Female sexual dysfunction: Don’t assume it’s a side effect
Watch for medical, psychiatric causes.
Case Continued: Telling test results
We measure Ms. S’ prolactin because she is taking risperidone, which can cause hyperprolactinemia. Prolactin is 61.86 ng/mL, suggesting medication-induced prolactinemia or a pituitary abnormality. We consult with endocrinology and refer the patient to a radiologist for brain MRI, which reveals a prolactin-secreting tumor in the pituitary gland.
Tapering and discontinuing risperidone over 1 week reduce but do not normalize Ms. S’ prolactin. Although dopamine agonists are first-line therapy for prolactin-secreting tumors, we fear such drugs would activate Ms. S’ psychotic symptoms. She instead undergoes surgery to remove the adenoma. Her sexual symptoms, galactorrhea, and irregular menses eventually resolve.
Related resources
- Hitt E. Female sexual dysfunction common. WebMD. Available at: https://www.webmd.com/content/Article/64/72281.htm. Accessed June 6, 2006.
- Basson R, Leiblum S, Brotto L, et al. Revised definitions of women’s sexual dysfunction. J Sex Med 2004;1(1):40-8.
- Dennerstein L, Hayes R. Confronting the challenges: epidemiological study of female sexual dysfunction and the menopause. J Sex Med 2005;suppl 3:118-32.
- Michelson D, Bancroft J, Targum S et al. Female sexual dysfunction associated with antidepressant administration: a randomized placebo-controlled study of pharmacologic intervention. Am J Psychiatry 2000;157:239-43.
- Bupropion SA • Wellbutrin SR
- Clonidine • Catapres
- Paroxetine • Paxil, Pevexa
- Risperidone • Risperdal
- Spironolactone • Aldactone
The authors report no financial relationship with any company whose products are mentioned in this article, or with manufacturers of competing products.
