Hyperprolactinemia and Erectile Dysfunction

Hyperprolactinemia can also cause visual field defect............Alok 

Rev Urol. 2000 Winter; 2(1): 39–42.

PMCID: PMC1476085

Hyperprolactinemia and Erectile Dysfunction

Scott I Zeitlin, MD and Jacob Rajfer, MD

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Abstract

Hyperprolactinemia from a pituitary adenoma is a rare cause of erectile dysfunction. Men with erectile dysfunction who are found to have a low testosterone level should have a measurement of their prolactin level. Treatment consists of lowering the prolactin level by medication or surgery, or both. Bromocriptine, a dopamine agonist, is efficacious in lowering elevated prolactin levels and can simultaneously shrink these pituitary tumors. With large tumors, transphenoidal surgery may be used to debulk/remove the tumor. Post-treatment prolactin levels can be used to monitor the efficacy of treatment.

Key words: Erectile dysfunction, Hyperprolactinemia, Impotence, Pituitary neoplasms, Prolactin, Magnetic resonance imaging (MRI)

A 40-year-old obese man presented with a complaint of erectile dysfunction throughout the previous 6 years. He was unable to attain and maintain a rigid erection, yet his libido was normal. Mammography, performed recently for a breast lump, was negative for malignancy. The patient had a history of sleep apnea but did not have any neurologic or visual complaints. He was not on any medications. There was also a question of whether he fathered a child in the past.

On physical examination, the patient was markedly obese (1,575.5 kg, or 347 lb) with normal vital signs. Pertinent physical findings included bilateral gynecomastia and a large abdominal pannus. The penis did not have any palpable plaques. Total serum testosterone level was 123 ng/dL (normal, 280 to 1,250 ng/dL), the free testosterone level was 3.1 pg/mL (normal, 12 to 40 pg/mL), and the prolactin level was 396 ng/mL (normal, less than 13 ng/mL). An MRI of the pituitary gland revealed a pituitary macroadenoma with minimal involvement of the right cavernous sinus (Figure 1A – Figure 1D). The optic chiasm was not involved. Because of the large size of the tumor, a transsphenoidal hypophysectomy of the pituitary adenoma was elected. Following surgery, the patient’s prolactin levels dropped to about 90 ng/mL, which indicated subtotal resection of the adenoma. Postoperative medical therapy with a dopamine agonist would be required to lower the prolactin level to normal range.

Figure 1A

Midline sagittal section of precontrast MRI of head revealing pituitary macroadenoma (arrow).

Figure 1D

Midline coronal section of postcontrast MRI of head demonstrating no enhancement of pituitary adenoma.

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Discussion

In the evaluation of patients with erectile dysfunction, an endocrinopathy is the rarest of causes.1,2 However, when an endocrinopathy does affect erectile function, it is almost always caused by hypogonadism.1–3 Obtaining a serum testosterone (T) level is the most cost-effective way of screening for an endocrinopathy as the cause of erectile dysfunction.2,3 If the serum T level is abnormally low, then additional evaluation should include obtaining serum luteinizing hormone, free T, and prolactin levels.2 If the serum T is elevated, then a thyroid evaluation may be indicated.2

In our patient, hypogonadism as well as an elevated prolactin level (prolactin was emanating from the lesion within the pituitary gland) were found. Hyperprolactinemia induces hypogonadism by interfering with the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus (Figure 2).4,5 The resulting decrease in serum T is believed to be the cause of the erectile dysfunction, although there may be an end-organ effect of prolactin on the penis.4 Surprisingly, not everyone with hyperprolactinemia has a low serum T level or complains of erectile dysfunction.6,7 However, when the serum prolactin is corrected in patients with an elevated prolactin level and a low serum T level, the serum T level usually returns to a normal value, and erectile function is usually restored (if erectile dysfunction was present).2 Simply treating the patient with exogenous T does not usually correct the erectile dysfunction (unless the prolactin levels are returned to normal).

Figure 2

Dopamine from higher brain centers stimulates release of prolactin inhibitory factor (PIF), and prolactin (PRL) from the pituitary inhibits gonadotropin-releasing hormone (GnRH) secretion. Bromocriptine, a dopamine agonist, works to further increase production ...

Hyperprolactinemia is a very rare cause of impotence in a general population of men with impotence.8 However, men who have hyperprolactinemia have a high incidence of sexual dysfunction, and the erectile dysfunction appears more likely to resolve in patients with the most severe hyperprolactinemia once this glandular disorder is corrected.7

Many medications may also elevate prolactin levels, and this may interfere with erectile function (Table 1). Some of these medications belong to the dopamine antagonist group; this is not surprising, since the normal regulation of prolactin in man is primarily inhibitory (dopamine from the hypothalamus inhibits the secretion of prolactin from the pituitary gland by the inhibiting hormone prolactin inhibitory factor [PIF]). This forms the basis of medical treatment for hyperprolactinemia: dopamine agonists, such as bromocriptine, exert their antiprolactinemic effects by inhibiting the secretion of prolactin by the pituitary cells, which normally secrete prolactin. In hyperprolactinemia induced by exogenous medications, once the suspect medication is stopped, the prolactin and serum T levels and the erectile function (if the impotence is caused by elevated prolactin levels) usually return to normal.9,10 If erectile dysfunction is not corrected by lowered prolactin levels, then other causes of the dysfunction must be considered.

Table 1

Medications Causing Hyperprolactinemia

More than half of patients with hyperprolactinemia (Table 2) have no demonstrable pituitary lesion, and not every pituitary adenoma produces prolactin. It has been theorized that hyperprolactinemia can also be caused by interfering with PIF that is transported down the pituitary stalk (such as a craniopharyngioma or cystic enlargement within an empty sella that prevents the PIF from reaching its target in the pituitary gland). Whether this PIF is dopamine or some other chemical remains to be determined. Like other causes of erectile dysfunction from hyperprolactinemia, these nonpituitary causes may also lead to erectile dysfunction.

Table 2

Causes of Hyperprolactinemia

One of the predominant symptoms in men who are hyperprolactinemic is loss of libido.11 Johnson and Jarow1reported on a series of 330 consecutive patients who presented for evaluation of impotence; they found an endocrine etiology in 7 (2.1%). All 7 patients had either decreased libido or testicular atrophy; therefore, these investigators recommended that screening for endocrine disorders (as opposed to obtaining a serum T level) should only be done in those patients with clinical signs of hypogonadism. Routine prolactin measurements are not necessary in the evaluation of patients with erectile dysfunction.12,13

Other presenting symptoms of a pituitary adenoma, with or without hyperprolactinemia, are headaches and visual-field defects (Table 3). When hyperprolactinemia is managed with dopamine agonists, such as bromocriptine, not only will the prolactin levels be decreased, but also shrinkage of the tumors may be seen in about two thirds of patients with pituitary tumors. If present, headaches and visual-field defects may also improve with treatment, regardless of whether the treatment is medical or surgical.14,15 Recently, another synthetic dopamine agonist, cabergoline, has been found to be a potent inhibitor of prolactin secretion. Cabergoline is taken twice weekly and is an alternative for patients who are sensitive to bromocriptine.16

Table 3

Signs and Symptoms of Hyperprolactinemia

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Conclusion

While pituitary tumors—specifically, prolactin-secreting adenomas—are seen rarely in patients presenting solely with impotence, when such tumors do occur, they can be successfully managed with surgery and/or medication. Most patients who present with erectile dysfunction caused by a prolactin-secreting adenoma will harbor a low serum T level. Therefore, the serum T appears to be an excellent screening test for these patients. Once the prolactin level is determined to be elevated, the pituitary/hypothalamic area is imaged either by MRI or by CT scan. Treatment of patients with hyperprolactinemia—whether by surgery, medication, or both—depends on the findings seen on radiologic scans, with most patients receiving a dopamine agonist initially. For those who undergo surgery and still have a postoperative elevated prolactin level, which suggests residual adenoma, medical therapy is instituted.17

Main Points

• The prolactin level should be measured in men presenting with a complaint of erectile dysfunction who have a low serum testosterone level.
• Hypogonadism is almost always the cause of an endocrinopathy that affects erectile function.
• In hyperprolactinemia, which induces hypogonadism, the excess prolactin interferes with secretion of gonadotropin-releasing hormone, resulting in decreased testosterone and erectile dysfunction.
• Hyperprolactinemia caused by a pituitary tumor can be managed with surgery and/or a dopamine agonist.

30th National Conference Of Sexology

after accepting all goodies they will slap on ur face if u try to act as elder/ wise man

Alok Tholiya

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  Sawan Solanki १००% √

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  Deepak Tapkire Right

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  Alok Tholiya now a days when u try to teach staff, children, wife etc they take it as a insult and bounce back. If family takes it that way even guidance and instructions of elders and remains ever ready to retaliate then definitely others will take revenge for what they will take as insult.

And where you over zealously rush for their aid, help, assistance then u r welcome and your act of kindness is not challenged  but if you try to change / improve / guide them then they will say did we ask / appoint you for this???

What Are the Benefits of Avena Sativa?

Last Updated: Feb 26, 2014 | By Linda Tarr Kent

Oats belong to the haygrass family. Photo Credit Sea Oats at Sunset image by Mary Beth Granger from Fotolia.com

Avena sativa means “wild oats” in Latin. This plant, also referred to as oat straw or oat extract, was used as a medicine prior to being used as food. This plant may have sparked the phrase, “sowing your wild oats,” due to its effect on sexual stimulation, according to “Prescription for Herbal Healing” by Phyllis A. Balch. Potential benefits are not limited to its impact on the libido, however. Wild oats are rich in B vitamins, phosphorous and calcium.

Sex Booster

Wild oats may be a mild sexual enhancer, according to Dr. Ray Sahelian, author of “Natural Sex Boosters.” However, he notes that most claims for sexual enhancement rely on research done in the 1980s by the Institute for Advanced Study of Human Sexuality in San Francisco, a company that marketed avena sativa products. In the animal kingdom, Balch notes that stallions that are fed wild oats are said to become lustful.

Inflammation Fighter

Wild oats can help you fight inflammation, advises the online-newspaper, The Oregonian. Molecules in oats called avenanthramides help reduce levels of inflammatory cytokines, which are immune system chemicals. Lowering cytokines is a good idea because when levels are high they raise risk for chronic conditions such as diabetes and heart disease, advise The YOU Docs columnists Mehmet Oz and Mike Roizen in The Oregonian.

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Heart Health Booster

Wild oats can boost heart health. Avena sativa helps you lower the “bad” low density lipoprotein, or LDL, cholesterol levels as well as overall cholesterol levels, according to a Canadian study published in the "European Journal of Clinical Nutrition." This is due to the main component of the oats’ soluble fiber, called beta-glucan, according to lead study author J.T. Braaten of the University of Ottawa. Wild oats may help reduce your waistline at the same time, which further reduces risk for coronary heart disease, advises Venezuelan researcher N. Reyna-Villasmil, who authored a 2007 study published in the "American Journal of Therapeutics." Avena sativa helps you to lower risk for heart-threatening blood clots and keeps your arteries flexible as well, according to Oz and Roizen.

ADD Helper

If you or a loved one suffers attention deficit disorder or attention deficit hyperactivity disorder, you may benefit from avena’s sedative properties, according to Balch. Herbalists use avena to reduce symptoms of methylphenidate withdrawal and to alleviate mild depression for adults with such conditions. However, science is lacking for this use, making it controversial. Before you try any sort of alternative therapy, especially one that is controversial, you need to consult with your doctor, advises the National Resource Center on AD/HD.

Other Uses

You may see Avena sativa advertised as an aid to help combat osteoporosis because it can boost hormone levels that stimulate cell growth. However, evidence for this use so far is lacking, according to the University of Maryland Medical Center.

Avena sativa also may help you if you have a condition called amenorrhea, which is when you've stopped having a period unrelated to menopause. That’s because it is rich in minerals that potentially promote better thyroid function, according to UMMC. However, evidence for this use is based on traditional use rather than scientific study, so you need to consult with a doctor if you’d like to incorporate oat straw use into your regimen for treating this condition.

Give Erectile Dysfunction the Cold Shoulder

Let’s Take Care of Our Men:  Give Erectile Dysfunction the Cold Shoulder

By Barbara Brownell-Grogan

Published Aug 25, 2014

As we age, a healthy sex life continues to bring joy. Mature love, wisdom, and respect can make it sweeter than the sex you experienced as a 25 or 30 year old. But that’s only if you and your partner are also physically healthy and responsive.

In Let’s Take Care of Our Men Part I, we looked at general prostate health and avoiding prostate cancer. In Part II we’ll focus on keeping the prostate and genitals naturally healthy for sex.

Some 30 million men in the U.S. suffer from erectile dysfunction. There can be many reasons for it, including high blood pressure, diabetes, drinking too much alcohol or taking recreational drugs, and prostate cancer.

Current treatments range from counseling to hormonal replacement, penile implants, and vascular surgery.

And there are the oral medications — with their ads featuring twin bathtubs, pulling trucks out of the mud, and mid-life flirting on the porch swing. While such medications are enticing quick fixes, they don’t necessarily get to the root of the problem—or offer long-term solutions.

If your partner has erectile dysfunction, start with an open discussion. You’ll need to lend your support and love: Join him on doctor visits. Stay patient and positive. Find alternative ways to physically enjoy and appreciate one another.

And try a natural approach: Over time, studies consistently show that a healthy lifestyle can prevent and even reverse erectile dysfunction. And that while you’re boosting your ability to have sex, you’re also enhancing your heart, nerves, vascular system, and psyche.

A recent report from Harvard reveals that men who exercise 30 minutes daily are 40 percent less likely to develop ED than couch potatoes. And there’s more. The report’s five natural tips have seen consistently strong results:

1. Walk 30 minutes a day.
2. Eat a diet rich in fruits, vegetables, and whole grains.
3. Keep your blood pressure in check (through lifestyle change and/or medications).
4. Stay slim. (A man with a 42-inch waistline is more likely to have ED than one with a measure of 32!)
5. Make your pelvic floor superman strong through Kegel exercises. (A 2005 British studyshowed that combining lifestyle changes with Kegels had amazing results—far more than lifestyle changes alone.)

We feature the time-honored Kegel in our book 500 Time-Tested Home Remedies and the Science Behind Them. The exercise ensures that during an erection the pelvic floor stays rigid and presses on an important vein, keeping blood in the penis.

• First, locate the pelvic floor muscles, below the bladder; do this during urination. (You use the same mus­cles to stop yourself from passing gas.)

• Partway through urination, contract those muscles to stop the urine flow. Don’t hold your breath or tense other muscles in your abdomen, legs, or buttocks. When you interrupt the flow, you’ve located the correct muscles. Also, the contraction causes your testicles and base of your penis to rise.

• From now on, perform Kegels when you’re not urinat­ing. (Over time that weakens rather than strengthens pelvic floor muscles.)

• Next: With an empty bladder, lie on your back on a firm surface.

• Count to five, slowly contracting the pelvic floor muscles you located above.

• Counting to five again, slowly relax the pelvic floor muscles.

• Repeat this pair of movements ten times for one full set. Do three sets daily.

• Work up to counting to ten and doing five sets daily.

As your muscles become stronger, do the exercise while standing—to increase muscle control. If you’re unsure how to locate the muscles, ask your doctor to help you.

Stay happy, healthy, and sexy,

Thanks to : http://www.everydayhealth.com/columns/white-seeber-grogan-the-remedy-chicks/lets-take-care-of-our-men-part-ii-give-erectile-dysfunction-the-cold-shoulder/?xid=nl_EverydayHealthMensHealth_20140901

Venous Flow Controllers, Pubis ring, or (Cock ring)

Venous Flow Controllers, Pubis ring, or (Cock ring)

When a man is sexually stimulated by sight, thought, or touch, the brain sends signals that relax the smooth muscles around the arteries that supply blood to the spongy and cavernous bodies. The veins draining the bodies can't keep up, resulting in swelling.  As the swelling reaches the limit of the penile skin, the penis becomes firm.  The pressure of the spongy and cavernous bodies against the skin partially closes the veins, helping to maintain the erection.  Erection continues until the signals from the brain stop.  Pubis ring mechanically helps to increase pressure slightly, and sustain the erection as long as you want. 

Men have only very limited control over their erections.  Likewise, it is impossible to "will" an erection. Although sexual thoughts can cause erection it is very difficult for average person to fantasize so strongly during an attempt to do intercourse. . The epicenter responsible for such essential arousal is actually within the brain. Only after the brain receives visual, audio or mentally stimulating input will it transmit (via the central nervous system) instructions to the smooth muscles along the penis to relax. At the same time, the artery to the penis widen to twice its diameter, increasing the blood flow sixteen-fold, and the veins which carry blood away from the penis are blocked. As a result, the two spongy-tissue chambers in the shaft of the penis fill with blood and the penis becomes firm. The corpora cavernosa, acting like a sponge, fill with blood. In fact, the corpora absorb up to eight times more blood than when the penis is flaccid. As your penis swells and lengthens, the filled corpora cavernosa press against the veins. The veins surrounding the chambers are squeezed almost completely shut by this pressure. The veins are unable to drain blood out of the penis and so the penis becomes rigid and erect. This condition normally keeps this erection firm enough for intercourse. After a few years of marriage due to overexposure of your partner’s body it is difficult to get proper erection every time. 

At this most basic level this function is considered to be normal if a man is able to maintain his erection sufficiently long to engage in satisfying intercourse and the subsequent ejaculation. The length of time a man might stay continuously erect can be on the average be about 30 minutes. Of course the duration of his erection vary greatly, in which case it may be a shorter or a great deal longer.  After ejaculation or cessation of further stimulation to the penis itself or to the brain excess blood will be allowed to drain away, while the level of blood flow into the penis returns to normal. The penis once again becomes flaccid as it loses the built up pressure.

Pubic Ring

Pubic rings are used to maintain an erection once it has developed. The erection is sustained well after the ejaculation. Every time one uses pubis ring the erection becomes maximum. Thus there is effective increase in length and width of the penis too.

Penile constriction ring is strong, expandable band that help maintain erections by retaining the blood that engorges the penis, and are suitable for use with natural erections or those induced through the use of oral medication.

To put the pubis ring on erect penis, just loosen it then put it around the base of penis and tighten it by pulling the loose ends upwards while pressing the horizontal tube down wards. Since the rings may catch in your pubic hair, it is advisable to trim or shave hair closest to the base of your penis.

To remove the ring, pull both tabs to expand the ring as much as possible then gently slide the ring off your penis. After the ring is removed, your erection will subside and your circulation and penis will return to normal. 

                                 

Use of pubis ring.

Pubis ring is very effective in all problems of penis erection. The feeble erection, penis not firm enough to get into the vagina, loosing erection while doing intercourse, loosing erection while entering the vagina, erection does not remain strong till the end of intercourse.

Pubis ring is also useful for the problem of premature ejaculation. Or ejaculation before both the partners reach the climax. While using the pubis ring the strong erection is sustained beyond ejaculation; man can continue doing coital movements till he gives the partner one or many many more climaxes. If the glans is sensitive after ejaculation, stop coital movements for few moments after ejaculation and then restart the coital movements to give the partner most powerful climax.

Continuous use of pubis ring every time you do sex for 2-3 months will slowly and definitely increase the timing of ejaculation and thereafter a man may prolong his performance even without using the pubis ring.

The pubis ring is useful for all the problems of man. The Erectile insufficiency, Erectile inadequacy, premature ejaculation, low staying power all these are curable with the use of pubis ring.

This is research sample for scientific study. Not for sale.

For any queries contact:

Prof Dr Prakash Verekar, 6 mayuresh sankul, pipe line road, Nasik 422007.  Mobile +91 9822281142.

He is the chief researcher of effects of pubis ring in India. He is world-renowned sexologist.

Web site www.healersupreme.com   www.drverekar.com

Marriage

Avoiding these 2 things may make for a better marriage.and keeping husband full of confidence

Marriage Mistakes Women Make

Avoiding these 2 things may make for a better marriage.

1. Underestimating the Effect of Tone of Voice

No matter who's speaking, man or woman, tone of voice can be an issue if it's tinged only slightly with negativity.

If you have concerns, Heitler encourages "verbalizing them in a respectful way," rather than speaking in a frustrated, irritated voice. 

By all means, discuss what's bothering you. But do it in a way that searches for solutions and alternatives, rather than venting in a way that puts a peaceful solution further out of reach.

2. Mismatched Communication Styles

If you feel you aren't being heard by your husband, you may want to explore the ways you try to get through to him.

Some women repeat their complaint or a concern a few times in an effort to get their husband's attention. Some men may call that nagging, but it may just be about having different communication styles.

Karam calls it the "demand-withdraw" dynamic: One person wants a conversation, but the other hasn't figured out how to respond or appears to have shut down, so the speaker presses further. "That's a vicious pattern," Karam says. 

If that happens in your relationship a lot, remember to pause to let your spouse absorb what you're saying and have "a chance to validate what they've heard," Karam says.

It might be useful to take a hard look at what is fixed -- personality quirks, for example -- and what can be changed. Citing the work of marriage/couples researcher John Gottman, Karam says nearly 70% of marital problems are "perpetual," meaning that these are issues that drag on. 

The challenge is to recognize what can't be corrected. It helps to "move toward acceptance," Karam says. "You're not going to change a cautious person into a risk-taker or an introvert into an extrovert.''