Prolactinergic and dopaminergic mechanisms underlying sexual arousal and orgasm in humans


Dopaminergic mechanisms play a major role in modulating sexual behavior in humans and animals. Animal data demonstrate important interactions between the dopaminergic and prolactinergic system. As recently demonstrated, dopamine agonists have facilitatory properties for penile erection but may also enhance sexual drive and orgasmic quality. In contrast, chronic elevations of prolactin inhibit appetitive as well as consummatory parameters of sexual behavior. Recent human studies show a marked increase in prolactin after orgasm in males and females. Concerning the biological relevance of acute prolactin alterations after orgasm, prolactin might serve as a neuroendocrine reproductive reflex for peripheral reproductive organs. Alternatively, prolactin may feedback to dopaminergic neurons in the central nervous system and thereby modulate sexual drive and satiation. Here, we provide a brief overview of the physiology of dopamine and prolactin in regulating sexual behavior. In addition, recent experimental and clinical evidence for a postulated feedback mechanism for prolactin and its implications for orgasmic disorders are discussed.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Bailey DJ, Dolan AL, Pharoah PD, Herbert J (1984) Role of gonadal and adrenal steroids in the impairment of the male rat’s sexual behaviour by hyperprolactinaemia. Neuroendocrinology 39:555–562

    CAS  PubMed  Google Scholar 

  2. 2.

    Barbeau A (1969)L-Dopa therapy in Parkinson’s disease: a critical review in nine year’s experience. Can Med Assoc J 101:791–800

    Google Scholar 

  3. 3.

    Bartke A, Doherty PC, Steger RW, Morgan WW, Amador AG, Herbert DC, Siler-Khodr TM, Smith MS, Klemcke HG, Hymer WC (1984) Effects of estrogen-induced hyperprolactinemia on endocrine and sexual functions in adult male rats. Neuroendocrinology 39:126–135

    CAS  PubMed  Google Scholar 

  4. 4.

    Bole-Feysot C, Goffin V, Edery M, Binart N, Kelly PA (1998) Prolactine (PRL) and its receptor: actions signal transduction pathways and phenotypes observed in PRL receptor knockout mice. Endocrine Rev 19:225–268

    Article  CAS  Google Scholar 

  5. 5.

    Bowers MBJr, Van Woert M, Davis L (1971) Sexual behavior duringL-dopa treatment for Parkinsonism. Am J Psychiatry 127:1691–1693

    PubMed  Google Scholar 

  6. 6.

    Bradley KC, Meisel RL (2001) Sexual behavior induction of c-Fos in the nucleus accumbens and amphetamine-stimulated locomotor activity are sensitized by previous sexual experience in female Syrian hamsters. J Neurosci 21:2123–2130

    CAS  PubMed  Google Scholar 

  7. 7.

    Buvat J (2003) Hyperprolactinemia and sexual function in men: a short review. Int J Impot Res 15:373–377

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Buvat J, Lemaire A, Buvat-Herbaut M, Fourlinnie JC, Racadot A, Fossati P (1985) Hyperprolactinemia and sexual function in men. Hormonal Res 22:196–203

    CAS  Google Scholar 

  9. 9.

    Cannon CM, Palmiter RD (2003) Reward without dopamine. J Neurosci 23:10827–10831

    CAS  PubMed  Google Scholar 

  10. 10.

    Cebeira M, Hernandez ML, Rodriguez de Fonsesca F, De Miguel R, Fernandez-Ruiz JJ, Ramos JA (1991) Lack of effect of prolactin on the dopaminergic receptor sensitivity of striatal and limbic areas after experimentally-induced alterations in peripheral levels. Life Sci 48:531–541

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Chambers RA, Taylor JR, Potenza MN (2003) Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability Am J Psychiatry 160:1041–1052

    Google Scholar 

  12. 12.

    Chen JC, Ramirez VD (1989) Effects of prolactin on tyrosine hydroxylase activity of central dopaminergic neurons of male rats. Eur J Pharmacol 166:473–479

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Cruz-Casallas PE, Nasello AG, Hucke EE, Felicio LF (1999) Dual modulation of male sexual behavior in rats by central prolactin: relationship with in vivo striatal dopaminergic activity. Psychoneuroendocrinology 24:681–693

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    De Rosa M, Colao A, Di Sarno A, Ferone D, Landi ML, Zarilli S, Paesano L, Merola B, Lombardi G (1998) Cabergoline treatment rapidly improves gonadal function in hyperprolactinemic males: a comparison with bromocriptine Eur J Endocrinol 138:286–293

    Google Scholar 

  15. 15.

    De Rosa M, Zarrilli S, Vitale G, Di Somma C, Orio F, Tauchmanova L, Lombardi G, Colao A (2004) Six months of treatment with cabergoline restores sexual potency in hyperprolactinemic males: an open longitudinal study monitoring nocturnal penile tumescence. J Clin Endocrinol Metab 89:621–625

    Article  PubMed  Google Scholar 

  16. 16.

    DeMaria JE, Lerant AA, Freeman ME (1999) Prolactin activates all three populations of hypothalamic neuroendocrine dopaminergic neurons in ovariectomized rats. Brain Res 837:236–241

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    DeMaria JE, Livingstone JD, Freeman ME (1998) Characterization of the dopaminergic input of the pituitary gland throughout the estrous cycle of the rat. Neuroendocrinology 67:377–383

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    DeMaria JE, Zelena D, Vecsernyés M, Nagy GM, Freeman ME (1998) The effect of neurointermediate lobe denervation on hypothalamic neuroendocrine dopaminergic neurons. Brain Res 806:89–94

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Doherty PC, Bartke A, Smith MS, Davis SL (1985) Increased serum prolactin levels mediate the suppressive effects of ectopic pituitary grafts on copulatory behavior in male rats. Horm Behav 19:111–121

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Doherty PC, Baum MJ, Todd RB (1986) Effects of chronic hyperprolactinemia on sexual arousal and erectile function in male rats. Neuroendocrinology 42:368–375

    CAS  PubMed  Google Scholar 

  21. 21.

    Doherty PC, Lane SJ, Pfeil KA, Morgan WW, Bartke A, Smith MS (1989) Extra-hypothalamic dopamine is not involved in the effects of hyperprolactinemia on male copulatory behavior. Physiol Behav 45:1101–1105

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Doherty PC, Wu DE, Matt KS (1990) Hyperprolactinemia preferentially inhibits erectile function in adrenalectomized male rats. Life Sci 47:141–148

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Dudley CA, Jamison TS, Moss RL (1982) Inhibition of lordosis behavior in the female rat by intraventricular infusion of prolactin and by chronic hyperprolactinemia. Endocrinology 110:677–679

    CAS  PubMed  Google Scholar 

  24. 24.

    Erskine MS (1995) Prolactin release after mating and genitosensory stimulation in females. Endocr Rev 16:508–528

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Exton MS, Bindert A, Krüger T, Scheller F, Hartmann U, Schedlowski M (1999) Cardiovascular and endocrine alterations after masturbation-induced orgasm in women. Psychosom Med 61:280–289

    CAS  PubMed  Google Scholar 

  26. 26.

    Exton MS, Krüger THC, Bursch N, Knapp W, Schedlowski M, Hartmann U (2001) Neuroendocrine response to masturbation-induced orgasm following a 3-week sexual abstinence. World J Urol 19:377–382

    Article  CAS  PubMed  Google Scholar 

  27. 27.

    Exton MS, Krüger THC, Koch M, Paulson E, Knapp W, Hartmann U, Schedlowski M (2001) Coitus-induced orgasm stimulated prolactin secretion in healthy subjects. Psychoneuroendocrinology 26:287–294

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Exton NG, Truong TC, Exton MS, Wingenfeld SA, Leygraf N, Saller B, Hartmann U, Schedlowski M (2000) Neuroendocrine response to film-induced sexual arousal in men and women. Psychoneuroendocrinology 25:189–199

    Article  Google Scholar 

  29. 29.

    Fiorino DF, Coury A, Phillips AG (1997) Dynamic changes in nucleus accumbens dopamine efflux during the Coolidge effect in male rats. J Neurosci 17:4849–4855

    CAS  PubMed  Google Scholar 

  30. 30.

    Freeman ME, Kanyicska B, Lerant A, Nagy G (2000) Prolactin: structure, function, and regulation of secretion. Physiol Rev 80:1523–1631

    CAS  PubMed  Google Scholar 

  31. 31.

    Ganong WF (2000) Circumventricular organs: definition and role in the regulation of endocrine and anatomic function. Clin Exp Pharmacol Physiol 27:422–247

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    Gitlin M (2003) Sexual dysfunction with psychotropic drugs. Expert Opin Pharamacother 4:2259–2269

    Article  CAS  Google Scholar 

  33. 33.

    Giuliano F, Allard J (2001) Dopamine and sexual function. Int J Imp Res 13:S18-S28

    Article  Google Scholar 

  34. 34.

    Gonzales-Mora JL, Guadalupe T, Mas M (1990) In vivo voltammetry study of the modulatory action of prolactin on mesolimbic dopaminergic system. Brain Res Bull 25:729–733

    Article  PubMed  Google Scholar 

  35. 35.

    Gunnet JW, Freeman ME (1983) The mating-induced release of prolactin: a unique neuroendocrine reponse. Endocr Rev 4:44–61

    CAS  PubMed  Google Scholar 

  36. 36.

    Haake P, Exton MS, Haverkamp J, Krämer M, Leygraf N, Hartmann U, Schedlowski M, Krüger THC (2002) Absence of orgasm-induced prolactin secretion in a healthy multi-orgasmic male subject. Int J Imp Res 14:133–135

    Article  CAS  Google Scholar 

  37. 37.

    Heaton JPW, Adams MA (2003) Update on central function relevant to sex: remodeling the basis of drug treatments for sex and the brain. Int J Impot Res 15:S25-S32

    Article  Google Scholar 

  38. 38.

    Heaton JPW (2000) Central neuropharmacological agents and mechanisms in erectile dysfunction: the role of dopamine. Neurosci Biobehav Rev 24:561–569

    Article  CAS  PubMed  Google Scholar 

  39. 39.

    Hernandez ML, Fernandez-Ruiz JJ, Navarro M, De Miguel R, Cebeira M, Vatic S, Ramos JA (1994) Modifications of mesolimbic and nigrostriataldopaminergic activity after intracerebroventricular administration of prolactin. J Neural Trans Gen Sec 96:63–79

    Article  CAS  Google Scholar 

  40. 40.

    Hull EM, Meisel RL, Sachs BD (2002) Male sexual behavior. In: Pfaff DW (ed) Hormones, brain and behavior, vol 1. Academic Press, San Diego, , 3–137

  41. 41.

    Hummer M, Huber J (2004) Hyperprolactinemia and antipsychotic therapy in schizophrenia. Curr Med Res Opin 20:189–197

    CAS  PubMed  Google Scholar 

  42. 42.

    Kalra PS, Simpkins JW, Luttge WG, Kalra SP (1983) Effects on male sex behavior and preoptic dopamine neurons of hyperprolactinemia induced by MtTW15 pituitary tumors. Endocrinology 113:2065–2071

    CAS  PubMed  Google Scholar 

  43. 43.

    Kamel F, Mock EJ, Wright WW, Frankel AI (1975) Alterations in plasma concentrations of testosterone, LH, and prolactin associated with mating in the male rat. Horm Behav 6:277–288

    Article  CAS  PubMed  Google Scholar 

  44. 44.

    Kooy A, Weber RF, Ooms MP, Vreeburg JT (1988) Deterioration of male sexual behavior in rats by the new prolactin-secreting tumor 7315b. Horm Behav 22:351–361

    Article  CAS  PubMed  Google Scholar 

  45. 45.

    Krüger T, Exton MS, Pawlak C, Von zur Mühlen A, Hartmann U, Schedlowski M (1998) Neuroendocrine and cardiovascular response to sexual arousal and orgasm in men. Psychoneuroendocrinology 23:401–411

    Article  PubMed  Google Scholar 

  46. 46.

    Krüger THC, Haake P, Hartmann U, Schedlowski M, Exton MS (2002) Prolactin release following orgasm: a feedback control of sexual arousal? Neurosci Biobehav Rev 26:31–44

    Article  PubMed  Google Scholar 

  47. 47.

    Krüger THC, Hartmann U, Haake P, Chereat D, Knapp W, Janssen OE, Exton MS, Schedlowski M (2003) Specificity of the neuroendocrine response to orgasm during sexual arousal in men. J Endocrinol 177:57–64

    Article  PubMed  Google Scholar 

  48. 48.

    Krüger THC, Haake P, Haverkamp J, Krämer M, Exton MS, Saller B, Leygraf N, Hartmann U, Schedlowski M (2003) Effects of acute prolactin manipulation on sexual drive and function in males. J Endocrinol 179:357–365

    Article  PubMed  Google Scholar 

  49. 49.

    Labbate LA, Croft HA, Oleshansky MA (2003) Antidepressant-related erectile dysfunction: management via avoidance, switching antidepressants, antidotes, and adaptation. J Clin Psychiatry 64 [Suppl 10]:11–19

  50. 50.

    Lal S, Ackman D, Thavundayil JX, Kiely ME, Etienne P (1984) Effect of apomorphine, a dopamine receptor agonist, on penile tumescence in normal subjects. Prob Neuropsychopharmacol Biol Psychiatry 8:695–699

    Article  CAS  Google Scholar 

  51. 51.

    Lal S, Laryea E, Thavundayil JX, Nair NP, Negrete J, Ackman D, Blundell P, Gardinier RJ (1987) Apomorphine-induced penile tumescence in impotent patients: preliminary findings. Prog Neuro-Psychoph 11:235–242

    Google Scholar 

  52. 52.

    Lookingland KJ, Moore KE (1984) Effects of estradiol and prolactin on incertohypothalamic dopaminergic neurons in the male rat. Brain Res 323:83–91

    Article  CAS  PubMed  Google Scholar 

  53. 53.

    Montorsi F, Perani D, Anchisi D, Salonia A, Scifo P, Rigiroli P, Zanoni M, Heaton JP, Rigatti P, Fazio F (2003) Apomorphine-induced brain modulation during sexual stimulation: a new look at central phenomena related to erectile dysfunction. Int J Imp Res 15:203–209

    Article  CAS  Google Scholar 

  54. 54.

    Oliver C, Mical RS, Porter JC (1977) Hypothalamic-pituitary vasculature: evidence for retrograde blood flow in the pituitary stalk. Endocrinology 101:598–604

    CAS  PubMed  Google Scholar 

  55. 55.

    Paredes RG, Agmo A (2004) Has dopamine a physiological role in the control of sexual behavior? A critical review of the evidence. Prog Neurobiol 73:179–226

    Article  CAS  PubMed  Google Scholar 

  56. 56.

    Pi XJ, Grattan DR (1998) Differential expression of the two forms of prolactin receptor mRNA within microdissected hypothalamic nuclei of the rat. Brain Res Mol Brain Res 59:1–12

    Article  CAS  PubMed  Google Scholar 

  57. 57.

    Robbins TW, Everitt BJ (1992) Functions of dopamine in the dorsal and ventral striatum. Sem Neurosci 4:119–128

    Article  Google Scholar 

  58. 58.

    Rosen RC, Lane RM, Menza M (1999) Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol 19:67–85

    Article  CAS  PubMed  Google Scholar 

  59. 59.

    Rosen RC, Marin H (2003) Prevalence of antidepressant-associated erectile dysfunction. J Clin Psychiatry 64 [Suppl 10]: 5–10

  60. 60.

    Rowland DL, Keeney C, Slob AK (2004) Sexual response in men with inhibited or retarded ejaculation. Int J Impot Res 16:270–274

    Article  CAS  PubMed  Google Scholar 

  61. 61.

    Sauder SE, Frager M, Case GD, Kelch RP, Marshall JC (1984) Abnormal patterns of pulsatile luteinizing hormone secretion in women with hyperprolactinemia an amenorrhea: responses to bromocriptine. J Clin Endocrinol Metab 59:941–948

    CAS  PubMed  Google Scholar 

  62. 62.

    Schedlowski M, Hosch W, Oberbeck R, Benschop RJ, Jacobs R, Raab HR, Schmidt RE (1996) Catecholamines modulate human NK cell circulation and function via spleen-independent β2-adrenergic mechanisms. J Immunol 156:93–99

    CAS  PubMed  Google Scholar 

  63. 63.

    Shrenker P, Bartke A (1985) Adrenelectomy does not prevent the hyperprolactinemic induced sexual behavior deficits in CDF male rats. Life Sci 36:1881–1888

    Article  CAS  PubMed  Google Scholar 

  64. 64.

    Sobrinho LG (1993) The psychogenic effects of prolactin. Acta Endocrinol 129:S38–40

    Google Scholar 

  65. 65.

    Verhelst J, Abs R, Maiter D, Van den Bruel A, Vandeweghe M, Velkeniers B, Mockel J, Lamberigts G, Petrossians P, Coremans P, Mahler C, Stevenaert A, Verlooy J, Raftpoulos C, Beckers A (1999) Cabergoline in the treatment of hyperprolactinaemia: a study in 455 patients. J Clin Endocr Metab 84:2518–2522

    Article  CAS  PubMed  Google Scholar 

  66. 66.

    Volavka J, Czobor P, Cooper TB, Sheitman B, Lindenmayer J-P, Citrome L, McEvoy JP, Lieberman JA (2004) Prolactin levels in schizophrenia and schizoaffective disorder patients treated with clozapine, olanzapine, risperidone, or haloperidol. J Clin Psychiatry 65:57–61

    CAS  PubMed  Google Scholar 

  67. 67.

    Walsh JP, Pullan PT (1997) Hyperprolactinaemia in males: a heterogeneous disorder. Aust N Z J Med 27:385–390

    CAS  PubMed  Google Scholar 

  68. 68.

    Walsh RJ, Slaby FJ, Posner BI (1987) A receptor-mediated mechanism for the transport of prolactin from blood to cerebrospinal fluid. Endocrinology 120:1864–1850

    Google Scholar 

Download references


This article was supported by a grant by the Deutsche Forschungsgemeinschaft (DFG Sche 341/10-2)

Author information



Corresponding author

Correspondence to Tillmann H. C. Krüger.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Krüger, T.H.C., Hartmann, U. & Schedlowski, M. Prolactinergic and dopaminergic mechanisms underlying sexual arousal and orgasm in humans. World J Urol 23, 130–138 (2005).

Download citation


  • Sexual behavior
  • Dopamine
  • Prolactin
  • Sexual arousal
  • Orgasm