VIII
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KEVAN WYLIE
Hyperprolactinaemia and Retrograde Ejaculation
8 August 2009: 10 Messages
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1
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Does anyone know of an association between hyperprolactinaemia and retrograde ejaculation? My patient is asking if there is any long term risk from the retrograde ejaculation (he is aware of the risks of high prolactin). Does anyone have any
thoughts or evidence about this?
Kevan Wylie (k.r.wylie@SHEFFIELD.AC.UK)
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2
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I had a 45 yrs old paranoid schizophrenic who was treated with Respridone 4 mg daily and suffered from anejaculation when his prolactin levels became high. I had to reduce the dose, since I didn’t want to give
Bromocriptin (as it may exacerbate psychotic symptoms) and his ejaculation was regained after reduction of dose.
Mona Reda (monareda1910@YAHOO.COM)
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3
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I'm not aware of a causal relationship between elevated prolactin levels and retrograde ejaculation, but would be interested to hear from any member who knows of evidence supporting this. It is important to recognize
that the antipsychotic medications are known to cause hyperprolactinemia as well as a variety of additional sexual side effects, including anorgasmia and anejaculation. When these appear together, it seems likely that both represent a medication
effect, and not that one (high prolactin) is causing the other (anejaculation or retrograde ejaculation).
Abe Morgentaler (amorgent@YAHOO.COM)
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4
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I'm not aware of any association between retrograde ejaculation and hyperprolactinemia but retrograde ejaculation is a common occurrence after prostate surgery and apart from ‘psychological
issues’ there are no long term problems.
Alvaro Bazo (bazo@DOCTORS.ORG.UK)
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5
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I am not aware of any association of hyperprolactinemia and ejaculatory disturbances. There is an association of pituitary disorders with low testosterone levels which
causes reduced ejaculate volume but not through retrograde ejaculation. Retrograde ejaculation is due to incompetence of the bladder neck due to either anatomic or neuromuscular disorders (i.e. TURP or
diabetes mellitus, respectively). There are no known risks, short or long term, for retrograde ejaculation other than the obvious potential fertility issue.
Jonathan Jarow (jjarow@JHMI.EDU)
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6
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An excellent point. Low T levels can be associated with profound ejaculatory disturbances (decreased force and volume, decreased sense of pleasure, and delayed ejaculation).
It must also be emphasized that retrograde ejaculation is often ‘presumptively’ diagnosed based on a patient's presenting complaints rather than by a quick microscopic evaluation of a post-ejaculate urine specimen.
The urology community at large has historically ‘bought in’ to the notion that alpha blockers cause retrograde ejaculation when studies, in fact, have shown that it is actually failure of emission. (A recent Silodosin study confirmed this).
Additionally, studies have also shown that force and volume of ejaculate do have an impact on perceived sense of pleasure with orgasm. Therefore, a potential ‘risk’ of TURP/GL PVP or any other prostate debulking surgery is a real and permanent
decline in ejaculatory/orgasmic pleasure. Clearly more scientific work needs to be done on the male ejaculatory/climactic experience and its impact on the perception of general sexual function/dysfunction.
Anthony B Balchunas (abb@HOT.RR.COM)
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7
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I share the opinion expressed. I see no relationship. Also, retrograde ejaculation causes no harm. I wonder if Jacques Buvat can comment. In the literature we always read that there is
ejaculatory disturbance with hyperprolactinemia, but not specifically retrograde ejaculation.
Pierre Assalian (pierreassalian@3WEB.NET)
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8
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I have neither data nor have found anything about this co-relationship but we do have evidence that all long term use of anti-psychotics (atypical antipsychotics) and other drugs will lead to hyperprolactinemia. These
drugs might lead to delayed ejaculation up to the level of dry or anejacualtion. The latter might be misinterpreted as ? retrograde by the patient?
Shedeed Asahour (shedeedash@YAHOO.COM)
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9
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From the discussion, it appears that discussants are assuming that your patient's hyperprolactinemia was due to antipsychotics. Is this is the case????
Pierre Assalian (pierreassalian@3WEB.NET)
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10
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Yes indeed Pierre.
Kevan Wylie (k.r.wylie@SHEFFIELD.AC.UK)
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