Sexual function ejaculation

SSRIs and venlafaxine can cause of variety of sexual dysfunctions including delayed ejaculation, anorgasmia, and decreased libido ( Table 7-24). For two reasons, the adverse effect of these medications on sexual function was underestimated during the early clinical trials. First, such trials rely on spontaneous reporting by participants. Second, these adverse effects appear to take several weeks to develop. These adverse effects develop in approximately 30% to 40% of patients on adequate doses of SSRIs and venlafaxine. Although all manufacturers of these medications endeavor to suggest that their product is less likely to cause these effects, there is no compelling evidence to indicate that is true. Comparisons of rates across studies are not fair comparisons because they may differ based on how these problems were assessed. 

Genitourinary smooth muscle is partially dependent on autonomic innervation for normal function. Therefore, ganglionic blockade causes hesitancy in urination and may precipitate urinary retention in men with prostatic hyperplasia. Sexual function is impaired in that both erection and ejaculation may be prevented by moderate doses. 

Adverse effects are reported with an incidence of 1-3%. The most common include gastrointestinal upset, hypertension, decreased libido, abdominal pain, impotence, back pain, urinary retention, and headache. In comparison to tamsulosin and finasteride, saw palmetto was claimed to be less likely to affect sexual function (eg, ejaculation). 

The effects of finasteride (n = 545), tamsulosin, or the proprietary herbal remedy Permixon on sexual function have been studied in patients with lower urinary tract symptoms due to benign prostatic hyperplasia (64). At 6 months tamsulosin and finasteride caused slight increases in sexual disorders and Permixon caused a slight improvement. Ejaculation disorders were the most frequently reported adverse effects after tamsulosin or finasteride. 

The glands that produce sperm are the testes. Prior to copulation, the sperm are stored and undergo further development in the epididymis, located on the testicles. For delivery, sperm are incorporated into seminal fluid produced by seminal vesicles, the prostate gland, and the bulbourethral gland, and ejaculated through the urethra of the penis. The process of forming sperm and other male sexual functions and characteristics are promoted by testosterone, the male sex hormone. 

These data suggest that antidepressant-induced sexual dysfunction is more likely to be associated with agents that greatly potentiate 5HT neurotransmission. This notion is supported by the results of a 6-week doubleblind study of 24 men with premature ejaculation, in which paroxetine (20 mg/day) increased latency to ejaculation six-fold while mirtazapine (30 mg/day) had minimal effect (4). In a randomized, 8-week, double-blind, placebo-controlled study in 450 patients with major depression, fluoxetine (20 -0 mg/day) significantly impaired sexual function, while the noradrenaline re-uptake inhibitor reboxetine had no effect (5). 

The adverse sexual effects of SSRIs have been reviewed (58). The use of SSRIs is most often associated with delayed ejaculation and absent or delayed orgasm, but reduced desire and arousal have also been reported. Estimates of the prevalence of sexual dysfunction with SSRIs vary from a small percentage to over 80%. Prospective studies that enquire specifically about sexual function have reported the highest figures. Similar sexual disturbances are seen in patients taking SSRIs for the treatment of anxiety disorders (59), showing that SSRI-induced sexual dysfunction is not limited to patients with depression. It is not clear whether the relative incidence of sexual dysfunction differs between the SSRIs, but it is possible that paroxetine carries the highest risk (58). 

In 12 men with schizophrenia (mean age 36 years) receiving neuroleptic drugs, amantadine 100 mg/day for 6 weeks improved sexual function (531). All 12 patients, who had a sustained relationship with a female partner, had reported sexual dysfunction. Four areas of sexual function were assessed desire, erection, ejaculation, and satisfaction there was an improvement in all but ejaculation. Amantadine had no effect on the symptoms of schizophrenia. 

Sexual function Decreased libido Impotence Ejaculation disorder Anorgasmia... 

All drugs that interfere with sympathetic autonomic activity, including diuretics, can potentially interfere with male sexual function, expressed as a failure of ejaculation or difficulty in sustaining an erection. Nevertheless, placebo-controlled trials have emphasised how common a symptom this is in the untreated male popialation (approaching sometimes 20-30%). It is also likely that hypertension itself is associated with an increased risk of sexual dysfunction since loss of NO production by the vascular endothelium is an early feature of the pathophysiology of this disease. Laying the blame on antihypertensive medication is probably... 

The adverse effects of thiazide and thiazide-like diuretics on male sexual function include reduced libido, erectile dysfunction, and difficulty in ejaculating. The exact incidence of sexual dysfunction in patients taking diuretics is poorly documented, perhaps because of the personal nature of the problem and the reluctance of patients and/or physicians to discuss it. However, these abnormalities have been reported with incidence rates of 3-32%. The true incidence of sexual dysfunction probably lies closer to the lower end of this range (119). In a meta-analysis of 13 randomized, placebo-controlled trials conducted over a mean of 4 years the NNH (number needed to harm) for erectile impotence with thiazide diuretics in hypertension was 20 and the relative risk was 5.0 (120). 

Clinical studies have reported very few adverse effects that are of a mild nature (usually gastric distress or headache) following saw palmetto administration at normal doses. One randomized, double-blind study of finasteride, tamsulosin, and saw palmetto for 3 months observed no differences among the three treatments in terms of the effectiveness measures and no change in sexual function in those individuals receiving saw palmetto, though ejaculation disorders were noted as the most common side effect in those individuals receiving either tamsulosin or finasteride (26). 

In men, occupationally exposed to fluoric intoxication, was observed an easing of sexual function (infringement of libido, erection and ejaculation). Laboratory parameters of these men were characterized by reduction of ejaculate volume, spermatozoa concentration in it, and increase in motionless and degenerated forms of spermatozoa. These changes were 3-4 times more frequent, than in control group. 

One male patient has retrograde ejaculation though no patient has loss of sexual function. There has been no loss other than in the L5 root so while minor L5 deficit is common and predictable, 22 of 27 patients have no iatrogenic dysfunction as a consequence of this complicated reconstruction. 

Sexual function Two physically healthy men taking bupropion 300 mg/day for depression experienced premature ejaculation [36 ]. Sexual function returned to normal in one case after combination with escitalopram 10 mg/day. The other patient experienced spontaneous prolongation of intercourse time to 2 minutes. 

Sexual function SSRIs can cause sexual dysfunction, particularly reduced libido, impaired orgasm in women, and inhibition of ejaculation or erectile difficulties in men. There have been two reports of unusual male sexual dysfunction. In two cases of spermatorrhea (excessive emission of semen without orgasm or erection) in men taking fluvoxamine, the problem resolved on drug withdrawal [IS ]. Spontaneous ejaculations occurred daily in a 27-year-old man after he had taken citalopram for 2 weeks [16 ]. They were unrelated to sexual fantasies, arousal, erection, or any sensation of orgasm and resolved on drug withdrawal. They did not recur when he took paroxetine. 

Sexual function Spontaneous ejaculation related to zotepine therapy has been reported, supposedly for the first time [140"]. 

Sexual function Retrograde ejaculation has been described in a young man with a pheochromocytoma who took doxazosin for preoperative blood pressure control [108 ]. 

Sexual function While ejaculatory disorders have been attributed to a-adrenoceptor antagonists it is less clear whether they affect semen. In a randomized, doubleblind, placebo-controlled 3-way crossover study of sperm in 48 healthy men after exposure to tamsulosin, alfuzosin, and placebo for 5 days each tamsulosin was associated with negative effects on ejaculate volume, sperm concentration, total sperm count, semen viscosity, and sperm motility compared with placebo alfuzosin was comparable to placebo [115 ]. Post-ejaculate urine sperm concentrations were comparatively normal between all agents, suggesting that retrograde ejaculation is not responsible for the ejaculatory dysfunction. There was complete absence of ejaculation in 17 of the 48 men (35%) during treatment with tamsulosin compared with none in the other groups. 

Sexual function Two cases of retrograde ejaculation occurring with iloperiodone are reported [158 ]. The first case involved a 22-year-old male after 2 weeks of treatment and led to self-discontinuation. The second was a 21-year-old male after 2-3 weeks of treatment who also experienced pain with impaired ejaculation. 

Sexual function A case of retrograde ejaculation attributed to blockade of ajA-adrenergic receptors is reported with the use of levopromazine [160 ]. 

Sedation is uncommon and instead many patients will find that these drugs may impair sleep, which is why the dose is best taken in the morning. There is also little effect on psychomotor function. Occasional patients have a small reduction in heart rate but otherwise effects on the cardiovascular system are rare. Epileptic convulsions can occur but are rare and much less common than with tricyclic antidepressants. There is some evidence for potentiation of electroconvulsive therapy (ECT)-induced seizures. Sexual dysfunction is reported, principally delayed ejaculation and anorgasmia. 

Anabolic steroids, antidepressants and drugs of abuse affect libido, potency, and ejaculatory function. Anabolic steroids are derivatives of testosterone, and have strong genitotropic effects. There is published evidence indicating that anabolic steroids increases sexual desire however, the frequency of erectile dysfunction is also increased. Treatment with the antidepressant fluoxetine has been associated with sexual side effects including delayed or nonexistent ejaculation and hyposexuality. Mice treated in utero with the anideukemic agent 5-aza-2/-deoxycytidine exhibit abnormal reproductive behavior and low reproductive capacity. 

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