Fluoxetine and Sexual Dysfunction

To the Editor. —Dr Hollander 1 noted that sexual dysfunction occurs in up to 1.9% of patients taking fluoxetine with less than 1% experiencing impotence or ejaculatory problems. These figures are significantly lower than reflected in the recent literature. Balon and colleagues 2 reviewed the existing literature on sexual dysfunction caused by antidepressants and reported a series of their own. The previously reported incidence of sexual dysfunction had ranged from as low as 1.9% for fluoxetine to as high as 92% for clomipramine. They found alterations in sexual functioning in 65% of their 60 patients, classifying 43.3% of these changes as sexual dysfunction. Of their 14 patients receiving fluoxetine, six (five female, one male) experienced one or more dysfunctions including decreased libido, more time to reaching orgasm, or difficulty reaching orgasm. Two became anorgasmic. Improvements in sexual function occurred in 16.6% of their patients, including two taking fluoxetine. Three patients