Nonpuerperal Lactation Research Articles

Induced lactation in a transgender woman: case report

BackgroundBreastfeeding offers significant health benefits, but its practice and success can vary. While research on induced lactation in cisgender women has been documented, there is limited research on lactation induction in transgender women.Case presentationA 50-year-old transgender woman undergoing hormone therapy and living with a pregnant partner sought to co-feed using induced lactation. After approval by the hospital ethics committee, a regimen of estradiol, progesterone, and domperidone was initiated, accompanied by nipple stimulation. Lactation was successfully induced and maintained, with milk composition analysis indicating high levels of protein and other key nutrients. This case, the seventh reported, highlights the complexity of lactation induction in transgender women, considering factors such as age, obesity, and insulin resistance. The nutrient profile of the milk suggests its suitability for infant feeding, despite some differences from typical human milk.ConclusionsInduced lactation is feasible in transgender women, expanding the understanding of non-puerperal lactation and its potential in diverse family structures. Further research is warranted to optimize lactation induction protocols in transgender women.

Sexual dysfunction, depression, and the impact of antidepressants

IntroductionSexual dysfunction is a common side effect of antidepressants and can have significant impact on the person’s quality of life, relationships, mental health, and recovery. The reported incidence of sexual dysfunction associated with antidepressant medication varies considerably between studies, making it difficult to estimate the exact incidence or prevalence.ObjectivesThe focus of this e-poster is to explore the incidence, pathophysiology, and treatment of depression disorder and antidepressant iatrogenic sexual dysfunction.MethodsA bibliopgraphical review was performed using PubMed platform. All relevant articles were found using the keywords: depression, sexual disfunction, antidepressant.Results Sexual dysfunction is a common symptom of depression. Although decreased libido is most often reported, difficulties with arousal, resulting in vaginal dryness in women and erectile dysfunction in men, and absent or delayed orgasm are also prevalent. Sexual dysfunction is also a frequent adverse effect of treatment with most antidepressants and is one of the predominant reasons for premature drug discontinuation. Selective serotonin reuptake inhibitors are the most widely prescribed antidepressants and have significant effects on arousal and orgasm compared with antidepressants that target norepinephrine, dopamine, and melatonin systems. The availability of an antidepressant that does not cause or exacerbate sexual dysfunction represents an advance in pharmacotherapy for mood disorders and should reduce treatment noncompliance and decrease the need for switching antidepressants.ConclusionsThe sexual problems reported range from decreased sexual desire, decreased sexual excitement, diminished or delayed orgasm, to erection or delayed ejaculation problems. There are a number of case reports of sexual side effects, such as priapism, painful ejaculation, penile anesthesia, loss of sensation in the vagina and nipples, persistent genital arousal and nonpuerperal lactation in women.Disclosure of InterestNone Declared

Non-Puerperal Induced Lactation among Married Women: Islamic Jurisprudence and Contemporary Practice

Objective: Among Muslims, milk kinship elucidates the relationships established by a wet-nurse and her breastfed infant, prohibiting marriage between those it relates after the fulfillment of prerequisites. When galactagogues are used in the non-gestational lactation state, the relationship between motherhood and fatherhood through human milk can be questioned. Therefore, this study aims to shed light on the jurisprudential opinion of this relationship and provide examples of it from real, contemporary life. Methods: The researched utilized a deductive, analytical, and inductive approach for the jurisprudential view regarding the prohibition (of marriage) among married deflowered women using galactagogues and toward their husbands. Three controversial statements were presented and discussed independently. A qualitative study method was performed to explore the psychological and social effects of non-puerperal induced lactation within Muslim foster family. A real-life experience of 10 families was presented. Results: The preponderant opinion was outweighed by a Shariʿah researcher proving the prohibition (of marriage) between the lactating non-gestational woman using galactagogues, the nursed infant, and similarly toward her husband. Infertility was observed to be the primary motive for fostering. Induced lactation-linked fostering demonstrated a positive psychosocial effect in terms of the new parenthood role and forward movement of a happy marital life. Originality: An integrative approach to study non-puerperal lactation is required for contemporary medical controversial issues. Milk kinship as it relates to the husband requires further research.

Abstract- Poster

There have been a lot of documented cases of antipsychotic drug induced galactorrhea or non-puerperal lactation and isolated case reports of selective serotonin reuptake inhibitor induced galactorrhea. Here we are reporting a case of amitriptyline, a tricyclic antidepressant induced galactorrhea and complete resolution when the drug was withdrawn. There are other literatures documenting antidepressant induced galactorrhea. This literature here is to support and understand the current trends and mechanism as it is different from what we encounter with antipsychotic.

Experiences of women who underwent induced lactation: A literature review.

This article aims to review the literature published over the past five decades related to the experiences of women who have undergone induced lactation. A comprehensive electronic search was conducted using PubMed, the Library of Congress, Google Scholar, SAGE, and ScienceDirect. The following search keywords were used: adoptive breastfeeding, induced lactation, non-puerperal lactation, extraordinary breastfeeding, and milk kinship. The search was restricted to articles written in English and published from 1956 to 2019. All study designs were included except for practice protocols. A total of 50 articles about induced lactation were retrieved. Of these, 17 articles identified the experiences of women who underwent induced lactation. The articles included original papers (n=7), reviews (n=5), and case reports (n=5). Four articles were specifically related to Malaysia, and the others were international. These 17 articles concerning the experiences of women who induced lactation will be reviewed based on four themes related to inducing lactation: (a) understanding women's perception of satisfaction, (b) emotional aspects, (c) enabling factors, and (d) challenges. Identifying a total of only 17 articles on induced lactation published over the last 53 years suggests that the subject is understudied. This review provides emerging knowledge regarding the experiences of women who have induced lactation in terms of satisfaction, emotions, enabling factors and challenges related to inducing lactation.

Amitriptyline induced Galactorrhea: A case report

There have been a lot of documented cases of antipsychotic drug induced galactorrhea or non-puerperal lactation and isolated case reports of selective serotonin reuptake inhibitor induced galactorrhea. Here we are reporting a case of amitriptyline, a tricyclic antidepressant induced galactorrhea and complete resolution when the drug was withdrawn. There are other literature documenting antidepressant induced galactorrhea. This literature here is to support and understand the current trends and mechanism as it is different from what we encounter with antipsychotic. Keywords: Amitriptyline, Galactorrhea, Tricyclic antidepressant.

An Adoptive Mother Who Became a Human Milk Donor.

Inducing lactation in the absence of pregnancy (nonpuerperal lactation) is not always successful and, in many cases, only partial breastfeeding is achieved. Different protocols have been described, but scientific evidence and research are lacking in this area. The authors describe the case of a woman with a history of a miscarriage, for whom the lactation induction process was so effective that she became a milk donor even before she received her adopted child. She had not previously used hormone treatment. She was given domperidone as a galactogogue for 1 month. The pumping protocol began with a double electric breast pump combined with manual pumping 6 months before her child was delivered, and 3 months later, she was accepted as a donor by our milk bank. This highlights the importance of regular stimulation as a milk production mechanism. This is the first case of human milk donation in an adoptive mother described in the literature.

Sertralin Induced Normoprolactinemic Galactorrhea

Galactorrhea is defined as non-puerperal lactation and frequently occurs as an adverse drug reaction due to typical antipsychotics. Furthermore antidepressants, especially SSRIs, cause galactorrhea since the introduction of imipramine to psychiatry practice. Although galactorrhea ususally accompany increased prolactin levels, in some cases prolactin levels could be in normal range. To date there are two case reports of normoprolactinemic galactorrhea due to sertraline and here we report a patient who developed normoprolactinemic galactorrhea 1 month after initiating sertraline 50 mg/day

Antidepressant-associated sexual dysfunction: impact, effects, and treatment

Sexual dysfunction is a common side effect of antidepressants and can have significant impact on the person’s quality of life, relationships, mental health, and recovery. The reported incidence of sexual dysfunction associated with antidepressant medication varies considerably between studies, making it difficult to estimate the exact incidence or prevalence. The sexual problems reported range from decreased sexual desire, decreased sexual excitement, diminished or delayed orgasm, to erection or delayed ejaculation problems. There are a number of case reports of sexual side effects, such as priapism, painful ejaculation, penile anesthesia, loss of sensation in the vagina and nipples, persistent genital arousal and nonpuerperal lactation in women. The focus of this article is to explore the incidence, pathophysiology, and treatment of antidepressant iatrogenic sexual dysfunction.

From Folklore to Scientific Evidence: Breast- Feeding and Wet-Nursing in Islam and the Case of Non-Puerperal Lactation

Breast-feeding practice has an important medical and socio-cultural role. It has many anthropological aspects concerning the "power structures" that find their expression in breast-feeding and the practices that formed around it, both socially, scientifically, and legally-speaking. Breast-feeding has been given much attention by religions and taboos, folklore, and misconception abound around it making it a topic of genuine curiosity. This paper aims at expanding the spectrum of folklore associated with breast-feeding. The paper deals with historical, religious, and folkloristic aspects of breast-feeding, especially wet-nursing, in Islam and focuses on an intriguing Islamic tale on breast-feeding - lactation by non-pregnant women (or non-puerperal lactation). Apparently, accounts of non-puerperal lactation are not restricted to Islam but have been documented in various societies and religions throughout centuries. Two medical situations - hyperprolactinemia and induced lactation, appear as possible explanations for this phenomenon. This serves as an excellent example for the value of utilizing contemporary scientific knowledge in order to elucidate the origin, anthropology and evolvement of ancient myth and superstition.

Prolactin, psychological stress and environment in humans: adaptation and maladaptation.

Non-puerperal lactation and/or hyperprolactinemia in humans have been related to psychological variables in a variety of ways: (1) Non-puerperal nursing; (2) Pseudopregnancy; (3) Rapid weight gain; (4) Psychogenic galactorrhea; (5) Acute prolactin responses to psychological stress; (6) High prolactin levels in persons who cope passively in real life stress situations; (7) Paternal deprivation in women with pathological hyperprolactinemia; (8) Clinical onset of prolactinomas following life-events. Publications on the above subjects are scattered in the literature as curiosities, anecdotal case-reports or unexplained associations, as there is no theoretical frame of reference to accommodate them. We propose that prolactin is a component of a biological, "maternal", subroutine, adaptive to the care of the young, which promotes accumulation of fat for the extraordinary expenses of pregnancy and lactation, the production of milk and maternal behavior. In an attempt to characterize the stimuli responsible for the activation of the maternal subroutine in the absence of pregnancy we studied the hormonal profiles of female volunteers during three types of sessions under hypnosis: (1) Relaxation-only, control sessions; (2) Sessions in which a fantasy of "nursing" was induced; (3) Sessions of evocations of memories. Prolactin surges were related to the evocation, with rage, of humiliating experiences, but not with the fantasy of nursing. Cortisol surges were related to surprise and shock and were negatively associated with prolactin. In conclusion--Prolactin and cortisol are measurable markers of two different, and alternative, coping strategies to "psychological stress".

Galactorrhea and hyperprolactinemia.

Galactorrhea refers to the secretion of a milky fluid from the breast, occurring either spontaneously or with manual expression, in the absence of pregnancy or the postpartum state. The development of a sensitive and specific radioimmunoassay for human prolactin during the last decade along with improved neuroradiologic techniques have greatly expanded understanding of nonpuerperal lactation. Discussion reviews the pevalence of galactorrhea, the etiology of hyperprolactinemia and/or galactorrhea, pituitary tumor, parapituitary lesions, oral contraceptive (OC) associated galactorrhea, drug induced galactorrhea, hypothyroidism, neurogenic stimulation, idiopathic galactorrhea, clinical features of galactorrhea, laboratory evaluation, neuroradiologic evaluation, hypocycloidal tomography, carotid angiography, pneumoencelphalography (PEG), computerized tomography (CT), management, and therapy. The prevalence of galactorrhea in women is reported to range from 0.1-32%. Much of this variability can be attributed to differences in examination techniques, the investigator's definition of galactorrhea, and the patient population studied. Nonpuerperal hyperprolactinemia is an important cause of galactorrhea and is found in 49-77% of cases, but hyperprolactinemia does not appear to be the sole prerequisite for galactorrhea since only 15-68% of patients with excessive prolactin secretion develop galactorrhea. Pituitary tumors are the most important diagnostic consideration have been reported in approximately 20% of cases of galactorrhea and 34% of cases of amenorrhea galactorrhea. Parapituitary lesions, an infrequent but important cause of hyperprolactinema and galactorrhea, can result in excessive prolactin secretion by interfering with either the production or delivery of prolactin inhibitory factor to the lactotrope cells of the anterior pituitary gland. OC associated galactorrhea is a frequent diagnosis in patients with nonpuerperal lactation and has been implicated in 10-14% of cases. OC discontinuation can also produce galactorrhea. Pharmacologic agents are a common cause of hyperprolactinemia and/or galactorrhea. A variety of forms of neurogenic stimulation have been linked to hyperprolactinemia and/or galactorrhea. Idiopathic galactorrhea is a diagnosis of exclusion and is applicable to 40-50% of patients with nonpuerperal lactation. In patients with galactorrhea, the presence of the abnormal, milky breast secretion may be the sole symptom or it may be associated with other pertinent clinical findings. All patients with galactorrhea should have measurements of thyroid stimulating hormone and serum prolactin performed. The optimal management of patients with prolactinomas is somewhat controversial. Surgical resection remains the most definitive form of therapy with the transsphenoidal approach most frequently used. Recent invesitgations show promise for bromocriptine as an alternative therapeutic modality.

A new era in breast feeding.

Increasing worldwide interest and advances in biochemical and analytical sciences are providing greater knowledge of human milk and lactation. Sophisticated techniques of analysis have revealed many specific sugars, fats and fatty acids, minerals, vitamins and other enzymes that combine in the mammary gland to create human milk. This active tissue in liquid form has been evolved by Darwinian selection principles specifically for the nurture of the human infant. However the statement “Breast fed is best fed” is not believed by many stout, upstanding citizens with sludge-lined arteries and corroding kidneys who have “thrived” in infancy on artificial formula. Human milk provides protection for the infant adapting to his new environment. It is also an index of environmental and social pollutants as the mammary tissues filter insecticide and weedicide residues, antidepressants and tranquilizers, antibiotics and analgesics through the secretory epithelium. Lactation is normally preceded by development of the mammary gland associated with endocrine changes of pregnancy although evidence of nonpuerperal lactation is well documented, with sucking stimulus effecting hormone release from the pituitary. Establishment and maintenance of lactation require adequate interaction between infant and maternal reflexes, the former being rooting, suckling and swallowing. The maternal milk secretion reflex is dependent upon stimulation of the nipple and areolar tissue. The maternal milk ejection reflex has both somatic and psychosomatic components. Knowledge, the ready availability of practical information, and social and familial endorsement and mores affect a mother's lactation capabilities. Breast feeding enriches the mother-child relationship, with cognitive reception by the developing infant, and endowment of love, security, confidence and a satisfying hormonal state upon the mother. Low incidence of lactation is an index of the social and interpersonal impoverishment in many technologically advanced communities today.

The Influence of Prolactin Secretion on Human Lactation

The elevation of endogenous prolactin secretion using thyrotopin releasing hormone was associated with significant increases in mammary milk production in postpartum women. More-over, a specific effect was seen on the percent fat composition which has been shown to rise as much as 228% over pretest conditions. As in the bovine, administration of high doses of estrogen is associated with mammary breast development and the sudden removal of this stimulus if accompanied by nipple stimulation is associated with non-puerperal lactation. The inhibitory effects of estrogen on the mammary cellular response to circulating prolactin has been deduced from studies in pregnant and parturient women by measuing the TRH-induced prolactin response. These studies support a relationship between prolactin and sex steroids on the initiation and maintenance of human lactation.

Nonpuerperal lactation and normal prolactin regulation.

Prolactin secretion was evaluated in 11 consecutive patients referred with nonpuerperal lactation who did not have clinical evidence of pituitary tumors. Six patients had normal fasting prolactin (PRL) levels, 13.8 plus or minus 1.8 ng per ml (Group I), and the other 5 women had elevated basal serum PRL concentrations, 182 plus or minus 72 ng per ml (Group II). All Group II patients had amenorrhea; however, 5 of 6 Group I patients had menstrual periods. The 24-h mean serum PRL concentrations were 12.8 plus or minus 1.2 (SEM), 13.3 plus or minus 0.7, and 165 plus or minus 62 ng per ml for the controls and Group I and II, respectively. A pattern of intermittent PRL discharge during the day characterized each group; however, a normal sleep related increase in serum PRL concentration was absent in the Group II patients. Chlorpromazine produced greater than two-fold increases in serum PRL concentrations in the controls and Group I patients; however, this response was absent in Group II. L-Dopa produced appropriate suppression of serum PRL concentrations in the normals and both patient groups. Normal serum growth hormone, thyroxine, and plasma cortisol characterized each group. Serum estrogen and/or LH and FSH were decreased in 3 of 5 Group II patients; however, the serum concentrations of these hormones were normal in 5 of 6 Group I patients. Short term L-dopa therapy was effective in suppressing lactation in 3 of 5 Group II patients, and it also decreased lactation in the 4 treated Group I patients without significantly altering 24-h mean serum PRL concentrations in the latter group. hypothalamic-pituitary dysfunction was present in certain patients with nonpuerperal lactation who had elevated 24-h mean PRL concentrations and no PRL release following chlorpromazine and sleep. Frequently, however, nonpuerperal lactation is associated with normal prolactin secretion.

MAMMARY STIMULATION CAUSES PROLACTIN SECRETION IN NON-LACTATING WOMEN

VARIOUS afferent neurogenic stimuli to the chest wall or breast have been associated with galactorrhoea in man. Non-puerperal lactation has been reported following mechanical trauma, surgery, or burns of the chest wall or breast1–4; following herpes zoster of the chest wall3; and induced by poorly fitting garments4 or breast manipulation3,4. Lactation has occurred in men in association with prolonged suckling of the breast1,3 and may occur in nulliparous and post-menopausal women in response to a suckling stimulus5,6.

Mammary stimulation causes prolactin secretion in non-lactating women.

VARIOUS afferent neurogenic stimuli to the chest wall or breast have been associated with galactorrhoea in man. Non-puerperal lactation has been reported following mechanical trauma, surgery, or burns of the chest wall or breast1–4; following herpes zoster of the chest wall3; and induced by poorly fitting garments4 or breast manipulation3,4. Lactation has occurred in men in association with prolonged suckling of the breast1,3 and may occur in nulliparous and post-menopausal women in response to a suckling stimulus5,6.

Levodopa suppression of prolactin in nonpuerperal galactorrhea.

Nonpuerperal lactation may be the result of pituitary tumors or functional pituitary disorders. Elevations of serum prolactin measured by radioimmunoassay were found in three patients with pituitary tumors and in one of two patients with functional pituitary disorders. Ingestion of 0.5 g of levodopa (L-dopa) produced a profound fall in serum prolactin in all patients by 90 minutes; thereafter, levels tended to rise toward base-line values. Sustained suppression of serum prolactin levels could not be achieved when L-dopa was given four times daily, although the suppressive effect of a single dose was always demonstrable. More prolonged treatment of one patient did not decrease lactation or lower basal prolactin levels. Because L-dopa probably exerts its effects on the pituitary gland via the hypothalamus, these studies suggest that pituitary tumors associated with lactation may not be autonomous.

During-induced lactation in uremia.

Nonpuerperal lactation occurred in 3 patients with uremia, while they were receiving small amounts of reserpine or phenothiazine derivatives. It is suggested that uremia may facilitate the development of galactorrhea in response to these substances.

Nonpuerperal lactation: a review with case reports.

Excerpt Classification of patients with nonpuerperal lactation (Latin,lactis, milk) or galactorrhea (Greek,galakto, milk) is frequently difficult, especially with the eponymic inconsistencies found...