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Sex, sexual dysfunction, and adrenal tumors  

This blog post will touch on the sensitive but very important topic: Sex, sexual dysfunction, and adrenal tumors. Sexual dysfunction and loss of sexual desire and interest in sex is common in patients with adrenal tumors, due to overproduction of adrenal hormones (cortisol, aldosterone, and adrenaline-type hormones, catecholamines). Thus, adrenal tumor disease can seriously affect the sexual function and cause strain in a relationship. Both women and men have a nice benefit to their sex lives from adrenal surgery and cure of their adrenal tumor.

Figure 1 summarizes some of the health benefits of sex

Sex, sexual dysfunction, and adrenal tumors  

How do adrenal hormones normally affect sex drive and sexual function?

The adrenal cortex produces hormones that control sex (androgens, estrogens), salt (aldosterone), sugar (cortisol), whereas the medulla produces hormones involved in the fight or flight response (epinephrine and norepinephrine; adrenaline).

Figure 2: The capsule of the adrenal gland under microscope magnification, as well as the three layers, zona glomerulosa (ZG), zona fasciculata (ZF) and zona reticularis (ZR) of the adrenal cortex, responsible for producing adrenal cortex hormones.

Alterations in sex-steroid hormones such as androgens and estrogens can, of course, lead to sexual dysfunction. In men, erectile dysfunction, and decreased libido are common, whereas in women, lack of arousal, sexual interest and vaginal atrophy leading to pain during intercourse are common. Conversely, in rare cases of androgen producing adrenal cancer, the sex drive can actually be enhanced. Again, this is very rare, and is usually seen in very large adrenal tumors.

Oxytocin is a pituitary hormone with a multitude of physiological and behavioral functions. Based on its association with reproduction - including social bonding, sexual behavior, birth, and maternal behavior - oxytocin also has been called “the love hormone”. It is released during orgasm and when a mother nurses her child, for instance. Not surprisingly, the regulation of oxytocin levels is influenced by stress (which affects adrenal hormone secretion), but also directly by adrenal hormones, specifically by cortisol and adrenaline-type hormones.

Thus, it is not surprising that adrenal tumor disease can affect intimate relationships and be detrimental to a couple’s sex life, and the relationship as a whole.

Cushing’s syndrome reduces sex drive, libido, and sexual function

Adrenal hypercortisolism (AHC), formerly called MACS or subclinical Cushing syndrome, and overt Cushing’s syndrome are caused by cortisol over-production from an adrenal tumor. One of the most common universal features of the excess cortisol is weight gain, typically involving the face, neck, or belly. Often, the legs tend to lose fat, and become very slender. Fat can also be distributed in the cheeks creating a “moon face” appearance.  A hump can occur over the back of the neck due to fat distribution.  Fat can also accumulate over the collar bones resulting in a short and wide-appearing neck.

Overweight and obesity have been identified as risk factors for sexual dysfunction in both men and women.

Learn more about Cushing’s syndrome symptoms, diagnosis, and treatment.

Too much cortisol is toxic to your body and directly affects the sex drive, libido, and sexual function.

In women, studies have shown that female sexual function, quality of life and depression status are worse in those with Cushing’s syndrome. Women with Cushing’s syndrome specifically had worse scores (compared to controls) when it came to sexual arousal, lubrication, orgasm, sexual satisfaction, and more frequently experienced pain during intercourse.

In men, Cushing’s syndrome has been associated with reduced sexual desire, orgasmic and ejaculatory dysfunction, erectile and other problems.

Hypercortisolism does not only affect sexual function but also leads to several comorbidities which themselves might deteriorate sexual well-being. Diabetes, hypertension, cardiovascular diseases, and blood-clotting problems are more frequently seen in Cushing’s syndrome.

Other adrenal tumors reduce sex drive, libido, and sexual function

Less well known is the fact that primary aldosteronism (PA), also called Conn’s syndrome or primary hyperaldosteronism, also can cause sexual dysfunction in both men and women.

Read more about Conn’s syndrome (primary hyperaldosteronism) symptoms, diagnosis, and treatment.

Too much aldosterone is harmful to the body, especially to the inner lining of blood vessels, called the endothelium. This is why primary aldosteronism causes high blood pressure and organ damage to the brain (stroke), heart (heart attacks and arrhythmia), and kidney (kidney failure). Since blood flow to genital organs is a key component to sexual function, arousal, orgasm, and erection, it is not surprising that patients with Conn’s syndrome (primary hyperaldosteronism) frequently suffer from sexual dysfunction.

In men, Conn’s syndrome (primary aldosteronism) is associated with erectile dysfunction (ED), which can be severe. This is the most common sexual problem in men. ED is defined as a consistent or recurrent inability to acquire or sustain an erection of sufficient rigidity and duration for sexual intercourse.

In women, Conn’s syndrome is also associated with sexual dysfunction such as problems with arousal, reduced sexual desire, and orgasmic dysfunction, but it has been less well studied.

Erectile dysfunction (ED) is also common in pheochromocytoma and paraganglioma (tumors overproducing epinephrine and norepinephrine; adrenaline). Given that these hormones are involved in the fight or flight response and blood flow, it is not surprising that these patients have problems with sexual function, arousal, orgasm, and erection, similar to patients with too much cortisol and aldosterone.

Another unique feature of pheochromocytoma and paraganglioma is that sexual activity in and of itself can be a trigger of a “spell” or “pheochromocytoma attack”. The typical spell is associated with very high blood pressure, headache, palpitations (heart racing), and sweating. Chest or abdominal pain is also common as is a sense of impending doom. Of course, if this happens every time you wish to be romantic with your partner, it is no wonder that the sexual activities are going to deteriorate.

Sex and sexual function after adrenal surgery

You probably know at this point that the best adrenal operation, by far, is the Mini Back Scope Adrenalectomy (MBSA).

The MBSA typically takes about 20 minutes and when an adrenal tumor is present can be rapidly curative. Both women and men have a nice benefit to their sex lives from adrenal surgery and cure of their adrenal tumor.

We see patients having improvements in their sexual function, arousal, lubrication, orgasm, and erection after adrenal surgery. The sooner an adrenal tumor can be diagnosed and treated, the more likely we are to see normalization in sexual activity and function after surgery. Unfortunately, we see many patients who have had Conn’s syndrome (and other adrenal tumors) for many years and decades, and this can lead to severe erectile dysfunction and other sexual dysfunctions, which may not be entirely reversible.

Many patients ask when they can return to healthy sexual activity with their partner after adrenal surgery and the Mini Back Scope Adrenalectomy. The good news: pretty much immediately! You may want to hold off on the most acrobatic maneuvers, but the schematics show recommendations of safe sexual activity after adrenal surgery.

Figure 3: Recommended safe sexual positions after adrenal surgery.

Returning to your typical daily activities, including enjoying sex, is usually the best thing you can do to speed up your overall recovery. Those who tend to do the best after adrenal gland surgery are those who go back to their daily routine the fastest. One day of lying around after surgery can equate to 3 days of deconditioning. As always, use common sense after any surgery, and if it hurts your incision, abdomen, etc., it is probably better to wait a little bit with sexual activity for the healing to occur.

Figure 4: Additional recommended safe sexual positions after adrenal surgery.

Sex, sexual dysfunction, and thyroid and parathyroid problems

Changes in your sexual function can also be related to thyroid disease.

Read more about thyroid disease and thyroid surgery.

Read more about sexual function in parathyroid disease and hyperparathyroidism.

Additional Resources: 

Author

Dr. Tobias Carling MD, PhD, FACS

Dr. Tobias Carling is a world-recognized endocrine surgeon and adrenal surgery expert, widely regarded as one of the highest-volume adrenal surgeons in the United States and globally. He is the Founder and Surgeon-in-Chief of the Carling Adrenal Center in Tampa, Florida, an international referral center dedicated exclusively to adrenal tumors and adrenal hormone disorders. Prior to founding the Carling Adrenal Center, Dr. Carling spent 17.5 years at Yale University School of Medicine, where he served as Chief of Endocrine Surgery, Associate Professor of Surgery, Endocrine Surgery Fellowship Director, and Founder of the Yale Endocrine Neoplasia Laboratory. His work helped advance the understanding and treatment of adrenal, thyroid, and parathyroid tumors. Dr. Carling specializes in advanced minimally invasive adrenal surgery, including complex and function-preserving adrenalectomy techniques. He holds both an MD and PhD from Uppsala University in Sweden and has published extensively in leading scientific journals, including The New England Journal of Medicine, Nature, Science, and PNAS. He is a Fellow of the American College of Surgeons (FACS) and a member of the American Association of Endocrine Surgeons and the International Association of Endocrine Surgeons. Patients from across the U.S. and around the world seek his expertise for complex adrenal disease.