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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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For individuals with premature ejaculation, SSRIs provide an effective treatment. In a double-blind placebo-controlled trial of men with lifelong rapid ejaculation, paroxetine delayed ejaculation the most, and fluvoxamine delayed ejaculation the least. Daily doses of 20 mg of paroxetine and 20 mg of fluoxetine may be regarded as effective treatments for lifelong rapid ejaculation.[28][Level of evidence: I] Cancer patients treated with these medications in clinical situations may have higher rates of anorgasmia, decreased sexual desire, and other problems, possibly because these medications compound the difficulties cancer patients encounter from multiple etiologies. There are several possible interventions in the management of SSRI-induced sexual dysfunction. An obvious, though not always appropriate, possibility is to decrease the dosage of the SSRI. Altering the timing of SSRI administration, either by delaying doses until after intercourse or dosing immediately before intercourse,[29][Level of evidence: IV] may be an effective intervention. There are published data to suggest a drug-holiday intervention over the weekend can improve the sexual dysfunction induced by SSRIs.[30][Level of evidence: II] Another possibility is the addition of another medication to help in the control of SSRI-induced sexual dysfunction or consideration of another antidepressant with less known sexual side effects. In a randomized, double-blind, multicenter trial comparison of sustained-release bupropion (bupropion SR) and sertraline, both were found to be similarly efficacious in the treatment of outpatients with moderate-to-severe depression. There was a significantly greater percentage of sertraline-induced sexual dysfunction (63% and 41% of men and women, respectively), compared with bupropion SR–induced sexual dysfunction (15% and 7%, respectively).[31][Level of evidence: I]

A definitive treatment has not been established for SSRI-induced sexual dysfunction in males or females. The oncology patient population presents with significantly more obstacles in the management of sexual dysfunction, as compared with patients whose symptoms are being managed with SSRIs for depression alone. The etiology of sexual dysfunction in cancer patients is multifactorial and complex. The above data are intended to provide practitioners and patients with possible options in the management of SSRI-induced sexual dysfunction.

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Last Updated: February 25, 2014
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