Fluoxetine and Sexual Dysfunction

To the Editor. —Dr Hollander1states that fluoxetine has a 1.9% incidence of sexual dysfunction, with impotence or ejaculatory problems occurring in less than 1% of patients. Although thePhysicians' Desk Referencelists 1.9% as the rate of sexual dysfunction with fluoxetine,2several case series and open studies have found rates ranging from 7.8% to 75%.3 The most common sexual problem associated with fluoxetine in these reports is anorgasmia. In one survey, 60 consecutive male patients who received fluoxetine (20 mg/d) were specifically questioned about ejaculatory changes, and 45 (75%) reported retarded ejaculation or ejaculatory incompetence.3 Hollander also states that he is unaware of any information on whether fluoxetine has a direct effect on improving sexual dysfunction. There are a few reports in the literature that suggest that fluoxetine's "adverse" sexual effects may be beneficial for some patients. Stratta et al4found fluoxetine helpful for two