Low prolactin level identifies hypoactive sexual desire disorder women with a reduced inhibition profile

Abstract

Purpose: Data on the role of prolactin (PRL) in the physiologic range in the female sexual response are scanty. We aimed at investigating the association between PRL and sexual function as assessed by the Female Sexual Function Index (FSFI). We explored the presence of a cut-off level of PRL able to identify Hypoactive Sexual Desire Disorder (HSDD).

Methods: 277 pre- and post-menopausal women consulting for Female Sexual Dysfunction (FSD) and sexually active were enrolled in an observational, retrospective study. 42 women were used as no-FSD controls. A clinical, biochemical and psychosexual evaluation was performed. The main outcome measures were: FSFI, Female Sexual Distress Scale-Revised, Middlesex Hospital Questionnaire and Sexual excitation/sexual inhibition scale (SIS/SES).

Results: Normo-PRL FSD women (n = 264) showed lower FSFI Desire score than controls (n = 42), and higher than hyper-PRL FSD women (n = 13). These differences emerged both in pre-menopausal and post-menopausal subjects. In the normo-PRL FSD group, those with PRL in the higher quintile reported higher FSFI Desire scores than those with PRL in the lowest quintile. Women with HSDD presented a lower PRL level than those without (p = 0.032). A ROC curve analysis for PRL showed an accuracy of 0.610 ± 0.044 (p = 0.014) in predicting HSDD. With a threshold of < 9.83 μg/L, sensitivity and specificity for HSDD were 63% and 56%, respectively. Subjects with PRL < 9.83 μg/L also reported lower sexual inhibition (p = 0.006) and lower cortisol levels (p = 0.003) than those with PRL > = 9.83 μg/L.

Conclusions: Hyper-PRL is associated with low desire; however, among normo-PRL FSD women, those with the lowest levels demonstrated a poorer desire than those with the highest levels. PRL < 9.83 μg/L predicted HSDD and a lower sexual inhibitory trait.

Keywords: Desire; Female sexual dysfunction; Hypoprolactinemia; Prolactin; Sexual distress.

Fig. 1

A and B Differences in Female Sexual Function Index (FSFI) Desire (panel A) and Satisfaction (panel B) domains, in women consulting for sexual symptoms, stratified according to their prolactin (PRL) levels, and controls. Statistic is derived one-way ANOVA and post hoc analysis, performed applying a Bonferroni correction, and general multivariate regression model. Main panel: data adjusted for age, years since menopause, body mass index, and cortisol levels. Inset: data adjusted for partner’s sexual dysfunction, graduation and current use of hormonal replacement therapy. I quintile: PRL 5.12–6.53 µg/L (109–139 mU/L). II quintile: PRL 6.54–8.45 µg/L (140–180 mU/L). III quintile: PRL 8.46–11.03 µg/L (181–235 mU/L). IV quintile: PRL 11.07–14.55 µg/L (238–310 mU/L). V quintile: PRL 14.58–24.59 µg/L (312–523 mU/L). * significantly different from Normo-PRL FSD; ° significantly different from Hyper-PRL FSD. FSFI female sexual function index, FSD female sexual dysfunction

Fig. 2

Means and 95% CIs of prolactin (PRL) according to the presence of Hypoactive Sexual Desire Disorder (HSDD). Data were adjusted for years since menopause

Fig. 3

Receiver operating characteristic (ROC) curve for prolactin (PRL) in the identification of Hypoactive Sexual Desire Disorder (HSDD). The arrow indicates the threshold of 9.83 µg/L, identified as the PRL value with the best sensitivity and specificity in detecting HSDD