Deleterious effects of selective serotonin reuptake inhibitor treatment on semen parameters in patients with lifelong premature ejaculation
International Journal of Impotence Research: The Journal of Sexual Medicine, Exclusive Author Commentary

Koyuncu H et al. – Although no drug for premature ejaculation (PE) has been approved by regulatory bodies, chronic selective serotonin reuptake inhibitors proved to be effective in treating lifelong PE. Despite the rising use and known effects of antidepressants on ejaculation, only a few reports have evaluated the impact of these drugs on the male fertility.

Following View Author Commentary page

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.

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Physician Assistant

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Physician Assistant Articles

1 Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): A randomised, multicentre, open-label, phase 3 non-inferiority trial The Lancet Oncology, October 22, 2014    Clinical Article

2 Dance for Parkinson's: A new framework for research on its physical, mental, emotional, and social benefits Complementary Therapies in Medicine, June 17, 2014    Review Article

3 Omega-3 supplements for patients in chemotherapy and/or radiotherapy: A systematic review Clinical Nutrition, November 21, 2014    Clinical Article

4 Global burden of cancer attributable to high body-mass index in 2012: A population-based study The Lancet Oncology, November 26, 2014    Clinical Article

5 Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents New England Journal of Medicine, November 18, 2014    Evidence Based Medicine    Clinical Article

6 Nonobstructive coronary artery disease and risk of myocardial infarction JAMA, November 6, 2014    Evidence Based Medicine    Clinical Article

7 Treatment of syphilis: a systematic review JAMA, November 13, 2014    Review Article    Clinical Article

8 Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial The Lancet, November 26, 2014    Evidence Based Medicine    Clinical Article

9 Effects of salt substitutes on blood pressure: A meta-analysis of randomized controlled trials American Journal of Clinical Nutrition, October 31, 2014    Evidence Based Medicine    Review Article    Clinical Article

10 Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period The Lancet, November 19, 2014    Evidence Based Medicine

11 Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial The Lancet, November 26, 2014    Clinical Article

12 Initial choice of oral glucose-lowering medication for diabetes mellitus: a patient-centered comparative effectiveness study JAMA Internal Medicine, November 14, 2014    Evidence Based Medicine    Clinical Article

13 Optimization of rituximab for the treatment of diffuse large B-cell lymphoma (II): extended rituximab exposure time in the smarte-R-CHOP-14 trial of the German High-grade Non-hodgkin Lymphoma Study Group Journal of Clinical Oncology, November 26, 2014    Clinical Article

14 Early versus on-demand nasoenteric tube feeding in acute pancreatitis New England Journal of Medicine, November 26, 2014    Evidence Based Medicine    Clinical Article

15 Ventriculitis caused by primary T-cell CNS lymphoma in an immunocompetent patient Journal of Clinical Oncology, November 26, 2014

16 Long-term safety and efficacy of factor IX gene therapy in hemophilia B New England Journal of Medicine, November 26, 2014    Evidence Based Medicine    Clinical Article

17 Management of high-grade gliomas in the elderly Seminars in Radiation Oncology, October 3, 2014    Clinical Article

18 The diagnosis and management of hiatus hernia BMJ, November 14, 2014    Evidence Based Medicine    Review Article    Clinical Article

19 Statins in the elderly: an answered question Current Opinion in Cardiology, June 9, 2014    Evidence Based Medicine    Review Article    Clinical Article

20 Changes in bone mineral density at 3 years in postmenopausal women receiving anastrozole and risedronate in the IBIS-II bone substudy: An international, double-blind, randomised, placebo-controlled trial The Lancet Oncology, November 26, 2014    Clinical Article

Indexed Journals in Physician Assistant: Advance for Physicians Assistants, American Family Physicianmore