Hyperprolactinemia-associated erectile dysfunction: retrospective cohort evaluating the effect of prolactin normalization on IIEF-5.

Objective: In addition to hypogonadism, other endocrine disorders-particularly hyperprolactinemia-can significantly influence erectile dysfunction (ED) in men. The aim of our study was to evaluate the effect of normalizing prolactin (PRL) levels on erectile function in men diagnosed with ED and hyperprolactinemia. The primary outcome was improvement in IIEF-5.

Methods: We retrospectively analyzed a three group of patients (N = 20) diagnosed with hyperprolactinemia who simultaneously presented with ED, confirmed by clinical criteria and results of the International Index of Erectile Function-5 (IIEF-5) questionnaire. Group Conservative did not receive hyperprolactinemia treatment. Treatment of hyperprolactinemia consisted of pharmacotherapy with dopaminergic agonists (group Dostinex) and/or neurosurgical intervention, depending on individual findings (group Surgery). For ED therapy, each patient received one of the phosphodiesterase 5 inhibitors (PDE5I)-specifically sildenafil, tadalafil, vardenafil, or avanafil.

Results: After successful hyperprolactinemia therapy, all treated patients achieved normalized PRL levels. At the same time, each patient showed an improvement in IIEF-5 scores, indicating a significant enhancement in erectile function. Groups Conservative showed tendency to improve. Groups Dostinex and Surgery reached significant enhancement in erectile function.

Conclusion: Our results confirmed the positive impact of resolving the primary endocrine cause on overall sexual health. These findings underscore the importance of comprehensive hormonal assessment in the management of male sexual dysfunction, including measurement of PRL levels. While hyperprolactinemia is a relatively uncommon cause of ED, its treatment-whether pharmacological or surgical-can lead to PRL normalization and a marked improvement in erectile function. The combined use of PDE5I and hyperprolactinemia treatment represents an effective therapeutic approach that should be considered in the care of men with ED.