Beyond erectile difficulties, diabetics may also be bothered by other sexual disorders, such as lack of ejaculate (anejaculation or retrograde ejaculation) or premature ejaculation. Successful antegrade ejaculation depends on the coordination of three neurologic events: seminal emission, bladder neck closure, and contraction of the muscles of the pelvic floor (e.g. bulbocavernous, ischiocavernous, etc.). In diabetes, sympathetic nervous system derangement may cause retrograde ejaculation (i.e. ejaculate is present but transmitted to the bladder and expelled with voiding) or, if more severe, lack of seminal emission entirely. Either of these conditions will impact fertility, but they may be disturbing to the patient from an aesthetic point of view, as well. From a fertility standpoint, post-ejaculate urine may be treated and then used for artificial insemination. Strategies to overcome retrograde ejaculation generally focus on attempts to coapt the bladder neck. Electroejaculation has been used with limited success , and a variety of pharmacologic agents have also been used, including anticholinergics, antihistamines, and alpha-adrenergics .