Re: no-needle jet anesthetic technique for no-scalpel vasectomy.

Reply by Authors. We appreciate the interest of Delgrange in our study. MacRoprolactinemia is a clinically and biologically heterogeneous condition. Leslie et al studied 55 women with typical hyperprolactinemia and reported that symptoms of typical hyperprolactinemia were uncommon. Vallette-Kasic et al examined 106 patients with macroprolactinemia and found that 61% had normal menstruation and 54% did not have galactorrhea. On the other hand, Gibney et al examined 453 patients with macroprolactinemia and found that oligomenorrhea/amenorrhea and galactorrhea were more common in patients with true hyperprolactinemia, although they were also frequently present in patients with macroprolactinemia. They also reported that cases of macroprolactinemia could not be differentiated from true hyperprolactinemia on the basis of clinical features alone. Although plasma levels of estradiol and luteinizing hormone, and luteinizing hormone-to-follicle-stimulating hormone ratio were significantly greater in macroprolactinemic compared to true hyperprolactinemic cases, normal estradiol levels also occurred in the setting of true hyperprolactinemia, while, conversely, estradiol levels were sometimes suppressed in macroprolactinemic cases. The bioactivity of macroprolactin is also unclear. De Schepper et al studied clinical and biological characterization of macroprolactinemia and found that PRL-IgG complexes possess a PRL-like biological activity in the Nb2 assay. Finally, macroprolactinemia can be classified as “idiopathic hyperprolactinemia” in the differential diagnosis of hyperprolactinemia. The screening for macroprolactin in patients with hyperprolactinemia is important with regard to cost-effectiveness, and can alter treatment in up to 20% of patients with hyperprolactinemia. Our study focused on the frequency of female sexual dysfunction in patients with hyperprolactinemia. We think that examination of the difference in female sexual dysfunction between true hyperprolactinemic and macroprolactinemic cases could also be important. However, this comparison was outside the scope of our study and needs to be examined in further studies.