Testicular pain sensation in diabetic autonomic neuropathy

Testicular sensation was examined in 32 male diabetics with symptoms suggestive of autonomic neuropathy to evaluate its usefulness as a clinical sign in this condition. Vascular reflex responses to the Valsalva manoeuvre and sustained handgrip and blood pressure fall on standing were measured as objective tests of autonomic involvement. Absent or diminished testicular sensation correlated well both with the clinical features of autonomic neuropathy, except where impotence occurred alone, and with abnormal vascular reflexes. Most patients with impotence alone had normal testicular sensation and normal vascular reflexes. It is concluded that this sign is useful in diabetics with impotence, the presence of intact testicular sensation indicating that the impotence is unlikely to be due to autonomic neuropathy.