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Sexuality and Reproductive Issues (PDQ®): Supportive care - Health Professional Information [NCI] - Pharmacological Effects of Supportive Care Medications on Sexual Function

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There are no well-controlled studies that evaluate the effects of SSRIs on sexual function within the oncology patient population. There are several studies, however, that have examined the effects of fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft) on sexual function in patients being treated for depression or obsessive-compulsive disorder. There are few data regarding the prevalence of sexual dysfunction with the use of citalopram (Celexa) in the treatment of depression. Sexual dysfunction from SSRIs has generally been reported to affect approximately 1% to 15% of patients in clinical trials of these medications in physically healthy depressed patients. Other studies, however, report significantly higher rates of sexual dysfunction that may more accurately reflect the incidence typical of clinical practice. A large-scale retrospective nonrandomized comparison trial of 596 psychiatric outpatients (167 men, 429 women) treated for at least 6 months with sertraline (n = 170), fluoxetine (n = 298), venlafaxine (n = 36), or paroxetine (n = 265) found that symptoms of sexual dysfunction were spontaneously reported by approximately 20% of patients overall and were more common in men (23.4%) and married individuals of both genders. The rates of sexual dysfunction associated with each of the SSRIs were the following:

  • Sertraline (16%).
  • Fluoxetine (20%).
  • Paroxetine (22%).
  • Venlafaxine (38%).

For this sample, the most common sexual symptoms reported were orgasmic delay or anorgasmia, followed by decreased desire and arousal difficulties.[24][Level of evidence: III]

A prospective multicenter study of 344 patients (152 men, 192 women) with mixed psychiatric disorders treated with SSRIs and systematic inquiry of sexual dysfunction by the physician found the frequency of sexual side effects was highest for paroxetine (65%), followed by fluvoxamine (59%), sertraline (56%), and fluoxetine (54%).[25][Level of evidence: II] Paroxetine produced significantly greater delay of orgasm or ejaculation (48%) and more frequent erectile dysfunction and vaginal lubrication difficulties than sertraline (37% and 16%), fluvoxamine (31% and 10%), or fluoxetine (34% and 16%). Loss of libido and anorgasmia were more severe in women, though men reported a greater frequency of sexual dysfunction. The effects of SSRIs are dose related and may vary among the group. The incidence of sexual dysfunction obtained by patient self-report does not appear to reflect the true incidence of sexual dysfunction associated with antidepressant therapy, and systematic inquiry by providers is needed as sexual dysfunction may be an unrecognized cause of noncompliance.[26] Two critical reviews of the effects of SSRIs on sexual function are available.[26,27][Level of evidence: IV]

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