]. Available from: https://www.ijam.co.in/index.php/ijam/article/view/4953/1295

 

[1] Chaturvedi D. CLINICAL STUDY ON THE EFFECT OF TRIPHALADI KAAL BASTI IN THE MANAGEMENT OF STHOULYA ROGA (OBESITY). IJBPAS [Internet]. 2023 [cited 2025 Jan 11];12(4):1690–700. Available from: https://doi.org/10.31032/IJBPAS/2023/12.4.7061

 

[1]  Kumari M, Ram B. Effect of Triphaladi Kwatha in Madhumeha (Diabetes Mellitus Type 2) - A Case Report. Chettinad Health City Med J. 2022;11(4):95-99.

 

[1] View of Management of Shukrakshaya (Oligospermia) by implementing traditional Ayurveda treatment: A case report [Internet]. [cited 2025 Jan 11]. Available from: https://www.ijam.co.in/index.php/ijam/article/view/4953/1295