Fluoxetine and Sexual Dysfunction-Reply

In Reply. —Since my answer to the question of fluoxetine and sexual dysfunction, JAMA has received numerous letters disputing my statement that sexual dysfunction occurs in up to 1.9% of patients. I wish that I could claim a typing error, but I chose to quote the Physicians' Desk Reference in search of a rate of sexual dysfunction to explain the patient's delayed orgasm. Clearly, the rate of delayed ejaculation or anorgasmia is much higher than 1.9%. Indeed, drugs that inhibit serotonin reuptake may have a therapeutic effect in patients with premature ejaculation. At this time, the letters I have received from JAMA quote rates of 7.8% to 75% of patients having problems with sexual dysfunction. 1,2 Many articles address overall sexual dysfunction, including anorgasmia in patients receiving fluoxetine, but careful perusal shows small numbers of men studied. Zajecka et al 1 suggest a 7.8% incidence of sexual dysfunction in men