Premature ejaculation (PE), the most common sexual dysfunctions in men and is characterized by the loss or absence of ejaculatory control. The prevalence rate of PE has been reported to be between 21% to 31% and is recognized to impact on a man’s life in many ways, such as reducing self-esteem, affecting interpersonal relationships, causing anxiety, embarrassment, depression and reducing overall quality of life.
Recent guidelines have proposed chronic use of SSRIs (e.g. fluoxetine, sertraline, paroxetine and citalopram) for the treatment of lifelong PE. The SSRIs block 5-hydroxytriptamine (5-HT) transporter mechanisms and thereby increase 5-HT within the synapses. This in turn activates 5-HT1A and 5-HT1B receptors resulting in inhibition of serotonin release into the synapse. With chronic administration of SSRIs, the receptors become desensitized and there is a reduction of inhibitory action on serotonin release. The end result is more serotonin release into the synapse, of the ejaculatory set point, and delay in the ejaculatory reflex.
In spite of their efficacy, adverse effects are the major drawback in chronic use of SSRIs in PE patients. Well known adverse effects of SSRIs include sexual dysfunction (sexual desire and arousal difficulties, anejaculation, absent and delayed orgasm), dizziness, nausea, constipation, insomnia and fatigue. Few studies have addressed the impact of SSRIs on spermatozoal function and fertility. Published data clearly show that chronic SSRI treatment has a detrimental effect on spermatogenesis and sperm transport, damages the sperm membrane, alters sperm DNA and has an impact on hormonal homeostasis. These effects may not be important for men undergoing treatments for severe depression; however they must be taken into consideration when SSRIs are administered to a sexually active man with PE.
In summary, the potential advers effects of SSRIs on male fertility needs to be considered when treating a young man with PE.